Even if you're aiming for an unmedicated birth, it's important to know your options, just in case. The two most common types of pain relief are narcotics, which may be given as an injection or intravenously, and an epidural block, which is injected into the spinal area.
Narcotics, such as Demerol, act on your whole nervous system to change your perception of pain. The negatives: These drugs may make you nauseated and sleepy and could slow your baby's reflexes and breathing. For this reason, narcotics aren't given just before delivery.
An epidural numbs the pain-sensing fibers in your spine and can essentially remove feeling from the waist down. First-timers often fear having a catheter inserted into their spine, but the procedure isn't especially painful, although you do have to lie still while it's being done. (In rare instances, the spinal cord is accidentally pierced, which can cause a severe headache if it's not treated.) The anesthesia is then administered as needed.
Epidurals aren't without controversy. Although they allow you to stay alert, they can slow your labor and temporarily decrease your blood pressure. While some hospitals still wait until women are four centimeters dilated before giving pain relief, the American College of Obstetricians and Gynecologists states that pain relief should be given at whatever point it's requested. Depending on the type of epidural you have, you may be confined to your bed. Some combined spinal-epidural blocks, or "walking" epidurals, allow you to move around in the early stages of labor. An epidural can affect your ability to push, which may result in the use of vacuum extraction or forceps. In some cases, a lower dose of medication may give you control over your discomfort while not eliminating your ability to help push.
Another option is a pudendal block -- an injection that relieves pain in the perineum, vagina, and rectum. This local anesthesia will help you endure an episiotomy or instrument-assisted birth with a minimum of discomfort.