Itâs one of the big questions for birth plans: âDo you want an epidural?â But there are plenty of other ways to make those contractions more bearable. We asked two expertsâAnn Schaeffer, D.N.P., C.N.M., a midwife in Harrisonburg, Virginia, and a consultant for the American College of Nurse-Midwives, and Rebecca Dekker, Ph.D., R.N., the founder of Evidence Based Birth, an organization that works to make research about birth accessibleâto weigh in on three options that might be less familiar to laboring moms.

Photograph courtesy of iStock
Nitrous Oxide
Nitrous oxide, or laughing gas, is becoming more common again, Schaeffer says. (It was widespread in the â70s and â80s but fell out of vogue, she says.) Itâs inhaled as a blend with oxygen. Mom controls the mask and holds it to her face as needed. The downside? âIt has a very, very short window of effectiveness,â Schaeffer says. Breathe in for relief, breathe out, and itâs gone. Nitrous oxide promotes a feeling of calm, making it more of an anxiety easer than a pain reliever. âThe intent is not so much to relieve pain but to help you cope,â Dekker says, adding that it usually isnât the first thing moms reach for in laborâbut it can help them get through the end.
Sterile Water Injections
This is exactly as it sounds: sterile water injected into points in the back. The method is âa little old-school,â Schaeffer says. Itâs usually administered in four spots, and âit can be pretty painful while you get it placed,â Schaeffer warns. It offers relief through the âdiffuse noxious inhibitory controlâ method, or âdeliberately causing an unpleasant sensation to increase your comfort,â Dekker says. In other words, the injections trigger the brain to release its own pain-relieving hormones (endorphins). Research shows the injections take effect quicklyâwithin a minute or two, Dekker saysâand can last up to two hours. Since the injections are only water, you can safely repeat them.
TENS Unit
Transcutaneous electrical nerve stimulation, or TENS, is a fancy way of saying a low voltage back treatment. The sensation is âprickly,â Schaeffer says, and moms control the intensity. Itâs noninvasive and safe, but Dekker says it takes time to kick in: One study showed it took laboring moms about two to four hours to feel relief. Thatâs because researchers think it partly relieves pain by the âgate controlâ method, which means your brain can only receive so many sensations at once. So, the added sensation helps prevent moms from feeling contractions. Hospitals may have TENS units, but you can buy them for as little as $30. âItâs something you can do at home, or in the hospital, or even while driving to the hospital,â Dekker says.
Ultimately, these things are all part of what Schaeffer calls a toolbox of pain relief methods: âIdeally, when we have someone in labor, we are able to give them a few options.â And Dekker says that research shows that the best way to manage labor pain is to combine pain relief options. âYou canât just slap a TENS unit on someone and say, âHere you go; have a great labor!â â Dekker says. âYou have to also include other comfort measures.â
A Labor Revolution
TENS units, nitrous oxide, and sterile water injections might sound foreign to many American moms-to-be, but not to midwives and laboring mothers in the United Kingdom. âTheyâre all extremely common in England,â says Rebecca Dekker, the founder of Evidence Based Birth. Why is that? âItâs more of a reflection of the medical management model in the U.S.,â Dekker says, âwhereas in the U.K., most women are cared for by midwives.â
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