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Labor-Pain Control: Weighing Your Options

If you're like most pregnant women, you're wondering how painful your labor will be. In anatomical terms, your relatively nonstretchy cervical opening is enlarging from the size of a pin to the size of a grapefruit; plus there's the pressure to your kidneys, bladder, colon, stomach, and spine as your baby passes through. First labors tend to cause greater pain, as do big babies, a small pelvis, and certain positions of the baby.

But there's no way to predict how you'll react to the pain, which is why you should at least know what pain-relief choices are available, and what the advantages and disadvantages are for each.

And what about the baby? Thanks to low doses and new drug combinations, the effects on newborns are minimal, say experts. (The exception: See "IV Narcotics.")

The best time to start talking to your doctor or midwife about pain relief is during your last trimester. Although not every hospital has the same range of choices available, your options are likely to include the following:

Epidural

What happens: An anesthesiologist injects a needle with a catheter threaded through it into your spinal column. The catheter stays in, delivering medication continuously into the covering around the spinal cord, called the dura. You can ask for an epidural at any stage of labor.

What's good about it: Most women lose sensation from the waist down within five minutes (sometimes it takes slightly longer), depending on the strength of the dosage. Epidurals block the pain of contractions without inhibiting your ability to move around. You're also able to rest, possibly even sleep, before the pushing stage.

What to be aware of: The most common side effect is a headache, which occurs about 1 in 200 times -- a result of the needle nicking the dura and releasing fluid into the spinal canal. Other possible side effects include nausea, vomiting, itching, and shaking, which usually go away after the drugs wear off. (Contact your doctor if your symptoms don't subside. For ways to alleviate some of them, see "3 Sure Bets.")

An epidural may also decrease your ability to use the muscles of the pelvic floor, which could mean a longer second stage of labor. You should expect to push for about three hours -- about an hour longer than a woman who hasn't had one, says Joy Hawkins, M.D., director of obstetrical anesthesiology at the University of Colorado in Denver. There's also a slightly greater chance that you may need forceps.

Nationwide, epidurals are the most popular form of pain relief. And doctors have worked on reducing dosages and combining drugs to minimize side effects and increase the expectant mom's mobility. In fact, say experts, many of the epidurals given today are known as "walking" ones -- which means you can literally get up and stroll if you feel like it. One innovation is the patient-controlled epidural, in which you regulate the amount of medication delivered by pushing a button.

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