What to Know About Opioids for Pain Relief During Labor

Medically Reviewed by Dan Brennan, MD on July 30, 2022
5 min read

If you’re getting close to your due date and starting to put together your birth plan, you’ve probably thought about what to do for pain management. There are many different options you can choose to manage your pain. Opioids for pain relief during early labor are a common choice.

Opioids are a type of narcotic medication used to treat pain. They are most commonly taken orally or given through an IV.

Opioids attach to nerve cells, blocking pain signals to the brain. Opioids also have the potential to release endorphins, which can make you feel relaxed and calm.

The Centers for Disease Control and Prevention (CDC) categorizes opioids into the following categories: 

Natural Opiates. Natural opiates come from seeds of certain poppy plants. They include medications like morphine, codeine, thebaine, and papaverine.

Semi-Synthetic Opioids. Labs make semi-synthetic opioids out of natural opiates. These include:

  • Oxycodone (brand names: OxyContin, Percocet)
  • Hydrocodone (brand name: Vicodin) 
  • Hydromorphone (brand names: Dilaudid, Exalgo)
  • Oxymorphone (brand name: Opana)

Methadone. Methadone is a synthetic opioid similar to morphine. It’s often used to help people addicted to heroin as it doesn’t produce a high.

Synthetic Opioids. Synthetic opioids are man-made. These include:

  • Pethidine, also called meperidine (brand name: Demerol)
  • Fentanyl (brand names: Actiq, Duragesic, Sublimaze)
  • Alfentanil (brand name: Alfenta)
  • Remifentanil (brand name: Ultiva)
  • Tapentadol (brand name: Nucynta)

Heroin. Heroin is a street version of diamorphine, an extremely powerful and illegal semi-synthetic of morphine. It's not given in hospitals in the United States.

When you’re in labor, you have a few pain management options to choose from. You can choose between a non-medicated birth or one or more pain management options. 

Opioids are a common choice during the early stages of labor, when you experience contractions and associated pain but aren’t in active labor yet. Opioids are:

  • Fast-acting. Depending on the type of opioid and how you take it, you can begin to feel relief in a few minutes.
  • Long-lasting. Pain relief can last several hours.
  • Relaxing. Opioids allow you to relax and get some rest before the hard work begins, but they don’t weaken your muscles or make it difficult to push.

However, there are several downsides to taking opioids during labor:

  • Sleepiness. They can make you feel drowsy, but this may be helpful if you’re expecting a long labor and want to rest beforehand.
  • Nausea. Opioids may cause an upset stomach.
  • Dizziness. You may feel dizzy or lightheaded.
  • Risk to baby. If given improperly, they can be dangerous for your baby’s health, causing reduced breathing and heart rate.

The type of opioids you’re offered may be different depending on your hospital and provider, but common opioids for labor pain relief include:

  • Morphine, a natural opioid
  • Nalbuphine (brand name: Nubain), a synthetic opioid
  • Butorphanol (brand name: Stadol), a synthetic opioid
  • Meperidine (brand name: Demerol), a synthetic opioid
  • Fentanyl, a synthetic opioid

Generally speaking, taking opioids for pain relief during labor is safe and may even be recommended, depending on your level of pain. However, that doesn't mean that opioid pain relief for labor is without risk.

Opioids should only be given before active labor starts. Active labor means that your cervix has dilated to at least six centimeters and your contractions are regular. This is partially because opioids aren’t as effective once you’re further along in labor. 

The right dosage must also be given. Too much can slow down the mother and baby's breathing, as well as the baby's heart rate.

With the widespread opioid epidemic, it’s understandable if you’re uncomfortable with the idea of taking opioids. However, taking opioids during labor is unlikely to cause an addiction.

Physical dependence on narcotics occurs because your body builds a tolerance to them. This happens over time, not over the course of labor. Unless you have a history of opioid addiction, taking opioids for labor pain will not cause a new addiction. 

If you’re unable to take opioids during labor or are concerned about pain management during active labor, many other pain management options are available. These include: 

  • Epidural block
  • Spinal block
  • Local anesthetic
  • Nitrous oxide

Epidural block. About 50% of births include an epidural for labor pain relief. With an epidural, a doctor will inject a liquid local anesthetic into the epidural space, the sac of fluid around your spinal cord. They will leave a catheter in your spinal cord to allow injections or continuous IV infusion.

Epidurals block the nerve signals from the lower half of your body. About 10 to 20 minutes later, you’ll notice your lower half feeling numb. You will not be able to walk while the epidural is in and likely need catheterization to use the bathroom. After birth, the doctor removes the catheter, and the effects will wear off.

Epidurals have some risks. Your blood pressure may drop, so your medical team will be continually monitoring your blood pressure. Some people find they have difficulty knowing when to push while the epidural is in. 

Spinal Block. Spinal blocks are similar to epidurals as they both require an injection of medication into the spinal area. In a spinal block, the medication goes into the spinal fluid and is only injected once to provide pain relief for up to two hours.

The risks of a spinal block are similar to those of an epidural. Spinal blocks are typically used in more complex birth situations or for C-sections. Your doctor may offer you a combination spinal-epidural block to provide immediate and long-term pain relief.

Local anesthetic. Local anesthetic is typically used instead of a spinal block or epidural. Your doctor may use it for an episiotomy, a surgical cut to expand the vaginal opening. 

Nitrous oxide. Nitrous oxide, or laughing gas, is inhaled through a mask just before each contraction. It doesn’t eliminate pain and doesn’t last long, but it does allow you to continue to walk and move freely during labor.

If you’re concerned about pain management during labor, your best option is to talk with your doctor. It’s also important to be flexible; every birth story is different, and you never know what may happen. Overall, it’s important to make the choice that will create the safest and best experience for you and your baby.