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If you're pregnant, you likely have a lot of questions about what to expect, especially when it comes to dealing with discomfort, pain, and, especially, labor. You may wonder, what medications are safe to take while pregnant? How painful is labor? What's a walking epidural?
When it comes to pain management during pregnancy and labor, there's a lot of confusion. Read more about pregnancy pain relief options as well as the pros and cons of pain management labor options.
It's normal to experience mild headaches, hip or pelvic pain, low back pain, or a combination of these types of pain in pregnancy. Many people also experience occasional abdominal cramping during pregnancy. (Talk to your doctor if you experience unusual or severe cramping in pregnancy).
By the second trimester, you may notice sharp, occasional pains on the side of your belly that may shoot down into your groin. This pain, called round ligament pain, happens because of pressure on the ligament that supports the uterus.
The best pregnancy pain relief approach is to try nonmedical options first and only use pain medication if that doesn't work. For example, if you have a headache, try drinking water or having a cup of coffee or tea. Resting or taking a nap could also help.
Caffeine can help relieve headaches, and doctors consider 200 mg or less of caffeine daily safe for pregnancy. That's the amount in about one 12-ounce cup of coffee or about three cups of black tea.
For pelvic, hip, or back pain, avoid prolonged periods of standing or sitting, and make sure your chair has lumbar support.
Other things to try:
You can take Tylenol (acetaminophen) throughout pregnancy. There is no evidence that Tylenol has any effect on fetal development or causes problems with pregnancy. Still, experts advise that you only take over-the-counter pain medication when necessary and use the lowest dosage that relieves your pain.
Pregnant people should start with a 650 mg dose of Tylenol and wait six hours before taking another dose. You can increase your dose to 1,000 mg if needed, but you shouldn't exceed 3,000 mg of Tylenol a day.
Advil or Motrin (both of which contain ibuprofen) is safe in early, but not late, pregnancy. The Food and Drug Administration says you shouldn't take ibuprofen after 20 weeks of pregnancy.
By this time, the fetal kidneys produce most of the amniotic fluid, which cushions the fetus and helps develop other vital organs. In rare cases, ibuprofen in the second half of pregnancy can affect kidney function and reduce the amount of amniotic fluid.
If you have recurring or severe pains or headaches during your pregnancy, talk to your doctor. They can help pinpoint the cause and suggest lifestyle changes that may help. They can also offer advice about which over-the-counter pain medications to take and prescribe pain medications or refer you to a physical therapist, if necessary.
While doctors may recommend low-dose aspirin (baby aspirin) to prevent preeclampsia, you should avoid regular aspirin throughout pregnancy. Higher doses of aspirin may increase the risk of miscarriage, as well as kidney and other problems in the fetus.
As for opioids, there's a link between frequent use of these medications and fetal heart problems; brain, spine, and spinal cord defects; and other conditions that may affect your baby. Suddenly stopping opioid medications in pregnancy can be dangerous for both the fetus and the pregnant person, however.
If you take prescription opioids and become pregnant, your doctor can help you safely taper your dose. If you have an opioid addiction, talk to your doctor. They can offer opioid replacement therapy during your pregnancy and treat your baby for opioid withdrawal after birth.
Short-term doses of opioids are considered safe if prescribed by your doctor for a medical condition.
Whether or not you have an easy and pain-free pregnancy, you've likely heard a lot about the pain of labor and the types of pain management available. Childbirth is usually described as quite painful. However, there are many options for treating this pain.
Many people describe the pain of labor contractions as extreme menstrual cramps. The pain of these contractions increases as labor progresses and the cervix fully dilates. For this reason, many people choose to labor without medication at first and request medication when the pain becomes too intense.
In addition to pain in the pelvis area, you may also feel pain in your back during labor and even pain in your thighs. Many find the pushing phase less painful than the end of the active labor phase. During active labor, the cervix dilates from five to 10 centimeters, and contractions are long-lasting and close together.
If you've had medicine to induce labor, your contractions may be stronger and more painful.
Options for managing pain in pregnancy include epidurals or spinal blocks, opioids, and nitrous oxide. An epidural is the most common pain relief option for labor.
These are anesthetic medications that numb the pelvis area and the legs. Most women feel little to no pain after the administration of an epidural or spinal block.
For an epidural, the doctor will first inject a local pain reliever into the lower back skin and muscles. This way, you won't feel pain when the doctor inserts the epidural. The doctor will then use another needle to insert a very thin, plastic tube into the lower spine.
Once the tube is in place, the doctor will remove the needle. This tube stays in place to deliver medication throughout labor. This medication stops the nerves in the spine from sending pain signals to the brain.
Epidurals take about 10 to 20 minutes to work. Because of how doctors give the medication, very minimal amounts of it reach the fetus. That makes the epidural safer for the fetus than IV medications during labor.
Because epidurals numb your pelvis and legs, you won't be able to walk during labor and for about one to two hours after the birth. You may not feel as strong of an urge to push with an epidural, but your health team will tell you when to push.
You may hear the term "walking epidural," which is a lower-dose epidural. Walking epidurals leave you with more sensation, making it easier to know when to push. Despite the name, most people with walking epidurals don't have enough sensation in their legs to walk.
A spinal block involves a doctor using a needle to insert anesthesia medication directly into the fluid around the spine. Unlike an epidural, a spinal block doesn't involve a tube that continuously delivers medication. It works almost immediately and lasts for one to two hours.
Epidurals are more commonly used for vaginal births, while spinal blocks are more common for C-section births. Sometimes, doctors combine an epidural and a spinal block. This provides the rapid relief of a spinal block with the longer-term pain relief of an epidural.
Some people can't get an epidural due to a spinal problem, blood clotting problems, or an allergy to anesthesia medication.
Epidurals and spinal blocks can cause low blood pressure, mild fever, itching, and allergic reactions (like a rash). These effects go away after the epidural or spinal block wears off. You need a catheter to collect urine while you have the epidural, so after it's removed, you may have problems peeing.
Doctors can also prevent and treat these side effects. For example, IV fluids can decrease the chance of low blood pressure.
Around 1% of people experience a headache that can occur after birth and may last several days or weeks in rare cases. This complication can happen if the needle punctures a layer around the spine and causes a slow leak of spinal fluid. If this headache is severe, doctors can perform a simple procedure to stop the fluid from leaking.
Infection, a blood clot in the lower back, and nerve damage are extremely rare complications of epidurals and spinal blocks.
Nurses usually give opioid medications through an IV, but they might also inject these medications into muscle (usually the thigh muscle).
Opioids don't work as well as epidurals and spinal blocks to relieve pain, and they can cause nausea and drowsiness. In rare cases, they can slow your breathing, requiring doctors to give you extra oxygen.
The medications can also cause temporary breathing problems in the fetus if given close to birth. If this happens, doctors treat the baby with supplemental oxygen. Doctors may try to avoid this by not administering opioids in the hour before delivery.
Opioids can help in the early stages of labor if an anesthesiologist isn't available to administer an epidural. They can also help those who can't get an epidural or don't want an epidural.
The common name for nitrous oxide is "laughing gas." Nitrous oxide is a medication you breathe in through a mask. It provides temporary pain relief and only works when breathing in the gas through the mask.
Some people feel dizzy or nauseous when breathing the gas, but this goes away when they remove the mask. Nitrous oxide doesn't affect the fetus. The pain relief isn't as strong as an epidural, however.
People who don't want an epidural or can't have an epidural can benefit from nitrous oxide during labor. This option can also help those who have fast labor and don't have time for an epidural to take effect.
Natural pain management labor options include breathing techniques, massage, movement (such as swaying or rocking on an exercise ball), and water therapy. You can use these methods before an epidural, for early labor pain, or instead of pain medications.
People who want to have a nonmedicated birth can benefit from working with a doula. They can provide coaching in natural pain relief options and emotional support during labor.
After a vaginal delivery, you will likely have some pain and swelling around the vagina, as well as cramping (especially during breastfeeding), headaches, and joint and neck pain during the postpartum period. Pain may last for several days to several weeks after delivery. Some people experience little to no pain after delivery.
You can take over-the-counter medications, including ibuprofen (Advil or Motrin) and acetaminophen (Tylenol) for postpartum pain. These medications are safe if you're breastfeeding, as very little medication passes through breast milk.
After a C-section, you may have pain around your incision. This pain will likely worsen when you move, get out of bed, or strain the abdominal area. For many people, over-the-counter pain medications are enough to control pain. You may need to take them every four to six hours at first. Some people may need a stronger pain reliever during the first few days after a C-section.
You may need to alternate medicines to stay within the daily maximum dose of each medication. That means taking your ibuprofen dose and then your acetaminophen dose three hours later. That way, when the ibuprofen is wearing off, the acetaminophen is at its peak.
If you have severe pain after a C-section or vaginal birth, talk to your doctor. They can look into the underlying cause and prescribe pain medication if necessary. Be sure to let your doctor know if you are breastfeeding, as not all medicines are safe during breastfeeding.
By UPMC Editorial Staff. Last reviewed on 2024-09-05.
