Pain relief is one of the major topics of conversation when it comes to childbirth. In this article, we will look at pharmacological pain relief and the different options available.

There are two different ways to go when it comes to pain relief during childbirth. Either you choose natural options, known as non-pharmacological pain relief, or you choose pharmacological pain relief - i.e. medicines. If you choose medicines, there are several different options that will numb the pain.

The options for pharmacological pain relief

-Nitrous oxide - Nitrous oxide has been used since the 1790s and was originally used as a party drug. More than 100 years later, it was used in obstetrics. Nitrous oxide can be adjusted in concentration together with oxygen. Approximately 14% of all births can be managed with nitrous oxide alone, and many find it satisfying to be able to control it themselves. Remember that there is no prestige in what type of pain relief, or how much pain relief, you choose to take.

- Epidural (EDA) - Epidural or spinal anesthesia is placed in what is called the epidural space. The anesthetic is not injected directly into the spinal cord as one might think, but the epidural space is outside the spinal canal.

Sometimes the anesthesiologist wants to administer the anesthetic while you are sitting on the edge of the bed or lying on your side, arching your back like an angry cat. Then the doctor first numbs the skin before inserting a thin plastic catheter into which anesthetic drugs are injected (the needle is removed, you have no needle left in your back). Either the anesthetic continues to be administered via a pump that the birthing mother can control herself (don't worry, there is a maximum dose, you can't press the button as many times as you like), a pump that delivers a continuous dose of pain relief medication, or the midwife adds the pain relief via repeated injections when the birthing mother wishes. The choice of administration method depends on local practice.

Disadvantages of EDA include itching (occurs with 50-80%) and a drop in blood pressure (compensated for by copious fluid intake or, for example, via an IV). If you have preeclampsia (which causes high blood pressure), EDA can have positive side effects. Researchers are still discussing the relationship between EDA and possible negative effects on the course of labor, the ability to push and the risk of instrumental delivery. After delivery, the thin plastic tube is removed.

- Spinal - Injection is given in the spinal space, i.e. inside the epidural space, and gives an analgesic effect in about 1-4 hours. This form of anesthesia gives a faster effect, but also disappears faster. It is therefore suggested to be beneficial for a birth that is expected to be quick (more so for pre-term mothers).

- PCB (Paracervical block) - Local injection of anesthesia is placed in the cervix and blocks nerves that send pain signals to the brain. The effect of a properly placed PCB is comparable to that of a spinal anesthetic. The PCB does not provide pain relief in the vagina, pelvic floor or rectum, therefore it can be combined with a PDB in the expulsion (pushing) phase.

- PDB (Pudendal blockade) - Also called pelvic floor anesthesia. Local anesthetic is injected at the pudendal nerves, which are located near the spider veins (where the pelvis is most narrow). The midwife or doctor feels the location of the spinal nerves and then injects a local anesthetic to block the nerves that send pain signals to the brain. An external PDB can also be used, where the injection is given outside the vagina, but is intended to hit the same spot. This anesthetic numbs the vulva, perineum and lower third of the vagina.

- General anesthesia (sedation) - Sometimes done during a caesarean section in consultation between the anaesthetist and the obstetrician. This means that you will be asleep during your caesarean section.

Read about non-pharmacological pain relief here!