Pain Management Options — Evidence Library

What it is

The range of comfort and pain-relief options available in labor, from breathing and water to nitrous oxide, IV medication, and epidurals.

Evidence review links

Each link opens the full review on the publisher's site in a new tab.

Possible benefits

A range of options means people can choose what fits their goalsReview sources ↓
Non-pharmacologic options have few side effectsReview sources ↓
Epidurals can provide effective pain relief for those who want itReview sources ↓

Possible risks

Each option has its own risks — discuss specifics with your providerReview sources ↓
Epidurals can affect mobility, blood pressure, and may be associated with longer pushing phaseReview sources ↓
IV opioids cross the placentaReview sources ↓

Alternatives

Hydrotherapy (shower/tub)Review sources ↓
Counterpressure, massage, position changesReview sources ↓
TENS, breathing, hypnobirthingReview sources ↓
Nitrous oxide, IV medications, epiduralReview sources ↓

Current evidence

Pain management is not one decision; it is a menu that can change as labor changes. Non-pharmacologic methods (water, movement, counter-pressure, TENS, breathing) generally have low medical risk but variable pain relief. Pharmacologic methods (nitrous, IV opioids, epidural) can be very helpful and also have monitoring, mobility, or newborn trade-offs. Use the related method-specific topics and source links below to compare options with your care team.

Where the evidence is clear · where people may choose differently

For most topics, guidelines from ACOG, WHO, and other major bodies broadly agree on the core safety points (when to act in an emergency, informed-consent standards, monitoring baselines). Where reasonable people — and even guidelines — differ tends to be around thresholds (when to start or stop something), preferences (comfort, environment, support), and values (how you weigh small risks against benefits). Use the questions below to explore those pieces with your care team.

Educational only. Your care team can help you weigh what applies to your specific situation.