Anesthesia and Pain Control Options

Comprehensive pain relief options for labor and delivery

Obstetric anesthesiologists at Stanford Medicine Children’s Health provide a complete range of pain relief options. While you make the appropriate choices specific to your needs, we intricately balance your safety and possible side effects as we customize your analgesia (pain relief) and anesthesia. We are constantly researching innovations and techniques to improve every woman’s labor and delivery experience, and we make sure that our patients receive the latest options as soon as they become available. For example, we routinely use very low concentrations of epidural medications (i.e., ultralight epidurals) to avoid excessive numbness in your legs, which enables effective pushing during the delivery process. We also offer nitrous oxide (laughing gas) and other safe and proven labor pain relief options, some of which are available at only a few select hospitals across the nation.

We offer regional analgesia block techniques that improve your pain and comfort levels without reducing your ability to push, making sure that delivery progresses naturally. Our epidural pumps use a specialized program to deliver epidural medication to you, which has been pioneered at our institution and specifically researched for laboring women. We also offer patient-controlled epidural medication, which gives you the ability to have extra medication, putting you in control of how much pain medication you receive and allowing you to adapt to your pain needs as your labor progresses.

Epidural analgesic blocks. We offer the complete range of labor epidural blocks, which include the standard epidural, combined spinal-epidural, and dural puncture epidural. Epidural analgesia is popular because it blocks labor pain without complete loss of feeling or numbness in the legs. This means you are still able to feel your contractions as pressure (rather than as excessive pain) and push effectively. The epidural block interrupts signals from nerves in your abdomen that usually tell your brain to feel pain. Epidurals take approximately 10 to 20 minutes to work, whereas spinal and combined spinal-epidural blocks work within a few minutes and provide fast relief when labor is progressing rapidly.

  • After your pain has decreased and you feel comfortable with an epidural or combined spinal-epidural block, we maintain your comfort level until you have delivered your baby in these ways:
    • Using low-dose programmed intermittent epidural boluses (PIEB) administered through the epidural catheter
    • Offering an additional patient-controlled epidural analgesia (PCEA) option that lets you give yourself extra epidural doses if needed, because you are the best person to judge your level of pain
    • Having obstetric anesthesiologists available 24/7 to give you the appropriate amount of attention and to adjust your pain regimen if the pain relief that you are experiencing is not to your satisfaction
  • Every woman would like a speedy labor, yet every labor and delivery process is unique. The epidural blocks we offer at Stanford Medicine Children’s Health decrease the feeling of your contractions but do not affect your labor progress or your ability to deliver vaginally.
  • Newer techniques and medications used for epidural blocks at Stanford Medicine Children’s Health allow you to be comfortable with much less numbness than in the past, compared with options that are currently offered at many other birthing institutions.
  • As with any medical treatment, side effects or complications occasionally occur. That is why we monitor you and your baby carefully with the latest technology and equipment to achieve the perfect balance between pain control and potential side effects.
  • Recent studies using up-to-date epidural block techniques similar to those used at Stanford Medicine Children’s Health have found no increased risk of cesarean section with an epidural as compared with other forms of pain relief.

Intravenous and intramuscular medication. If you prefer to manage your labor pain without an epidural, your obstetrician or nurse may ask you if you would like a narcotic medication, such as fentanyl. Fentanyl is injected into a vein or muscle, often during early labor. Administered this way, it means small amounts of narcotic can keep you comfortable without making you or your baby sleepy. If you require higher or more frequent narcotic doses, there may be narcotic effects on your baby, so we encourage discussing other pain relief options with your obstetric anesthesiologist.

Nitrous oxide (laughing gas). If you prefer to manage your labor pain without an epidural, your obstetric anesthesiologist may offer you the option of nitrous oxide. This inhaled gas may help you cope better with your labor pain. If you do not obtain the desired pain relief, we encourage discussing other pain relief options with your obstetric anesthesiologist.

At Stanford Medicine Children’s Health, your obstetrician will recommend a cesarean section if it is indicated (which could be because of your health or your baby’s health). If a cesarean section is needed, please be assured that you will be in extremely capable hands with our world-renowned team of obstetric anesthesiologists. Our aim is always to provide the smallest amount of anesthesia and pain medication necessary, so that you are alert and mobile as quickly as possible after surgery and able to immediately bond with your baby and breastfeed (if applicable).

Regional blocks (epidural, spinal, and combined spinal-epidural). We use regional blocks to provide anesthesia for a cesarean section. You are awake during the surgery and able to experience the delivery of your baby. You are also able to have your baby skin-to-skin within minutes of the delivery (after assessment by the neonatology doctors). If you have a planned cesarean section, spinal anesthesia is the most common technique performed; however, combined spinal-epidural techniques are sometimes used because they allow greater flexibility with dosing regimens. If you already have an epidural that was inserted during labor and then require a cesarean section, we use your existing epidural to provide the anesthesia for your surgery.

General anesthesia. Very occasionally, general anesthesia is needed because a cesarean section needs to happen very quickly, or if there is a situation that involves bleeding or another serious unexpected complication. With general anesthesia, you will be asleep for the surgery. While you are under general anesthesia, your obstetric anesthesiologist carefully manages your critical life functions throughout the surgery.

Pain control after a cesarean section. Your pain is generally well controlled after a cesarean section at Stanford Medicine Children’s Health, and we are able to manage the pain of many women without narcotics. While you are in the hospital, you will receive scheduled (non-narcotic) medication to control your pain, which will eliminate the need for narcotics or minimize how much narcotic you might need. You can always request additional pain medication if needed. All pain medications that we use are safe for breastfeeding mothers. An obstetric anesthesiologist is available 24/7 if you require help managing your pain, and we will follow up with you after your delivery while you are in the hospital and if needed after discharge to ensure that your recovery is going well.

Stanford Medicine Children’s Health provides a cutting-edge enhanced recovery after cesarean program (ERAC) that aims for your recovery to proceed as quickly as possible, with excellent pain management. Stanford Medicine Children’s Health obstetric anesthesiologists helped develop these ERAC national guidelines. ERAC aims to ensure that women receive evidence-based, multidisciplinary patient-centered care that optimizes outcomes for moms and babies.

For more details on obstetric anesthesiology options, read our downloadable Pain Relief Options for Labor brochure.

Here are a few online resources to help you learn more about various pain relief options, explain the safety of offered procedures, and dispel any misleading information about labor and pain relief options.

At Stanford Medicine Children’s Health, we offer a variety of classes to expectant families, including a free birth center orientation that includes a discussion with an obstetric anesthesiologist on pain control and anesthesiology options during labor and delivery. Classes on childbirth prep, cesarean births, breastfeeding support, newborn care, and baby safety are also available.

We invite you to explore additional patient resources from Stanford's Division of Obstetric Anesthesiology.

We invite you to explore additional patient resources from Stanford's Division of Obstetric Anesthesiology and Stanford Medicine Children's Health