Medications and Anesthesia Commonly Used in Childbirth

Below is a list of analgesics and anesthetics commonly used during labor and delivery.

Sedatives Hypnotics
Note For example:

  • Seconal
  • Nembutal
  • Restoril
How Given Orally
When Given
  • Prelabor
  • Early labor
Uses and Benefits
  • 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.
Possible Risks and Side Effects for Woman
  • Slow down labor if given too soon.
  • Disorientation.
  • Drowsiness.
  • Lowered blood pressure.
Possible Risks and Side Effects for Baby
  • ِAccumulation in tissues.
  • Respiratory depression.
  • Decreased sucking ability.
  • Cord level: 70%

Tranquilizers Antiemetics
Note For example:

  • Vistaril (Atarax)
  • Compazine
  • Phenergan
  • Largon
How Given
  • Orally
  • IM
  • IV
When Given
  • Early labor.
  • Active labor or transition, alone or combined with analgesic.
Uses and Benefits
  • Relieve tension and anxiety.
  • Promote relaxation.
  • Prevent nausea and vomiting when used with analgesic; also potentiate effects of analgesics.
Possible Risks and Side Effects for Woman
  • Drowsiness.
  • Confusion.
  • Blood pressure change.
  • Heart rate change.
Possible Risks and Side Effects for Baby
  • Heart rate change.
  • Decreased sucking ability.
  • Decreased muscle tone.
  • Lowered body temperature.
  • Decreased attention, increased restlessness.
  • Cord level: 95%-100%

Analgesics
Note For example:

  • Demerol
  • Nisentil
  • Stadol
  • Nubain
How Given
  • IM
  • IV
When Given Active labor
Uses and Benefits
  • Reduce or alter pan perception.
  • Demerol may relax cervix and hasten dilation.
  • Stadol and Nubain contain narcotic antagonist that reduces side effects to baby.
Possible Risks and Side Effects for Woman
  • 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.
Possible Risks and Side Effects for Baby
  • 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.


Narcotic antagonist
Note For example:
Narcan
How Given
  • IM or IV to woman
  • IM or in umbilical vein to baby
When Given
  • Second stage.
  • After birth.
Uses and Benefits Reverses respiratory depression caused by narcotics.
Possible Risks and Side Effects for Woman
  • Rapid heart rate.
  • Elevated blood pressure.
  • Nausea and vomiting.
  • Sweating.
  • Trembling.
  • Return of pain.
  • Withdrawal symptoms if woman is addicted to narcotics.
Possible Risks and Side Effects for Baby
  • 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.

Oxytocics
(synthetic hormones to contract uterus)
Note For example:

  • Pitocin
  • Syntocinon
  • Oxytocin
  • Ergotrate
  • Methergine
How Given
  • IV (dosage best controlled when diluted in IV fluid)
  • IM (postpartum only)
When Given
  • Prior to labor
  • During labor
  • Postpartum
Uses and Benefits
  • Induce or stimulate contractions.
  • Control postpartum bleeding.
Possible Risks and Side Effects for Woman
  • 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.

Possible Risks and Side Effects for Baby
  • Heart rate change.
  • Fetal asphyxia due to tetanic contractions.
  • Increased jaundice.

Regional anesthesia
Note Uses local anesthetics or “caine” drugs such as procaine, bupivacaine, lidocaine, or ropivacaine.
How Given See below
When Given See below
Uses and Benefits
  • 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.
Possible Risks and Side Effects for Woman See below
Possible Risks and Side Effects for Baby See below
Local infiltration
Note
How Given Injection into perineum
When Given
  • Second stage
  • Prior to perineal repair
Uses and Benefits
  • Numbs perineum for repair of episiotomy or lacerations.
  • Response time: 3-4 minutes.
  • Duration: 1-2 hours.
Possible Risks and Side Effects for Woman Burning or stinging upon administration.
Possible Risks and Side Effects for Baby Decreased muscle tone.
Pundenal block
Note
How Given Injection into pudendal nerves via vagina.
When Given Second stage
Uses and Benefits
  • Numbs birth canal and perineum for forceps delivery, episiotomy, or repair.
  • Response time: 2-3 minutes.
  • Duration: 1 hour.
Possible Risks and Side Effects for Woman
  • Blocked urge to push—coaching needed during birth.
  • Possible toxicity caused by required large dose.
Possible Risks and Side Effects for Baby Fatal depression caused by required large dose.
Epidural
Note uses either “caine” drug; narcotic such as morphine, Demerol, fentanyl, or sufentanil; or conbination of the two.
How Given Continuously through catheter inserted into epidural space (low spinal area).
When Given
  • Active labor.
  • Second stage.
  • Prior to cesarean birth.
Uses and Benefits
  • 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 Risks and Side Effects for Woman
  • 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
Possible Risks and Side Effects for Baby
  • 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.
Spinal (intrathecal),
Saddle block (low spinal)
Note
How Given Single injection into spinal fluid
When Given
  • Labor
  • Second stage
  • Prior to cesarean
Uses and Benefits
  • 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).
Possible Risks and Side Effects for Woman
  • 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.
Possible Risks and Side Effects for Baby Decreased oxygen and heart rate if mother’s blood pressure drops.

General anesthesia
(Unconscious)
Note For example:

  • Sodium pentathol (IV)
  • Nitrous oxide (gas)
  • Isoflurane (gas)
How Given
  • IV
  • Via tube inserted into windpipe
When Given Prior to cesarean birth
Uses and Benefits Emergency cesarean when time is too short to administer regional anesthetic.
Possible Risks and Side Effects for Woman
  • 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.
Possible Risks and Side Effects for Baby
  • Crosses placenta rapidly.
  • Effects of deep anesthesia are same as for mother.
  • Cord level: up to 85%.

Postpartum analgesics [PART 1]
Note For example:

  • Acetaminophen (Tylenol).
  • Ibuprofen (Advil, Motrin).
  • Darvocet
  • Tylenol With Codeine
  • Percocet, Tylox
How Given Orally
When Given Postpartum
Uses and Benefits
  • Oral medication reduces pain from episiotomy, afterpains, hermorrhoids, and cesarean.
  • Compatible with breastfeeding.
Possible Risks and Side Effects for Woman
  • Drowsiness.
  • Codeine and Percocet can decrease motility of bowels (increase gas pains).
Possible Risks and Side Effects for Baby Percocet has been found in moderate amounts in breastmilk—has insignificant effect on full-term infant, but very preterm or ill newborn should be observed for sedation and lowered respirations.
Postpartum analgesics [PART 2]
Note For example:

  • Demerol
  • Morphine
  • Duramorph
  • Fentanyl
How Given
  • IM
  • IV by patient controlled analgesia (PCA)—woman pushes button to release small dose into IV.
  • Epidural catheter.
When Given First 12 to 24 hours after cesarean.
Uses and Benefits
  • Epidural narcotics give good pain relief for up to 24 hours after cesarean without additional medication.
  • Does not affect mobility.
Possible Risks and Side Effects for Woman
  • 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.
Possible Risks and Side Effects for Baby Insignificant in normal infants. At high maternal IV or IM doses, infant should be monitored for sedation, poor feeding, and respiratory depression.

Footnotes:

● IV = intravenously, IM = intramuscularly
●● Dependent on maternal dosage and timing in relation to birth.
●●● The cord level indicates the amount of medication that is in the baby's bloodstream as compared to that in the woman's.