Pain Management Options During Labour in Canada: Epidurals, Nitrous Oxide & Natural Approaches

By: Nicki Reid, Bilingual BA

What is an Epidural?

An epidural analgesia more commonly known as just epidural is a drug that helps with pain management and is typically administered to an individual who is in the process of giving birth. It helps to minimize pain in the lower body more specifically via numbing the nerves to the womb and birth canal. An anesthesiologist will give you an injection in your lower back. A nurse helps you get into position which will consist of either lying on your side or sitting, once you’re properly positioned, the anesthesiologist will find the epidural space using a special needle. Your back will be cleaned with antiseptic and your skin will be frozen. Once your skin is frozen, the needle will be inserted into the epidural space. A thin, flexible tube (the epidural catheter) is passed through the needle, which is removed. The freezing or the anesthetic is injected into the catheter to relieve labour pain and afterward is secured with tape. At this point, there is nothing hard or sharp in your back. It’ll take about 15 - 20 minutes to place the epidural and you can expect another 15 - 20 minutes for the medications to take full effect. 

Epidurals are common and are considered the most effective and easily adjustable type of pain relief for childbirth; note they’re only available in hospitals. Furthermore, not everyone can receive an epidural as some medical conditions make epidural insertion impossible or risky.
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Epidural Considerations

Some risks of taking an epidural are: 

• Not being able to feel your contractions or when you’re pushing. This may increase your chance of needing an assisted delivery which may look like the use of forceps or vacuum.

• Opioids, fentanyl, or similar drugs that are in the epidural can cross the placenta and impact your baby's breathing.

• Being confined to your hospital bed.

For more information, visit the risks of epidural analgesia.


What is Nitrous Oxide?

‍Nitrous Oxide (N₂O) also known as laughing gas is a colourless gas that’s used to reduce pain during the transitional stages of labour or while waiting for an epidural. It’s a combination of oxygen and nitrous gas that’s administered to you through a mask that goes over your face. Breathing in the gas helps to lessen labour pains by increasing relaxation in the body. Some possible side effects are: nausea, dizziness, and / or disorientation.


Natural Approaches‍

Studies have found that using natural approaches to pain management during labour result in: less pain, faster recovery time, and increased self-esteem after giving birth; decreased chance of a cesarean birth (C-section) and postpartum depression; as well as a calmer, more settled baby and an easier time breastfeeding. Below are some modalities to consider.

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• Movement: during labour, you may find it helpful to change positions (suggested every 20–30 minutes) from standing, walking, using a birthing ball, leaning on your partner or slowly swaying from side to side with them, etc. Remember to listen to your body and follow its lead.

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• Hypnobirthing: uses self hypnosis to help manage labour related pains and creates a more positive birth experience. Studies have found that hypnobirthing can result in shorter labors and higher rates of natural labor. A tenet of hypnobirthing is that birth should be approached as a normal part of life, not a medical event. One of the key components is changing the language used around birth. For instance, instead of saying contractions, you’ll say surges or as opposed to saying you’re in pain, use “feel a change in your comfort level”. Pro tip: practice the following exercises before your delivery so you’ll be more comfortable using them. Some aspects of hypnobirthing are:

1. Breathing Exercises: can help you relax and focus when you concentrate on your breath, especially when you’re in labour. Breathing deeply and slowly - inhaling for 4 counts, exhaling for 4 counts; or belly breathing where you expand your belly outward as you inhale and allow your belly to relax downward. 
2. Guided Imagery / Visualization: consists of holding an image in your mind of a soothing scene (beach shore), object (a candle flame), or sound (nature sounds like beach waves gently crashing against the shore line). Focus on the details of the experience (what do you see, hear, taste, touch, smell)? How does this experience make you feel?
3. Positive Affirmations: are statements repeatedly said to oneself either outloud or quietly that combat negative beliefs and restore trust in themselves. Some examples for labour are: I am strong, capable, and confident. I trust the wisdom of my body. I am calm, safe, and at peace.

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• Relaxing Environments: can help you feel more present and at peace while in labour. Some things to include:

1. Aromatherapy: is the use of aroma to enhance a feeling of well-being. Numerous studies have found that aromatherapy has a very strong pain-relieving effect during labor. In addition, it reduces stress, labour time, and relieves maternal anxiety. Common essential oils for labour are: lavender for calm, clary sage to encourage uterine contractions, peppermint for nausea and citrus oils such as orange or lemon for mood support. Speak with a knowledgeable provider or an aromatherapist about best practices and which oils to use; as well as your doctor / hospital staff about use in a hospital setting.
2. Music and lighting: relaxing music - white noise, singing bowls, classical music, etc. and dim lighting can contribute to a peaceful birthing environment.

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I encourage you to research and consider the benefits and drawbacks of each option and decide from there. Whatever method(s) you choose, remember there is no wrong choice, only what’s right for you, don’t allow judgement from ANYONE to make you doubt your body’s wisdom. 

As always mama - stay informed, live empowered, take deep care, and be well.

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Nicki Reid, Bilingual BA

Certified Transformational Health and Life Coach | Certified Yoga and Meditation Teacher | Certified Emotional Emancipation Facilitator | Certified Reiki Practitioner | Founder, Wholesome Mind Health Coaching

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