Special Situations During Labor that Require Medication

In a labor that Is out of the ordinary or involves complications, medication may be required for medical reasons. These special situations include preterm labor, pregnancy-induced hypertension, and post-term pregnancy.

Preterm Labor

Women who go into preterm labor may be hospitalized and given a tocolytic medication to relax the uterine muscles and stop the contractions. The most common tocolytic medications are terbutaline sulfate (Brethine) and ritodrine hydrochloride (Yutopar). The side effects of these drugs are rapid heart rate, anxiety, nausea, vomiting, tremors, and insomnia. While on these medications, women are carefully monitored, as they can develop complications such as chest pain, palpitations, high blood pressure, and pulmonary edema. Other medications that may also be used as tocolytics are magnesium sulfate, indomethacin, and nifedipine. These medications are given subcutaneously (under the skin) with a pump, intravenously, or orally.

If the preterm labor does not stop, the woman may be given steroids to prevent or decrease the severity of hyaline membrane disease (respiratory distress syndrome) in the premature infant. Steroids stimulate the production of surfactant in the infant’s lungs. However, they must be given 24 to 48 hours before delivery to be effective. If the preterm labor was a result of an Infection, the woman will also be treated with antibiotics.

Hints for the Labor PartnerDuring labor:

  • Ask a nurse about your partner’s progress before requesting medication or an epidural for her.
  • Suggest first trying a nondrug pain reliever such as changing position, emptying the bladder, massage, and laboring in a tub or shower.
  • Ask the nurse if your partner is allowed to get up and walk around. If yes, help your partner to do this.
  • Tell your partner that she is doing great.

Pregnancy-Induced Hypertension

PIH places both the woman and baby at risk. The treatment for P1H is bed rest and delivery of the baby when mature. If untreated, PIH can progress into preeclampsia (elevated blood pressure, protein in the urine, and excessive swelling) and eclampsia (seizures, stroke, and kidney failure). The most common medication used for preeclampsia is magnesium sulfate, which prevents seizures and also helps lower the blood pressure. It is given intravenously prior to labor, during labor, and for 24 hours after delivery. The blood pressure, reflexes, respiratory rate, and urine output of a woman on this medication are closely monitored.

Post-Term Pregnancy

At 42 weeks, a pregnancy is considered to be post-term. Since the incidence of stillbirth is higher after this time, many doctors induce labor. Prostaglandin gel (Prepidil or Cervidil) may be applied in or around the cervix before labor is induced to help “ripen” (soften) the cervix, or a pill of misoprostol (Cytotec) may be crushed and placed on the cervix. This increases the success rate of labor induction and reduces the need for a cesarean. (For a discussion of the self-induction of labor using natural methods, see “How Can I get Labor Started?”.)