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Health Essentials

Labor without an epidural - what other options do you have?

If you don't want - or can't have - an epidural, there are other options for pain relief in labor. An overview of nitrous oxide (laughing gas), IV pain medication, and TENS, with the pros and cons of each.

By · Published · Duration 2:57 · Series: בריאות נטו
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Key points

  • An epidural is not the only way to manage labor pain, and the three main alternatives are nitrous oxide laughing gas, IV opioid medication, and a TENS device, each with its own pros and cons.
  • Laughing gas is inhaled from a mask between contractions so the peak arrives with the next one, it has very few side effects, works and stops quickly, and does not cross to the baby.
  • IV opioid medication, from the morphine family, is given through a button on the drip and is effective and short-acting, but it can weaken breathing so it needs oxygen monitoring and a dedicated midwife.
  • A TENS device, rented for labor, uses four pads on the lower back sending electrical pulses meant to block pain signals to the brain, it has no side effects but lacks large proof of effectiveness.
  • You can choose the pain-relief alternative that suits you, weighing how well each one works against its downsides and how much handling it requires during labor.

Chapters

  1. 00:00 Intro
  2. 00:31 Nitrous oxide (laughing gas)
  3. 01:06 IV pain medication
  4. 01:49 TENS device

Frequently asked questions

What pain-relief options are there for labor without an epidural?

An epidural isn't the only way to manage labor pain. Three main alternatives are nitrous oxide (laughing gas), IV opioid medication, and a TENS device. Each has pros and cons, and you can choose what suits you.

How does laughing gas work during labor?

You get a mask and inhale from it between contractions so the peak effect arrives during the next one. The advantages are very few side effects, it works quickly and stops quickly when you stop using it, and it doesn't cross to the baby. The downsides are that it requires handling the mask and timed inhalations, it can cause some nausea, and it eases the pain without removing it entirely.

Does IV medication help with labor pain?

We can connect a special syringe to your IV with a button you press to get an opioid medication (the same family as morphine) when you need it. These medications are effective and short-acting, but because they can weaken breathing they require continuous oxygen monitoring and a midwife who stays with you.

What is a TENS device for labor?

It's a device you can rent for labor: you stick 4 pads on your lower back, and it sends electrical pulses meant to interfere with pain signals traveling from the uterus to the brain. Its advantage is that it has no side effects and is easy to use, but it's relatively new and there aren't yet large studies proving it's meaningfully effective.

Full transcript

Show full transcript

If you're approaching labor and don't want an epidural, or for some reason you're not allowed to have one - maybe you found that out thanks to my video on epidurals - you might be feeling…

"How do we go on from here?"

Don't worry. An epidural isn't the only way to manage labor pain.

I'm Dr. Elisheva Fiszer, I'm an anesthesiologist, and in the next 3 minutes I'll give you 3 alternatives to an epidural. Let's start.

## Nitrous oxide (laughing gas)

Many delivery rooms in Israel now offer nitrous oxide - or "laughing gas," as its friends call it. It's a substance that's mildly disorienting and also a mild pain reliever.

How it works: you get a mask and inhale from it between contractions, so the peak effect arrives during the next contraction.

**Pros:** very few side effects, it works quickly and stops working quickly when you stop using it, and it doesn't cross to the baby.

**Cons:** it does require you to deal with the mask and timed inhalations, which can be challenging especially later in labor. It can cause some nausea. And it helps with pain but doesn't eliminate it entirely.

## IV pain medication

There are two similar medications that can be given this way, both from the opiate family - the same family as morphine.

During labor we can connect a special syringe to your IV line - and you get a button you can press to get more of the medication when you need it.

These medications are effective at managing pain and have a short duration of action, which is nice because you press when you need it during labor - and it doesn't require a separate procedure beyond placing the IV.

But because they can sometimes make us breathe less well, they require continuous monitoring of blood oxygen levels with a saturation monitor. They also require a midwife who stays with you at all times to constantly check you're okay - which unfortunately isn't always feasible.

## TENS device

There's a good chance you've heard of it! It's a device you can rent specifically for labor. How does it work?

You stick 4 pads on your back - 2 on the very lower spine and 2 a bit higher, like in the image here.

It sends electrical pulses that are meant to interfere with the transmission of pain information from the uterus to the brain, and thereby lower the level of pain.

The main advantage is that it has no side effects at all and it's easy to use.

It's relatively new in use for labor and so we don't yet know how effective it is. There's some evidence it helps, but there are still no large studies proving it's meaningfully effective at preventing labor pain.

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