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