Medications For Labor

Many women are very relieved to know that there are medical methods for relieving labor pain - and some can even eliminate most of the pain! Before deciding on what type of drug you would like, it is important to learn what classifications labor medication often falls under.

Drugs that relieve your pain but do not cause a complete loss of sensation are known as analgesics. A systemic-analgesic will affect your entire nervous system. Pain medications that are classified as anesthesia do cause of a loss of sensation but do not cause you to lose consciousness unless you are adminstered a general anesthetic.

Inhalation Analgesics: Entonox
Although most inhalation drugs will knock you completely out, there is one type, entonox, that has been effectively used in labor. Entonox is made up of a mixture of oxygen and nitrous oxide. This inhalation analgesic is delivered through a mask fitted over your face. You hold the mask and are in control of how much of the drug you inhale. It only takes about 45 seconds to take effect. However, the pain relief is very temporary and is best suited to helping you deal with contractions.

This procedure can make you lightheaded and dizzy if you over inhale. However, becuase the nitrous oxide quickly leaves your body, there is little harm to you or your baby.

Narcotics and Analgesics
The most common type of narcotics given during labor are fentanyl (Sublimaze), meperidine (Demerol), butorphanol (Stadol), and nalbuphine (Nubain). These drugs are administered either by musculature injection (commonly to the thigh or buttocks) or by IV. Depending on the hospital you are giving birth in, you may be able to control the amount of drugs you recieve via a button that will release a set amount of medication intp your IV. The affects of these narcotics can last anywhere from two to six hours.

One advantage of these drugs is that they are able to reduce the amount of pain you feel without causing any muscle weakness, leaving you free to move about. However, they can make you feel sleepy, cause you to have a decrease in your labor memories and may also depress respiration for you and your baby, although this is just temporary.

Epidural
Perhaps the best known labor medication, an epidural is a local anesthetic that can be combined with narcotics to numb the lower body. It can provide almost complete pain relief. However there can be health complications for the mother afterwards.

The general procedure for an epidural is as follows: A nurse will clean your lower back and inject the area with a numbing medicine. Then, with the help of a needle, a catheter is inserted below the vertebrae into the dura (a tough sac that surrounds the spinal cord). The catheter is then secured in place with tape. Following that, a small test dose of medication will be administered to ensure all is well. If everything goes smoothly, a small amount will be continuously pumped through the catheter to ensure total pain relief.

After administering an epidural, the nurse or doctor will monitor your blood pressure and your baby's heart rate to ensure all is well. It takes approximately 20 minutes to administer the epidural and another 20 minutes to take effect. Because of this, it is generally not administered to women who are more than three to five centimeters dilated.

Epidurals that contain narcotics will help to relieve your pain while still leaving you some muscle strength to walk. Theese are known as "walking epidurals".

It is inadvisable to have the medication administered towards the end of labor, as you must be able to feel the pressure of the contractions in order to know when to push.

While some women have found that an epidural hinders their ability to bear down during delivery, for the most part, the use of an epidural has not been found to significantly slow down labor and delivery.

Possible Negative Side Effects and Complications
There are a number of side effects that can happen to the mother or the baby after an epidural is given during labor.

• Some women find that their epidural provides an uneven amount of pain relief
• An allergic reaction is possible
• If the epidural is injected into a vein, the mother may feel dizzy
• The mother's blood pressure may drop. This can mean decreased blood flow to the baby, causing his heart rate to drop. It can be treated with medication if it is too severe.
• Itchiness may occur: not a big problem
• There is a chance a "spinal headache" could develop and last for days. An anesthetic can be administered for this.
• A backache is likely for a few days.
• You may not know when you need to urinate due to loss of sensation. A temporary catheter may be necessary.
• An epidural can also cause a fever. Since it is never known whether the fever is caused by the epidural or an infection, you and your baby will probably have to take antibiotics.
• Blood clots develop in the back. There are two kinds: epidural hematoma and epidural abscess. These are very rare, but very serious.
• The baby will ingest a very small amount of the medicine; however, it should not affect the baby at all.

Spinal Block
An alternative to the epidural is the spinal block. While very similar to an epidural, the main difference between an epidural and a spinal block is that a spinal block is injected one-time directly into the dura. Just like the epidural, it is injected below the base of your spinal cord. A spinal block can provide pain relief from the chest down for up to two hours.

One advantage of a spinal block is that it is quicker to administer than an epidural. If you're progressing rapidly, there may not be time to administer an epidural before birth.

Another advantage is that the pain relief is almost immediate, whereas with an epidural there is a 20-minute delay.

Possible Negative Side Effects & Complications
Unfortunately, all the possible negative side effects that epidurals have are shared by spinal blocks, as well as some new ones:

• A spinal block carries an increased risk of a spinal headache.
• Rarely, a spinal block can cause a mother to feel lightheaded and nauseous.
• In rare cases it can affect breathing, and even worse, it can cause injury or infection of nerves!

WARNING: If you have low blood pressure, a blood infection, a skin infection on the lower back, a bleeding disorder, take blood thinning medication, or have had allergic reactions to anesthesia in the past, you should not have a spinal block or an epidural.

Combined Epidural and Spinal Block
It is possible to have both procedures administered! It is done by administering the spinal block through the catheter used for the epidural, so only one needle is really inserted through your back.

However, this method exposes you to the possible negative side effects of both epidurals and spinal blocks!

Local Infiltration Anesthetics
This type of pain medication is used specifically to relieve the discomfort of an episiotomy or when a tear is to be repaired after delievery. Administration of these types of drugs is usually done just before or after delivery. The pain medication is injected directly into the tissue surrounding the vaginal opening and numbs the immediate area.

While these typs of anesthetics have few effects on the mother and baby, there is the possiblity of an allergic reaction occuring. Additionally, the drug provides no relief from uterine contractions. Moreover, if the medication is injected directly into a vein, it could cause a drop in blood pressure.

Pudendal Block
Similar to a local infiltration anesthetic, a pudenal block involves having a drug injected directly into the vaginal walls shortly before delivery and works to numb the perineum. A pudendal block is useful when an episiotomy is to be performed as well as in forcep-assisted or vacuum extraction deliveries.

The effects of a pudendal block can last anywhere from a few mintues to an hour. In addition to possibly decreasing the urge to push, this type of anesthetic also shares the same disadvantages as a local infiltration anesthetic.

Learn About Your Options
It is best to learn all about the different pain relief methods available to you before you go into labor. Discuss these things with your practitioner early on in the pregnancy and then make a birth plan. Do not let labor take you by surprise!

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