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Understanding Childbirth Medications

Pregnancy Image Gallery Medications and anesthesia are available to help ease the physical and emotional pain that can go along with labor. See more pregnancy pictures.
©2006 Publications International, Ltd.

While the new mother can never fully know what to expect when giving birth, everyone should have at least a vague idea the physical and emotional events of normal spontaneous labor. It is concern about or fear of labor pain that influences many women to choose to use pain-relieving medications in labor. The following discussion of labor pain and medications for birth may help you decide which method of childbirth you wish to attempt:

  • Labor Medications As pain begins to intensify during labor, you may begin to re-evaluate decisions you have made about medication. In this section, you will learn about the options that will be available to you at the hospital. We will tell you about the various pain medications you can use for both early and established labor.
  • Anesthesia for Childbirth If the pain during delivery becomes overwhelming, you may decide to ask for anesthesia. Find out about the pros and cons of the different types of anesthesia available to women during the delivery process. We will tell you about the three types of anesthesia --regional, general, and local. We will also tell you about epidurals, spinal blocks, and saddle blocks, and which method is used in which situation.

Medications are available to women who experience prolonged, exhausting labor.
Medications are available to women who experience prolonged, exhausting labor.
©2006 Publications International, Ltd.

Once the childbirth process begins, the pregnant mother begins experiencing painful contractions that grow in intensity. Medications that stop the pain, however, cannot be used right away.

The Use of Pain Medications or Anesthesia

Pain medications have been used in childbirth for centuries. At one time even alcohol and opium were used.

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When using pain medications, you make a tradeoff. In return for relief of pain and tension and possible speeding up of labor, you accept the possibility of side effects on labor progress, on your mental or physical well-being, or on your baby. You and your doctor must balance the advantages and disadvantages in your situation before using or not using medication.

First of all, the choice of natural versus medicated childbirth really exists only as long as the labor remains normal. If, however, you or your baby requires intervention (such as induction of labor, use of forceps, or a cesarean section) for medical reasons, you will need pain medication.

Medications for Early Labor

Because the medications that provide the greatest pain relief also tend to interfere with early labor progress, they cannot be used too early, unless you want to stop labor. Medications are available if a very prolonged and exhausting prelabor or early labor has caused excessive anxiety and worry.

Sedatives or barbiturates (sleeping pills or medications) may help you rest. These are given in pill form or by means of injection. They may temporarily halt your labor while relaxing you or allowing you to sleep. These drugs reach your baby, who cannot easily excrete them, so it is important not to receive large doses. Because babies born with such drugs still in their bodies may have problems breathing or sucking, your doctor will probably use only small doses and will try to ensure they have worn off before birth.

Tranquilizers are also used in long prelabors to reduce muscle tension and anxiety. Certain medications also help if you have severe nausea and vomiting. Depending on the drug, you may feel dizzy and confused, your mouth may feel dry, and your blood pressure could be altered. These drugs also cross the placenta to the baby and may have effects on fetal heart rate and newborn muscle tone, suckling, and attentiveness.

Morphine, a narcotic, may be used in an attempt to stop a long, nonprogressing labor. While it may cause you nausea, dizziness, and confusion, it also may do just what you need -- put you to sleep and stop labor temporarily. Narcotics tend to linger in the baby and can have some effects on the baby's behavior and breathing after birth. The greater the amount of the drug given, the greater the effects on the baby.

Medications for Established Labor

Once your labor is well established, it is less likely drugs can slow it for more than a short time. More effective pain-relieving drugs may then be used. Also called analgesics, these drugs are given by means of injection under your skin, into your muscle, or into an intravenous line.

Demerol (meperidine) is the narcotic analgesic most widely used in obstetrics. Its effects are similar to those of morphine and may be associated with a speeding up of labor in some circumstances. If anxiety, tension, and pain are great enough to actually slow labor, a narcotic or tranquilizer may reduce anxiety and allow labor to speed up again. These drugs reduce your pain, though you are still aware of the peaks of your contractions. They also help you sleep or relax between contractions.

You may feel nauseated shortly after receiving them, and you may not like the dizzy, confused feeling. The pain relief lasts for an hour or so, after which another dose may be given. The drug does accumulate in the baby's body, however, and larger total doses may have more noticeable effects on your baby's behavior. If your doctor sees that you will give birth when the narcotic effects on the baby are at their greatest, she may give you (or your baby after birth) a drug called a narcotic antagonist, to reverse the effects of the narcotic.

After the pain of labor is over, the pain of delivery begins. Go to the next page to find out about anesthetics available to ease the delivery process.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

The brand name products mentioned in this publication are trademarks or service marks of their respective companies. The mention of any product in this publication does not constitute an endorsement by the respective proprietors of Publications International, Ltd. or HowStuffWorks.com, nor does it constitute an endorsement by any of these companies that their products should be used in the manner described in this publication.

Analgesia means relief of pain; anesthesia means loss of sensation. There are ways of injecting certain drugs in particular areas of the body to cause a loss of all sensation (numbness) in a limited area. Local anesthetic agents, like Novocain (procaine) used by your dentist, are used in this way.

Regional Anesthesia

Agents such as lidocaine and bupivacaine are used in obstetrics. Depending on where they are injected, they cause varying amounts of pain relief. For example, a spinal or saddle block creates a rather large area of total numbness. An injection of anesthetic is made in the lower part of the back, and the medicine enters the spinal fluid. The anesthetic is heavy and stays low in the spine. You might become numb from your ribs down to your toes (spinal block) or from your buttocks and lower part of the abdomen down your inner thighs (saddle block). The amount of numbness is determined by how low the injection is given, how low in the spinal canal the medicine remains, and what concentration of anesthetic solution is used. You can have a spinal headache after a spinal anesthetic; this is very painful, can last for days, and usually requires you to lie down much of the time.

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Because spinals can stop labor at a critical time, they tend to be used for very late labor and for cesarean births.

Epidural and caudal blocks differ from spinal blocks; they are given with the same anesthetic agents but in slightly different places. The main difference is they are not injected into the spinal fluid. The medicine is placed low in the back, just outside the canal where the spinal fluid is (therefore, you do not get a spinal headache). Although trickier to give than a spinal block, anesthesiologists prefer them for labor because they are not as likely to stop labor, and the actual area of anesthesia can be better controlled (especially with the epidural).

The main difference between the caudal and the epidural block is the site at which they are administered: The caudal is given at the top of the separation of your buttocks; the epidural, a few inches higher. As a result, the area of numbness with the epidural tends not to extend as far down into your birth canal and legs as with the caudal. You can push better and move your legs better with an epidural.

Both spinal and epidural blocks are also used for cesarean births, allowing the mother to remain awake and alert to greet her baby.

Pain relief with these forms of regional anesthesia can be excellent; in fact, many women report total relief of pain. This welcome relief comes with no effects on your mental capacity. You do not become groggy or sleepy.

Forceps-assisted deliveries tend to be more common after regional anesthesia because women cannot push as well when anesthetized. Anesthesia can be light or heavy; women can push better (and feel more) if the anesthesia is light.

Another drawback to regional anesthesia is the possibility of a sudden drop in blood pressure soon after receiving the anesthetic. This sudden drop can temporarily reduce the amount of oxygen available to the baby. Since this side effect is well known, measures are taken to prevent it, identify it as soon as it happens (blood pressure is checked constantly while the anesthetic takes effect), and treat it, if necessary, with drugs.

Local Anesthesia

Three types of local anesthesia may be used for childbirth: the paracervical block, the pudendal block, and local infiltration of the perineum.

The paracervical block is given during the late first stage. Two injections of local anesthetic drugs are made into the cervix and bring pain relief during contractions. Although this form of anesthesia rarely causes problems for the mother, it frequently causes sudden drops in the fetal heart rate and noticeable effects on the baby's muscle tone and reactivity after birth.

Although the amount of pain relief provided by a paracervical block is far less than with the regional blocks, a significantly greater amount of the anesthetic agent is used -- thus, more serious side effects occur. So this form of block has been discontinued in many areas of the country.

The pudendal block causes anesthesia in the birth canal and is given in the second stage. Local anesthetic agents are injected into each side of the vaginal wall. Again, a larger amount of medication is used than for an epidural, but the incidence of drops in fetal heart rate appears not as serious as with the paracervical block. A pudendal block can be used for forceps delivery or pain in the second stage. Most doctors also give a pudendal block before an episiotomy is performed.

Local infiltration of the perineum consists of several injections to numb the area of skin and muscle between the vagina and the anus. It is most commonly used after natural childbirth if stitches are needed. It can also be given in the second stage before an episiotomy is performed. Side effects of a local block appear to be slight.

General Anesthesia

General anesthesia means a loss of consciousness along with pain relief. In other words, a woman is put to sleep and wakes up after the anesthetic has worn off. Nowadays, general anesthesia is uncommonly used-and is generally reserved for emergency situations.

General anesthetics are usually gases, which are inhaled. They cause a total loss of awareness. Nitrous oxide, Trilene (trichloroethylene), and Penthrane (methoxyflurane) are examples of such inhalation agents. Sometimes these are used along with sedatives that cause drowsiness. The sedatives might be injected into your vein.

One reason general anesthetics are used less often today is that they have profound side effects. The mother's breathing may slow down or stop; her blood pressure may drop and cause her heart rate to change. General anesthetics may also stop contractions of the uterus and cause excessive bleeding after birth. The baby is also affected. Babies often have breathing difficulties, sucking difficulties, and poor muscle tone after the use of general anesthetics.

Now that you have a basic understanding of childbirth medications, talk to your doctor about what the right choices will be for you during your birth process.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

The brand name products mentioned in this publication are trademarks or service marks of their respective companies. The mention of any product in this publication does not constitute an endorsement by the respective proprietors of Publications International, Ltd. or HowStuffWorks.com, nor does it constitute an endorsement by any of these companies that their products should be used in the manner described in this publication.

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ABOUT THE AUTHOR:

Elizabeth Eden, M.D. is a practicing obstetrician with her own private practice in New York City. She serves as an attending physician at the Tisch Hospital of the New York University Medical Center, as well as a Clinical Assistant Professor at the New York University School of Medicine.

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