Medications in Labor
3 Main Uses
1. Sleep: if a woman has early labor that goes for days, sometimes she will be given a sedative to help her sleep, a barbiturate such as Nembutal or Phenobarbital. These can relieve anxiety and induce sleep only in the absence of pain. If the woman is experiencing pain, sedatives without analgesics increase anxiety, may make her hyperactive and disoriented. Sometimes morphine is used for sleep; one study of morphine use found that after sleeping for several hours, 2/3 of the women woke up in active labor, but 1/3 woke up to find their labor had stopped.
2. High anxiety; mom experiencing excessive fear and apprehension which may complicate early labor. May be given sedatives or tranquilizers, such as Thorazine. (See side effects chart at the bottom of this page.)
3. Most common use: Pain relief.
Communicating with your partner about pain medications
Some time in late pregnancy you and your partner should sit down and really talk about what your preferences are regarding pain medication so that when you’re in labor, your partner will know what your preference is. (See Simkin, Whalley, and Kepler for the Pain Medication Preference Scale, a good starting point for this discussion.)
Also, agree on how you will communicate that the time has come for pain medication. I had a client who really wanted to have a birth without pain medication, but knew there would be times in labor she would feel discouraged, and was likely to say things like “I can’t do this anymore, it’s too painful.” We agreed ahead of time that if she said things like that, it was a call for more active emotional support and reassurance, and some suggestions about positions and comfort techniques to try, and that we should not discuss pain medications. However, she wanted to know that she could choose pain medications if necessary, so we agreed that if she said “I’m done”, we would know to begin discussing medication with her.
Narcotic Analgesia (e.g. Morphine, Fentanyl)
- Usually given by I.V. Sometimes given as a shot.
- Generally given at least 2 hours before baby is expected, takes effect in minutes, lasts a few hours. You can get additional doses, but not as effective.
- Note that narcotics are not anesthesia: they do not take away pain sensations. They are analgesia: they make you less sensitive to pain, or “raise your pain threshold”, by depressing the central nervous system. They may alter your reaction to the pain.
- Benefits: May help with relaxation and rest between contractions.
- Some people refer to narcotic effects as “taking the edge off the contraction.” Be aware that they are not referring to the peak of the contraction: narcotics generally don’t reduce the intensity of the peak of the contraction. Instead, they may take off the beginning “edge” and the ending of the contraction.
If
you feel like you’re handling peak, and just need some rest in between,
may be good option- If you’re expecting relief from the most intense part of the ctx, you may be disappointed, and may turn to epidural.
- Side effects on mom: Vary, depending on which medicine is used. Generally: Drowsiness, hallucinations, dizziness (3-32%), nausea (0-40%), itching, respiratory depression (100%), lowered blood pressure. May slow early labor.
- Side effects on baby: Before birth: may make fetal heart less reactive, causing concerns about fetal distress. After birth: reduced alertness because of depression of central nervous system, decreased sucking reflex. Effects may last for several days.
- If narcotic effects are causing significant problems, they can be countered by giving a narcotic antagonist, which cancels out the effects of the narcotics.
- An alternative to pure narcotics are combinations of narcotics and antagonists (e.g. Stadol, Nubain) which help to minimize the side effects, especially reducing the euphoria narcotics can cause.
- Environmental factors: To maximize the effectiveness of sedatives, tranquilizers, or narcotics, it’s best to make your environment as calming, safe, and soothing as possible. Turn down the lights, turn on quiet music, minimize interruptions.
Epidural Anesthesia
The most common pain medication during labor and birth is epidural anesthesia. It is covered in a separate article.
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