Childbirth without an epidural — all the pain-relief alternatives
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.
Chapters
Frequently asked questions
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.
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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.
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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.
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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