Regardless of the type of birth you’re planning (natural & vaginal, induction, scheduled c-section, etc.), it’s still really important that you educate yourself about the many medications that you may be offered during labor.

Maybe you’re planning to have an epidural. Okay, fine. Just know the risks associated with your choice so that you can consent in an informed way!

Maybe you’re planning a natural birth and don’t want any interventions. Okay, fine. Just know what medications might be pushed at you so you can refuse them and even explain why you won’t be taking any.

Knowledge is power, lovely folks!

Overview of Pain Relief Medications During Labor

This overview does not include other non-medical pain relief choices like massage, movement, hiring a doula, laboring in the water, etc. We’ll talk about that another time. Today we’re only focused on medications and their risks and benefits!

Pain medications (or all medications, for that matter) are considered either general or local (also called regional). General pain meds act on the entire body and local pain meds act in a specific, localized spot. More on this, with examples later…

First of all, there are 2 basic types of pain relief: analgesics and anesthetics. It took me what felt like forever to understand the difference, especially since both of these medication types might be used simultaneously. Here is the basic breakdown of their differences:

Analgesia (Analgesics)

• Only dulls the pain; it does not take all pain away
• General analgesics (also considered systemic meds) are delivered through an IV line or a muscle injection and affect the entire body. Sometimes they can be delivered via gas form!

Anesthesia (Anesthetics)

• It works by numbing the nerves, so it removes all pain, feeling, and hinders movement
• Local anesthesia is the form generally used during labor so that the birthing woman can remain awake and alert to meet her baby. General anesthesia is usually used during labor only for emergencies, since the person receiving this form of medication will be unconscious.

Now that you know the 2 broad types of medications open to women during labor, let’s looks a little more deeply at the risks and benefits of specific medications and interventions.

Types of Analgesics

Each of the analgesics below are general/systemic medications so they affect the entire body.

What are the risks of analgesics?

• They cross the placenta and affect your baby during labor and after birth.
• They can cause you to feel sleepy, drowsy, dizzy, or disoriented. Sometimes care providers recommend that you stay in bed because of these side effects.
• It’s possible that you could feel nauseous or very itchy.
• Because analgesics often relax your body, and since medication cross through the placental barrier so your baby also receives them, they may affect your baby’s heart rate or the reading of their heart rate. This can lead to further interventions if a problems is suspected.

What are the benefits of analgesics?

• These meds are often less invasive than a regional anesthetic (that is often administered near the spine).
• There is a patient-controlled option where you increase/decrease the medication levels at will.
• No anesthesiologist is required for pain relief.
• Birthing women are less likely to use Pitocin, a vacuum extractor, or forceps to deliver their baby than women who chose the epidural (or other local anesthetic option).

Narcotics/Opiates

Narcotics and opiates are phrases used interchangeably for the same class of medications. They are usually administered through a spinal injection or an IV placed in the arm. They are administered in early labor and meant to dull the pain or “take the edge off.” Use in the later stages of labor is usually not recommended because the side effects your baby might experience are more intense when used during this time.

What are the risks of narcotics?

• The mother may experience one or many of the following symptoms: nausea, vomiting, overwhelming itchiness, dizziness, sedation, decreased gastric mobility, loss of protective airway reflexes (which could make choking a risk), and hypoxia because of depressed respiration.
• Because narcotics do cross the placenta to the baby, some side effects your baby might experience are: central nervous system depression and altered neurological behavior which can impair early breastfeeding success, respiratory depression, and a decreased ability to regulate body temperature.

What are the benefits of narcotics?

• They provide some level of pain relief but you can still feel your body to more effectively push out your baby.
• Narcotics do not numb parts of your body, so you have a wider range of movement and control than if you chose an epidural.

What are some brands of narcotics I may be offered?

• Demerol: starts working in 5 minutes but can cause breathing issues with your baby if administered 2-4 hours before delivery.
• Morphine: this drug depresses the baby’s breathing and is not used as commonly used anymore.
• Stadol: is more potent than Demerol, starts working in less than 5 minutes, and produces minimal fetal effects and nausea.
• Fentanyl: works fast and lasts around 45 minutes, includes minimal fetal effects, and babies need less breathing help afterwards than when their mother uses Demerol.
• Nubian: is like morphine, fast acting, but mom can have feelings of sedation and dysphoria (a general feeling of overall uneasiness and negativity).

Tranquilizers

Tranquilizers don’t reduce pain at all, actually, but they are often used in labor to help a mother relax. This can allow her to experience the contraction as less painful because her physical and mental state is less tense. A tranquilizer generally works for 3-4 hours.

What are risks of tranquilizers?

• Tranquilizers might make the mother feel drowsy or “out of it” and she may not remember some of her labor or birth experience.
• Mothers who take tranquilizers deliver babies with decreased muscle tone and decreased activity levels at birth.

What are the benefits of tranquilizers?

• They help the mother feel relaxed and calm.
• They allow you to feel aspects of the labor so that you know when to push.

Nitrous Oxide (N20)

Nitrous oxide is considered an inhalation analgesic. This gas has long been used during labor in certain countries in Europe but it is just becoming well-known in the US. It is likely that your place of birth might not offer this as an option yet, but it’s worth asking about. To use nitrous oxide during labor, a woman must self-administer the gas via a hand held mask. As with the other analgesics, this gas does not remove pain, it only dulls the pain sensation.

What are the risks of nitrous oxide?

• It may cause dizziness and nausea.
• You should not use it if you’ve had recent ear surgery.
• Women who are deficient in vitamin B12 should not use N2O.

What are the benefits of nitrous oxide?

• It takes effect in less than 1 minute.
• According to current research, no negative side effects have been found for your baby if you use nitrous oxide during labor.

Types of Anesthetics

Epidural Block

Also called an epidural, the epidural block is the drug of choice during c-sections because it allows the mother to remain conscious but feel no pain so that she can meet her baby directly after birth. An epidural is delivered through a thin catheter needle placed in the space outside the membrane that surrounds your spinal column and spinal fluid. Usually an epidural is a combination of a local anesthetic and a narcotic, and takes 10-20 minutes to begin working.

What are the risks of an epidural?

• You do not have very much control over your lower body, and walking is very difficult and must be done with help.
• You may experience a drop in blood pressure that may lower your baby’s heart rate and lead to more tests and interventions.
• Fever is a normal response to an epidural but it is impossible to tell if your fever is brought on by the epidural or by a systemic infection. This requires further tests and perhaps interventions for you or your baby.
• If the covering of your spinal cord is pierced during administration, you may experience a crippling headache for days after the birth. This can hinder bonding with your baby and early breastfeeding.
• You may have a sore back after the birth.
• Your lack of feeling in your pelvic region may hinder the pushing stage of labor because you cannot feel when to push. The epidural may also relax your pelvic floor so much that the usually firm area that helps your baby’s head rotate into the birth canal might not act as it is supposed to. This can delay this stage of labor.

What are the benefits of an epidural?

• You do not experience any pain or feeling in your lower body.
• If you are exhausted from a long labor, it can allow you to rest and sleep to gather your strength.

Spinal Block

A spinal block is administered through a one time injection into the spinal fluid. It is considered a local anesthetic.

What are the risks of a spinal block?

• A spinal block carries all of the same risks as an epidural.

What are the benefits of a spinal block?

• A spinal block administers rapid pain relief for women who do not want to wait for the epidural to begin working.
• It only lasts for a few hours so it can be discontinued if desired.

Combined Spinal & Epidural Block (CSE Block)

A combined spinal and epidural block (CSE) is often used during labor. It is also considered a local anesthetic.

What are the risks of a CSE block?

• A CSE carries all of the same risks as an epidural and a spinal block.

What are the benefits of a CSE block?

• Pain relief is both fast acting and long lasting because of the use of both forms of medication.
• Lower doses of both medications can be used the achieve the same level of pain relief.

Pudental Block

A pudental block is injected at the site of the perineum during or after birth to numb the region for crowning or for stitching perineal tears.

What are the risks of a pudental block?

• For some women, pain relief only works on one half of their body.
• Although numbness means that you do not feel the stretching that occurs during crowning, also called the “ring of fire,” it also means that you cannot read your body’s signals about when to delay pushing (which can prevent or reduce tearing.)

What are the benefits of a pudental block?

• Full or partial pain relief in the perineal region.

 

References

• http://www.acog.org/Patients/FAQs/Medications-for-Pain-Relief-During-Labor-and-Delivery
• http://www.babycenter.com/0_systemic-pain-medication-for-labor_1489906.bc
• http://americanpregnancy.org/labor-and-birth/narcotics/
• https://www.drugs.com/mca/labor-and-delivery-pain-medications
• http://americanpregnancy.org/labor-and-birth/nitrous-oxide-labor/