Options for Labor Pain Management

Written by yvonnethornton on November 14th, 2013

No two women experience labor pain exactly the same way, but one thing is certain: if you go through labor, you will experience pain. The size of your baby, his or her position, and the strength of your contractions all affect the severity and location of your pain; your stress level, including whether you are afraid and how prepared you are mentally and physically for labor, will also have an effect. For these reasons, knowing what to expect and what your options are before you ever have your first contraction is vital. Education and preparedness can allow you to make informed decisions unpressured by the immediacy of pain that you are unprepared to handle.

Lamaze Still the Best Overall Option

Your best bet, all things considered, is a labor and delivery free of drugs of any kind. Lamaze training doesn’t seem to be as en vogue as it once was, but it remains the safest option and, when learned properly, is highly effective. It does not block the sensation of pain entirely, but instead, teaches you techniques for coping with the pain calmly by focusing your attention on your breathing and on some focal point outside of your body. Many women have been pleasantly surprised to find out how effective Lamaze actually is. Perhaps its biggest benefit is its complete lack of potentially harmful side effects – something that cannot be said about drugs used in labor pain management (or any drug, for that matter).

Epidurals Effective But (Somewhat) Risky

Despite the fact that Lamaze costs nothing, is free of risk, and is effective, many women understandably prefer a pain relief method they perceive to be better: the epidural. Epidurals have become so common that these days, almost every pregnant woman plans on having one. Epidurals offer the distinct advantage of blocking pain sensations entirely (some pressure is still felt but it isn’t painful) while leaving Mom wide awake and ready to greet her new baby.

Which sounds great, except for one tiny detail: epidurals are not completely harmless. For starters, they are extremely expensive, although that isn’t much of a deterrent for most women when an insurance company is footing the bill. The much more important issue is that the drug used in epidurals crosses the placenta and can slow the fetal heart rate, sometimes necessitating Cesarean deliveries that would otherwise not have been necessary. There are also potential risks to the mother, including the possibility of needing to be put on a respirator if the epidural blocks more sensation than it is meant to, and other risks such as headache and low blood pressure.

My personal assessment, after delivering 5,542 babies and being an obstetrician for over 40 years, is that prolonged use of epidural anesthesia is associated with the development of autism in childhood.  This is just a theory, based on anecdotal observations; but, I have found that the babies born to mothers who are attended by midwives, who don’t use epidural anesthesia,  are less likely to be diagnosed with autism compared to children who have been exposed for many hours to the drugs used in administering epidural during labor.  It sounds preposterous, but remember where you read it first.

This is not to say that I am against any woman ever having an epidural. But women need to be informed of the risks and provided with the opportunity to learn completely safe alternative pain management techniques, such as Lamaze. If an epidural is chosen, it should not be administered too early in labor – not before the cervix is dilated to at least five centimeters. In addition, the epidural should be stopped once the cervix is dilated ten centimeters and the mother is ready to push; otherwise, she will not be able to push effectively. For more information on this topic, as well as my theory on epidurals and autism, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.


Leave a Comment