Medication and Anesthesia During Childbirth
In a normal, uncomplicated labor and delivery, the use of medication is often unnecessary. Relaxation, breathing patterns, and other comfort measures can be very effective in combating the sensations of pain. The presence of a loving support person is probably the best tranquilizer available. In addition, the support given by the hospital staff and your caregiver may affect your need for medication. If you are given positive reinforcement (“You’re doing great!” “It’s almost over!”), are permitted to move about freely, and receive a minimum of medical interventions, you will probably experience very little need for medication. On the other hand, if you are frequently asked if you need something for pain, if you are made to lie in one position, or if medical interventions are used, you may have an increased desire for some type of medication.
Nature has provided its own painkiller for laboring women. Labor prompts the pituitary to release endorphins, called natural painkillers. Endorphins are narcotic-like pain relievers that are said to be several times more potent than morphine. They produce a sensation of enormous pleasure after a tremendous exertion such as labor. Scientists have found that if a woman is given any kind of drug during labor, production of this natural painkiller is disturbed.
Knowledge of the labor and birth process can also enhance a woman’s ability to cope with labor. During labor, before you decide to take a medication, find out how far along you are. Even if it has been only a short time since you were examined, get checked one more time, just to make sure you are not progressing rapidly. If you are in transition, your labor is almost over and you may have just a few more contractions left before completing the first stage. By the time the nurse goes out, prepares the medication, and returns with it, you may have reached 10 centimeters and no longer need it. Medication taken at this time may make you sleepy, interfering with your ability to push during delivery and to bond immediately after birth, plus it may have a strong effect on the baby. If you request an epidural, it may take approximately 30 minutes to be administered and take effect, and you do not want to be numb for the pushing stage.
Before you go into labor, you should discuss with your caregiver which medications and types of anesthesia you will be offered if the need arises. You must also make sure that your labor partner is aware of your desires long before your due date arrives. Labor is stressful and is not the time to decide which medication or anesthesia is best for you. If you wait until you are in active labor or transition, you may agree to something that is really not acceptable to you.
Know your alternatives and how they will affect both your and your partner’s participation in the labor and birth. When you discuss medications with your caregiver prior to labor, or when you are deciding whether to accept a medication or any prescribed treatment during labor, you should ask the following questions:
- How will this medication (or treatment) affect my labor, me, and my baby?
- What are the benefits and the risks?
- If I decide not to accept this medication (or treatment), what will happen?
- Is there an alternative form of treatment?
Even though relaxation and breathing work extremely well for many women, some find that these tools do not provide enough relief of pain or promote adequate relaxation. You may want to try some of the other techniques suggested in the “Tools for Labor” section on this website. Then, if you are still experiencing unbearable pain, medication or anesthesia is available. In a prolonged or difficult labor, some women feel they need medication to help them cope with their contractions. During a complicated delivery, in which forceps or a vacuum extractor is necessary, anesthesia may be beneficial. For a cesarean section, anesthesia is a necessity.
No one perfect medication exists for all circumstances. Since you cannot foresee what your labor will be like, except in the case of a planned cesarean, you must remain flexible in your attitude. Every medication and anesthetic has benefits and risks, and you need to be aware of them to make an informed decision. Only when the benefits outweigh the risks should you consider using a particular medication.
In a difficult labor, a small amount of medication can decrease some of the pain sensations and may aid relaxation, especially between contractions. You should realize, however, that an analgesic will not take away all your pain, although it may lessen it enough to enable you to better cope.
An epidural offers the most effective pain relief for labor, hence its popularity. If a woman previously had a cesarean after a long, hard labor and is afraid to attempt a vaginal birth, an epidural may give her the reassurance to go through labor again. For a woman who is delivering a breech baby vaginally, an epidural may provide both the pelvic relaxation and the anesthesia that would be necessary if the use of forceps is suddenly required.
In a prolonged labor, Demerol, or another narcotic, may relax the cervix, helping to speed up labor. It may also provide some needed rest if the woman has been in early labor for many hours without sleep.
If an intervention such as the use of forceps or a cesarean section becomes necessary, a regional anesthetic can relieve pain, while allowing you to be awake for your baby’s birth. Epidural anesthesia also presents fewer risks to the woman and baby than general anesthesia does. In addition, after surgery, further pain relief can be provided by an injection of narcotics through the epidural catheter. This provides excellent pain relief for 24 hours without the disadvantages of repeated narcotic injections, intravenously (IV) or intramuscularly (IM). These disadvantages include drowsiness, intermittent pain relief, pain of an intramuscular injection, and transfer of the medication to the baby via the breastmilk.
When weighing the risks of accepting a medication or anesthesia, you must take many factors into consideration. While the dosage of a medication is geared to the woman, two individuals are involved, one much smaller than the other. All medications affect the fetus in one way or another. The American Academy of Pediatrics’ Committee on Drugs has warned that there is no medication that has yet been proven safe for the unborn child.
The fetus may be affected either directly or indirectly by medication used during labor or delivery. Both effects are highly influenced by the dose of the medication and the time it is given before birth. If enough time passes between the administration of the medication and the birth, much of the medication will be metabolized by the woman, thereby decreasing some of the side effects in the infant. But, if the baby is born while a large amount of the medication is in his system, his immature liver will have to excrete the medication on its own. Liver enzyme activity is immature in the fetus and newborn, taking 4 to 8 weeks after birth to reach adult capacity. In a premature infant, the effects of a medication are even greater.
The direct effects of medication on the baby include toxicity or alteration of the central nervous system, respiratory system, or temperature regulating centers, and change in muscle tone. The indirect effects are caused by a medication’s influence on the woman’s physiology. If the medication depresses the woman’s respirations or blood pressure, the infant receives reduced amounts of oxygen.
The use of a medication or anesthetic may increase the need for additional interventions. For example, oxytocin used during labor intensifies the contractions, thereby increasing the possibility of needing pain medication. Stronger contractions may decrease the amount of oxygen the fetus receives. Conversely, some medications slow down or prolong labor, thus increasing the need for oxytocin. Certain anesthetics dull the urge to push, which can increase the need for a forceps delivery.
The decision to accept or refuse medication is not an easy one. You must learn what is available, and then, if the need arises, you can choose the medication with which you are most comfortable. If you have an allergy to a medication, make sure you tell your caregiver, who should note it on your chart.
Also, before accepting any medication, ask, “What are you giving me?” If you are very sensitive to medication, tell your caregiver and ask him to order a reduced dose. If the smaller dose is not sufficient, you can always ask for more. If the dose is too strong, however, you may not be able to handle the contractions effectively. Remember, once a medication has been given, it cannot be taken back.