Medications and Anesthesia Commonly Used in Childbirth

• Seconal
• Nembutal
• Restoril

• Prelabor
• Early labor

• Help differentiate prelabor from true labor.
• Effects depends on dose.
• Sedatives ally anxiety or excitement, and induce rest, but do not relieve pain.
• Hypnotics may induce sleep.

• Slow down labor if given too soon.
• Disorientation.
• Drowsiness.
• Lowered blood pressure.

• ِAccumulation in tissues.
• Respiratory depression.
• Decreased sucking ability.
• Cord level: 70%

• Vistaril (Atarax)
• Compazine
• Phenergan
• Largon

• Orally
• IM
• IV

• Early labor.
• Active labor or transition, alone or combined with analgesic.

• Relieve tension and anxiety.
• Promote relaxation.
• Prevent nausea and vomiting when used with analgesic; also potentiate effects of analgesics.

• Drowsiness.
• Confusion.
• Blood pressure change.
• Heart rate change.

• Heart rate change.
• Decreased sucking ability.
• Decreased muscle tone.
• Lowered body temperature.
• Decreased attention, increased restlessness.
• Cord level: 95%-100%

• Demerol
• Nisentil
• Stadol
• Nubain

• IM
• IV

• Reduce or alter pan perception.
• Demerol may relax cervix and hasten dilation.
• Stadol and Nubain contain narcotic antagonist that reduces side effects to baby.

• Dizziness.
• Dry mouth.
• Euphoria.
• Nausea.
• Respiratory depression.
• Lowered blood pressure.
• Drowsiness and possible difficulties concentrating on breathing or pushing if dose too large.
• Sleepiness during delivery.

• Depression respiration.
• Decreased sucking ability.
• Altered behavioral responses for several days or weeks.
• Cord level: Demerol, 80%-130%.

• FDA requires Demerol to carry warning label that it may have adverse effects on infants.

• IM or IV to woman
• IM or in umbilical vein to baby

• Second stage.
• After birth.

• Rapid heart rate.
• Elevated blood pressure.
• Nausea and vomiting.
• Sweating.
• Trembling.
• Return of pain.
• Withdrawal symptoms if woman is addicted to narcotics.

• Same to mother.
• Severe seizure if mother is addicted to narcotics.
• Little is known about long-term effects.
• Effects of antagonists are shorter than those of narcotics, and depression may recur.

• Pitocin
• Syntocinon
• Oxytocin
• Ergotrate
• Methergine

• IV (dosage best controlled when diluted in IV fluid)
• IM (postpartum only)

• Prior to labor
• During labor
• Postpartum

• Induce or stimulate contractions.
• Control postpartum bleeding.

• Lowered blood pressure; anxiety; increased heart rate; edema; water intoxication.
• Tetanic (very strong) contractions or rupture of uterus.
• Increased desire for pain medication.
• Increased need for coaching and support.
• Ergotrate or methergine given postpartum can increase blood pressure or cause severe “afterpains.”

• FDA warns that oxytocin should not be used for elective induction for convenience of doctor or woman.
• Oxytocin is released naturally during breastfeeding.

• Heart rate change.
• Fetal asphyxia due to tetanic contractions.
• Increased jaundice.

• Does not affect alertness.
• Does not affect cough reflex—less danger of aspiration if vomiting occurs.
• Does not affect labor partner’s participation in labor and birth.

• Second stage
• Prior to perineal repair

• Numbs perineum for repair of episiotomy or lacerations.
• Response time: 3-4 minutes.
• Duration: 1-2 hours.

• Numbs birth canal and perineum for forceps delivery, episiotomy, or repair.
• Response time: 2-3 minutes.
• Duration: 1 hour.

• Blocked urge to push—coaching needed during birth.
• Possible toxicity caused by required large dose.

• Active labor.
• Second stage.
• Prior to cesarean birth.

• Completely or partially relieves pain from uterine contractions, birth and repair, depending on dose.
• Avoids spinal headache if done correctly.
• Response time: 10-15 minutes.
• Duration: continuous.

• Possible ineffectiveness—technical difficulty may cause it not to work or to take on only one side.
• Prolonged labor.
• Lowered blood pressure.
• Increased maternal temperature, resulting in treatment for nonexistent infection.
• Increased need for medical supervision and interventions (IV, fetal monitor, urinary catheter, Pitocin).
• Relaxation of pelvic floor muscles along with diminished urge and ability to push, prolonging second stage and increasing need for forceps or cesarean delivery.
• Backache, either short or long term.
• Increased chance of cesarean delivery.
• Difficulty urinating

• Decreased oxygen and lowered heart rate if mother’s blood pressure drops,
• Subtle behavior alterations.
• Reduced muscle tone.
• Testing to rule out infection if mother or baby ran a fever.
• Nursing difficulties.

• Labor
• Second stage
• Prior to cesarean

• Pain relief during labor.
• Woman can walk.
• Numbs pubic area to toes for forceps delivery.
• Numbs area from above navel to toes for cesarean deliver.
• Requires small dose.
• Response time: 1-2 minutes.
• Duration: 3-10 hours for labor (narcotic). 1-3 hours for delivery (“caine drug).

• Nausea, vomiting, itching, prolonged labor, and respiratory depression if narcotic is used (labor).
• Lowered blood pressure.
• “Caine” drugs cause urge to push to be lost.
• Spinal headache.
• Difficulty urinating.

• Sodium pentathol (IV)
• Nitrous oxide (gas)
• Isoflurane (gas)

• IV
• Via tube inserted into windpipe

• Nausea, vomiting, aspiration of vomitus if intubated incorrectly.
• Deep anesthesia produces:
• Skeletal muscle weakness.
• Depression of central nervous system—requires constant supervision.
• Cardiac and respiratory depression, irregular heart pattern, lowered blood pressure.
• Depression of liver, kidney, and gastrointestinal tract function.
• Incompatibility with prepared childbirth.
• Labor partner often not allowed to be present.

• Crosses placenta rapidly.
• Effects of deep anesthesia are same as for mother.
• Cord level: up to 85%.

• Acetaminophen (Tylenol).
• Ibuprofen (Advil, Motrin).
• Darvocet
• Tylenol With Codeine
• Percocet, Tylox

• Oral medication reduces pain from episiotomy, afterpains, hermorrhoids, and cesarean.
• Compatible with breastfeeding.

• Drowsiness.
• Codeine and Percocet can decrease motility of bowels (increase gas pains).

• Demerol
• Morphine
• Duramorph
• Fentanyl

• IM
• IV by patient controlled analgesia (PCA)—woman pushes button to release small dose into IV.
• Epidural catheter.

• Epidural narcotics give good pain relief for up to 24 hours after cesarean without additional medication.
• Does not affect mobility.

• Repeated IM injections are painful.
• IM and IV medications cause drowsiness and give intermittent relief.
• Narcotics via epidural can cause itching.
• All narcotics can cause nausea, vomiting, and depressed respirations.