After we place the epidural tube in your lower back, we give you a handset attached to a pump. You can press a button to release medication. We program the pump so you can’t get too much.

Pros: People who control their own epidural often use less medication than they would receive with a standard epidural. They may also feel more in control of their pain relief.

Cons: These are the same as for a standard epidural.

This is a single injection of medicine into the spinal fluid in your lower back. It quickly makes the lower part of your body numb, but you stay awake and alert. It is often used to block pain during a C-section.

Pros and cons: A spinal block relieves pain much faster than an epidural, but lasts only one or two hours. Other risks and benefits are the same as for a standard epidural.

A spinal block to numb you quickly is combined with an epidural to give you continuous pain relief. We can use lower doses if you are giving birth vaginally and want to be able to move a little. We often use higher-dose combined spinal-epidural blocks during a C-section.

Pros: Combined spinal epidural blocks provide faster pain relief than standard epidurals and longer pain relief than spinal blocks.

We inject pain-blocking medication in your vaginal area or perineum (the area between your vagina and anus). We may do this just before delivery if we need to use forceps, suction or an episiotomy (a cut to enlarge the vaginal opening) to help your baby be born.

We also use a pudendal block or local anesthetic injection after delivery if you need stitches to repair tears.

Pros:

• It lessens pain for up to an hour.
• Side-effects for the baby are rare.

Cons:

• It may numb pain in only part of the perineum.
• It could cause an allergic reaction.
• In rare cases, it could cause an infection.
• Injecting the medicine into a vein might affect the mother’s heart or central nervous system.

A mild pain reliever that helps you relax and feel less anxious. You breathe it in through a mask or mouthpiece, before a contraction.

Pros:

• It can help you cope with pain.
• It is safe for you and your baby.
• You decide when and how to use it.

Cons:

• It’s not a strong pain reliever and won’t take away all your pain.
• It can cause dizziness, nausea and vomiting.
• It may take practice to get the timing right.

These pain relievers are usually given in a shot or IV.

Pros: 

• They can make you feel relaxed.
• They can lessen your pain without numbing you or affecting your ability to move.

Cons:

• They don’t take away all your pain. They are not as effective as epidurals.
• They can cause nausea, vomiting, drowsiness and itching.
• They can affect your baby’s breathing and heart rate for a short time.
• They can make your baby sleepy.

This may be a good option if an epidural or spinal is not safe for you. Remifentanil is an opioid that provides fast, strong pain relief. You press a button connected to a pump and IV to deliver a dose into your bloodstream. OHSU is the only hospital in Oregon to offer this form of pain relief.

Pros:

• It provides effective pain relief if you have a spinal, neurologic or bleeding disorder that means you can’t have an epidural.
• Unlike other opioids, it doesn’t make your baby sleepy.

Cons:

• It takes away pain for just a few minutes per dose. You don’t get the ongoing pain relief of an epidural.
• It can slow down your breathing, so we will monitor you closely.

For most C-sections, we offer the same pain relief options as for vaginal births. You stay awake. We use medication that takes away pain and sensation in your lower body. You might feel some pressure or tugging. Pain relief lasts through and after the surgery.

Options include:

• A spinal block: The anesthesiologist injects numbing medication into your spinal fluid. It works fast.
• An epidural: The anesthesiologist puts a thin plastic tube in a space near your spinal cord. Medication to block pain goes through the tube as needed. It takes longer to numb you than a spinal block.
• A combined spinal-epidural block: The spinal numbs you quickly for surgery. The epidural increases your medication if needed.

Chloroprocaine lavage: In rare cases, regional anesthetics don’t provide enough pain relief during surgery. This new technique provides pain relief during surgery without general anesthesia so you can stay awake for the birth of your baby.

OHSU was the first hospital in the U.S. to publish studies of chloroprocaine lavage. We have the most experience in this technique that is now used around the country.

The method involves splashing the abdominal organs with chloroprocaine. This numbing medicine takes away breakthrough pain and doesn’t have bad side effects for you or your baby.

This is rarely used. It’s only for some emergencies or if you can’t have regional anesthesia. The anesthesiologist puts you to sleep while a skilled team does the surgery. You are not awake for the birth of your baby.

Most people use opioids. We offer non-opioid options for people who have been addicted to narcotics or have some types of chronic pain. These include walking epidurals and IV ketamine or lidocaine.