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Pain relief in labor and delivery

The most widely used pain relief option in labor in the United States is epidural anesthesia. In studies comparing epidural pain relief with opiates, nitrous oxide, acupuncture, etc. epidurals score high in patient satisfaction. The epidural isn’t for everyone, though. There are common side effects, notably itchiness, drowsiness, shivering, fever, low blood pressure, longer labor, increased need for forceps or vacuum assisted delivery, and rare but serious side effects such as nerve injury, inability to urinate, and severe, long-lasting headaches.

Epidurals also limit how and where a mom may give birth. Since motor nerves are blocked with an epidural a mom can not walk or move about freely, which may be part of the mechanism by which labor progress slows with an epidural. Upright positions and movement in labor helps labor progress. Epidurals do create rare but overall increased risk of slowing the baby’s heart rate during labor, and seriously dropping the mom’s blood pressure in labor, so continuous fetal heart rate monitoring in a hospital environment is necessary.

Currently, a labor coping tool used worldwide holds some advantages over an epidural, although it is less effective as a pain relief agent: nitrous oxide. It is the same inhaled gas your dentist uses to reduce anxiety during dental procedures, and it is short-acting, does not paralyze motor nerves so moms can still move and change positions to aid labor progress as needed, and is self administered through inhalation, so moms remain in charge of their experience. However, it does not truly relieve pain, rather it temporarily dulls the senses and relieves anxiety.

For those moms who want to minimize side effects and the risk of interventions, but still want some pain relief, laboring and giving birth in water provides unique benefits without the risk associated with epidurals. Laboring in water is associated with high rates of maternal satisfaction with the labor process overall, decreased pain, reduced rates of slowed labor or the need for Pitocin to augment a slow labor. Water births also have lower cesarean section rates, lower rates of vacuum or forceps-assisted vaginal delivery, lower rates of perineal tears, lower rates of postpartum hemorrhage, fewer cases of respiratory distress syndrome in the newborn, and fewer hospital transfers postpartum for mother and baby.

Laboring in water may not be as effective at pain relief as the total lower body numbing experience of an epidural, but full body immersion in water during labor and delivery provides enough pain relief to allow the majority of labors to unfold effectively, naturally and with less risk of side effects and fewer interventions for both mother and baby.

With proper support and coping tools, and the benefit of some pain relief from laboring in water, most moms can successfully cope with labor while knowing they are protecting themselves and their baby from risky side effects and unnecessary interventions.


Emily Joy Tyde, MS, LDM


890 Beltline Road in Springfield


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