Medications Given During Labor
Medications that may be given during labor can be divided into three groups according to labor’s progression: early labor, active labor, and actual birth. Of course, if a cesarean is necessary, drugs will be given then.
Drugs Given in Early Labor
Sleeping Pills are generally the only medications given in early labor. These have no effect on pain, are given to encourage rest, and sometimes to discern whether this is true labor or not. Mothers may experience drowsiness, difficulty dealing with contractions, nausea, and with large doses hypotension (low blood pressure), lowered pulse rate, and disorientation. Possible effects on the baby are respiratory depression, impaired responsiveness and sucking ability, as well as decreased muscle tone.
Drugs Given in Active Labor
Drugs most commonly given during active labor include analgesics, narcotics, tranquilizers, spinals, epidurals, and paracervicals.
Analgesics and Narcotics. These are usually given through IV or intramuscularly. Some are given directly under the skin. There are no benefits to the baby. They may cause decreased respiration in the baby. If given after you have the urge to push, the baby may be born at the time the narcotic peaks and the baby may require
resuscitation or Narcan to reverse the effects. Also, after birth, the baby can no longer use the placenta to get rid of drugs. The baby’s blood-brain barrier, which prevents outside substances from entering the brain, is more permeable, and the liver and kidneys are less able to excrete the drugs. Drugs have been detected in the
baby’s blood at even eight weeks after the birth. Breastfeeding difficulties and disorganized behavior can occur. Benefits to the mother include a reduction in pain perception. The medication doesn’t eliminate discomfort, although it may give a chance to escape for a little while. A well-timed dose can help to regain the ability to work with labor. The intravenous route
If a woman
like a Goddess
during birth then
treating her right.
—Ina May Gaskin
is the quickest but doesn’t last as long. Intramuscularly administered, the medication doesn’t work as fast, but it works longer. If a mother does have it intravenously, she may want to request a heparin lock so she can still be mobile. Risks to the mother include hypotension; dry mouth; respiratory depression if given through IV; drowsiness; and a fuzzy, uncomfortable, disoriented feeling. It may compromise walking ability. Some mothers feel the amount of pain relief was not worth losing the rhythm of labor she was working with. It may slow labor and cause vomiting, dizziness, and the feeling of being spaced-out. It can reduce clear thinking. Medical personnel have reported interference with the bonding of the mother and infant as a result of both being spaced-out. Second doses of Nubain, which has the fewest side-effects, but include feeling spaced-out and sick, aren’t very effective.
Tranquilizers. Given intramuscularly or through IV to reduce tension and anxiety, relax muscles, relieve nausea, and enhance effects of narcotics, they can cause sluggishness, trouble concentrating, dry mouth, and hypotension in mother. In the baby they can induce declined responsiveness, sleepiness, and apathy toward learning to feed her baby.
Spinal. A spinal is anesthesia from the breasts down. Onset is rapid, but there is also a risk of rapid onset of hypotension. Mother is awake. There are risks of spinal headache and dense motor block. Small doses work well. There is a limited duration and more medication cannot be added.
Epidural. A needle is inserted at waist level into a space in the spine, and a tube is placed next to the spinal cord. Analgesia (which refers to a reduction in pain
without loss of movement) or anesthesia (which refers to a block of sensation and movement) are administered. It takes perhaps thirty minutes to administer and about twenty to thirty minutes for relief. It is usually a highly effective method, although sometimes incomplete. Caregivers often want mothers in their care to wait until they have reached 5 cm before receiving an epidural because particularly early on, an epidural can cause labor to slow or stall. Other procedures such as augmentation by Pitocin, and even cesarean, are often used if this happens. When administered before 5 cm, an epidural makes the slowing or stopping of labor a much more common occurrence. Be aware that your caregiver may also want the epidural to wear off for the actual birth as this allows the mother to use her own
power to birth the baby rather than having to depend on potentially harmful vacuum or forceps extraction.
Procedure: You must remain very still while in labor with your back rounded for quite a while. There is a sting as the needle is injected. The anesthesiologist inserts a test dose to determine that you aren’t allergic and to be sure the needle is in the right place. Then a catheter is threaded through the needle into the space and the needle is removed. You will start to feel numb. You probably will be turned from one side to the other for the next few hours to be sure the pain relief is even, and you must remain relatively horizontal at first to adjust, due to danger of falling blood pressure. An IV is used so that high doses of intravenous fluid can be administered.
Other safety measures need to be taken, such as blood pressure monitoring. The mother and baby are monitored continuously to make sure they are handling the medication okay. The baby’s heart rate pattern may begin to decelerate.
Risks for the Baby and Mother: Families are often told that there are no longer any risks with medications used today. However, there are small chances for a large number of things to occur including maternal breathing difficulty and a long-lasting spinal headache. Epidurals require skilled personnel to administer it. Large doses are needed. There is a slight risk of systemic poisoning from large doses. There is also the risk of inadequate pain relief, because levels can’t always be easily controlled. Managing to numb only the exact, desired area can be difficult. There are cases where the upper half, rather then the lower half, of the body were numbed, necessitating life support of the mother. Vacuum extraction or forceps use often cause deep vaginal tears which frequently yield subsequent future urinary and fecal incontinence as well as painful intercourse. A urinary catheter may need to be inserted in the mother’s urethra, introducing higher risks of infection. Unremitting backache is considerably greater among mothers who receive epidurals. Other technical errors such as inserting the needle in the wrong place can occur. Shivering, nausea and vomiting, itching, and trouble with urinating are common. Some women experience difficulty breathing. Epidural fevers in mothers are common. Fevers are a typical reason for yet more interventions.
It is difficult to determine for certain, why the mother has a fever. So the case must be watched in case Strep B or some other serious infection is the culprit. Then if the baby has a fever after the birth, it will be required to have blood drawn at least once, and as often as every few hours. They may have to have fluid removed from the spine. This is extremely painful and expensive, interfering with breastfeeding and causing anxiety and further pain.
Epidurals restrict movement and active participation and may prolong the actual birthing stage. Descent and rotation of the baby can be impaired since the mother can’t assume helpful positions and is forced to lie on her back causing pelvic diameter to also be decreased. So-called “walking epidurals” really only give some sensation and seldom the ability to walk. There must be a total dependence on nurses, physicians, and support people for basic physical needs during labor. The woman’s legs are left useless. Bedpans and catheters become necessary. Perhaps it is intended kindness that prompts some caregivers today to tell their clients that epidurals are safe and that there is nothing to worry about.
Though it might be easier just not to have to think about the above risks, they must nevertheless be considered for your baby’s safety and your own, and in order to make a truly informed decision. You will most likely be required to sign a form that protects the hospital if complications do occur, because they do occur, some things more often than others—thus the form to sign that protects the hospital. Epidurals do get to the baby. There is a very noticeable difference between a naturally-born and an epidural-born baby.
A baby that has been given epidural medication may be very tired, pale, shaky, and irritable. Epidural babies are often noticeably sleepy after birth. One study showed that in the first month, a baby may seem more disorganized, irritable and withdrawn, looking away, and suckling less. Mothers may be more likely to perceive their babies as disorganized which can affect mother-infant bonding. Problems with breastfeeding are also a likely natural result of epidural anesthesia. And there may need to be a separation between parents and baby while the baby (or mother) is in intensive care due to complications. Weeks after the birth, residue from the medication has been found in babies.
Benefits of an Epidural: Some benefits of having an epidural are that relief with an epidural is adjustable from slight to full relief in some labors, and that it allows for some movement, although “walking epidurals” are a myth. Onset of hypotension is slow, mother is awake, and more medication
There is a very
can be added easily. In the event of a cesarean, the mother can be awake. And once in awhile an epidural even enhances labor progress if the mother is exhausted (although it may also have the opposite effect). More medication can be added easily. Mother can be conscious and aware during labor and
birth. She may also still be numb for episiotomy (the cutting of the perineum to enlarge the outer birth passage opening) repair if needed. Though, epidural births often necessitate episiotomies to accommodate for vacuum or forceps which are often required to help birth the baby due to the effects of the epidural.
• Paracervical. A needle is inserted into the cervix by way of the vagina. It blocks uterine sensation. It can slow down contractions necessitating Pitocin with its risks. (see Risks of Inducing in chapter 8.) It also can cause slowed heart rate in the baby. Drugs Given During Actual Birthing Stage Drugs that may be given during actual birth include locals, pudendal blocks, spinals, and saddles.
• Local. This drug is given just prior to birth, or before episiotomy for repairs. There are not many known side-effects except temporary loss of sensations with inability to know when and how to control the descent of baby to avoid perineal injury. Since the needle is near the baby’s descending head, there is a slight risk of
injury in this regard.
• Pudendal Block. Given immediately before birth, or after birth for perineal repair, administered through the vagina into pudendal nerves as an anesthesia for the vagina and perineum. This eliminates the “stretching” sensation, and is employed for use of forceps. There is a possible partial loss of the sensation of the baby descending. This is not recommended when the baby is in distress.
• Spinal. (see above)
• Saddle. A saddle provides relief for those parts with which one would sit on a saddle. It is given in a side-lying position or sitting bent over with the back bowed. The purpose is to give complete anesthesia for contractions, birth, and repair of episiotomy. Mom is awake and alert. This medication can be used for forceps and cesarean deliveries. Possible side effects include hypotension, spinal headache, and need of a catheter. Labor may stop and sensation of how to work with one’s body may be lost, resulting in need for forceps. For the baby, hypotension in the mother can cause a drop in fetal heart rate and can also cause hypotonia, as well as subtle
* Cesarean. Cesareans are typically done with administration of an epidural, spinal, or general anesthesia.
• Epidural. (see above)
• Spinal. (see above)
• General Anesthesia. Onset is quick and mother is in a sleep state. General anesthesia can be used if the mother has low platelets or hypovolemia. There is a risk of aspiration, excessive bleeding, and neonatal RSD (reflex sympathetic dystrophy). Mother’s airway must be managed with a tube down her throat. There is chance of
awareness in the mother of what is happening without her ability to communicate this, and a need for analgesia after surgery
(Adapted from Wise Childbearing.)