Pain relief is one of the main topics of conversation when it comes to childbirth. In this article we will go through pharmacological pain relief and the different options available.

There are two different options when it comes to pain relief during childbirth. You can either choose natural alternatives, these are called non-pharmacological pain relief, or you choose pharmacological pain relief – i.e. drugs. If you opt for medication, there are several different options to numb the pain. You can choose between:

• Nitrous oxide – Nitrous oxide has been used since the 1790s and was originally used as a party drug. More than 100 years later, it began to be used in maternity care. The concentration of nitrous oxide can be adjusted using oxygen. Approximately 14% of all mothers manage with nitrous oxide alone, and many find it satisfying to be able to control it themselves. Remember that there is no prestige in the type of pain relief or how much pain relief you choose to take.
• Epidural – Epidural anaesthesia or spinal anaesthesia is used on what is called the epidural space. The anaesthetic is not injected directly into the spinal cord as you might think, but the epidural space is outside the spinal canal.Sometimes the anaesthetist wants to put the anaesthetic in when you are sitting on the edge of the bed or lying down on your side, arching your back like an angry cat. The doctor first numbs the skin before inserting a thin plastic catheter into which anaesthetic drugs are injected (the needle is removed, you have no needle left in your back). Either the anaesthetic continues to be administered through a pump that the woman 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 painkiller, or the midwife administers the painkiller through repeated injections whenever the woman wishes. The choice of administration method depends on local practices.

  Disadvantages of an epidural include itching (occurs in 50-80% of cases) and a drop in blood pressure (compensated for with plenty of fluids or an IV). If you have pre-eclampsia (which causes high blood pressure), an epidural can have positive side effects. There is still debate in research about the relationship between epidurals and potential negative effects on the course of labor, the ability to cry 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 of approximately 1-4 hours. This form of anaesthesia has a faster effect, but also wears off more quickly. It therefore is advantageous in a birth that is expected to go quickly (more so in mothers who have already given birth before).
• PCB (Paracervical Block) – Local injection of anaesthetic is in the cervix and blocks nerves that send pain signals to the brain. The effect of a properly placed PCB can be compared to the effect of a spinal anaesthetic. PCB does not provide pain relief in the vagina, pelvic floor or rectum, so it can be combined with a PDB in the pushing phase.
• PDB (Pudendus Block) – Also called pelvic floor anaesthesia. Local injection of anaesthetic is given to the pudendal nerves which sit next to the spinal nerves (where the pelvis is thinnest). The midwife or doctor feels where the spinal tags are and then injects a local anaesthetic that blocks the nerves that send pain signals to the brain. It is also possible to place an external PDB where the injection is placed outside the vagina, but which aims to hit at the same place. This anaesthetic numbs the vulva, perineum and the lower third of the vagina.
• General anaesthesia (sedation) – Sometimes performed during a C-section in consultation between anaesthetist and obstetrician. This means that you will sleep during your C-section.