It is important to know all your options for pain relief before your labor begins. I have written up a brief description of the medical options for pain relief as well as their benefits and side effects.
IV pain medication-
IV pain medications, or narcotic analgesics such as: Morphine, Stadol, Fentanyl, Nubian, and Demerol are used to temporarily ease the pain of labor. These medications do not numb the body, but are used to take the edge off and let the mother rest during labor. The effects of each dose usually last for 1 to 3 hours and can be felt within a few minutes of administration.
Side effects- IV pain medications cross the placenta; therefore they can cause side effects in both the mother and baby. For this reason, they should not be given close to delivery.
Effects on the baby:
- Central nervous system and respiratory depression- slow heart rate, slow breathing rate, possible loss of consciousness, etc
- Impaired early breastfeeding
- Altered neurological behavior
- Decreased ability to regulate body temperature
Effects on the mother:
- Decreased gastric motility-Slowed digestion, can cause pain
- Loss of protective airway reflexes-coughing, swallowing, etc
- Hypoxia due to respiratory depression- lack of oxygen
Epidural anesthesia is continuous pain relief from medications administered through a catheter inserted into the epidural space in your spine. The medication used is usually a combination of narcotics and a local anesthetic. The epidural usually numbs the area from your chest down and stops you from feeling pain, touch, movement, and temperature. Often, you won’t feel numbness but more of a sensation of warmth or tingling in your legs. Dosages and combinations of medications differ. Some will cause complete numbness and inability to move. Others will cause you to feel heavy and block the pain while still allowing you some ability to move.
A regular epidural administers the medication cocktail either by a pump or by periodic injections through the epidural catheter. This way, pain relief is continuous and the dosage can be raised or lowered each time it is given. Each dose will usually last between 2 and 3 hours and it takes about 5 to 15 minutes for the epidural to take effect.
An epidural can be beneficial by:
- Allowing you to rest
- Reducing discomfort
- Can virtually eliminate pain
- Allowing you to remain alert while being an active participant in your birth
- It can be used during a c-section so that you can stay awake during the surgery and continue to have pain relief during recovery
- May cause your blood pressure to drop suddenly
- Could cause a spinal headache- A severe headache caused by the leakage of spinal fluid. Can be treated with a blood patch, an injection of your blood into the epidural space.
- Ringing ears
- Difficulty urinating
- Long term back ache or soreness at the injection site
- Permanent nerve damage is possible
- Fever- A temperature rise common in women while using an epidural. It is not caused be an infection and is not contagious. However, it is hard to determine whether fever in a laboring woman is caused by the epidural or by neonatal sepsis. Often, babies born to mothers who experience a fever during labor are evaluated for sepsis. This process can include a spinal tap and admission to the NICU for 48 hours while sepsis is determined.
- Usually, you will be unable to move with an epidural. You will need to alternate sides while lying in bed and have continuous fetal monitoring
- Epidural use can slow labor. Usually this starts a chain of interventions that often leads to a c-section- Pitocin is used to speed up labor which can cause fetal distress. Or lying in bed prevents the baby from descending or getting into optimal position, causing failure to progress.
- Epidural use can make pushing more difficult, leading to interventions such as pitocin, forceps, vacuum extraction or c-section.
- The effectiveness of your epidural well depend on the skill of your anesthesiologist as well as other variables. You may only feel numbness in one side of your body or in one leg. This is a very common problem with epidurals.
A spinal block is similar to an epidural, but a spinal is delivered directly into the spinal fluid (rather than into the space just outside the membrane that surrounds your spine), and it's a one-time injection rather than a continuous feed through a catheter. As a result, relief is rapid and complete but lasts only a few hours. The spinal will numb the lower body.
A spinal may be given rather than an epidural in cases where there is not time for an epidural due to fast labor or when the woman decides she wants pain relief late in labor. Often, spinals are used instead of epidurals for scheduled cesarean sections.
Side effects and disadvantages with a spinal block are the same as with an epidural.
For more information about spinal blocks, click the link below.
Nitrous oxide, or laughing gas is commonly used in many countries around the world for pain relief during labor. However, it is only used by 1% of laboring women in the US.
Nitrous oxide is given in combination with oxygen through an oxygen mask that you hold over your mouth and nose. The gas only flows when you inhale through the mask.
Side effects and disadvantages:
- Hazy memory of labor
- Pins and needles
- Loss of consciousness
- It is not available in many hospital labor and delivery units in the U.S.
- It is tricky to time correctly: It takes about a minute after inhaling to achieve maximum effectiveness. You may not get the pain relief during the contraction if you don’t inhale at just the right time.
- It limits your ability to move about: the mouthpiece or mask is connected to a gas tank or other supply source.
- It has the potential for increased problems with sedation and decreasing your blood oxygen level: if used in combination with injected narcotics
- We do not know the effects it has on newborns.
- Can be used at any time in labor.
- Does not appear to interfere with labor progress or ability to push.
- Does not lower your blood oxygen level.
- Does not appear to have adverse effects on the baby’s condition at birth.
- Can be discontinued immediately and any side effects will reverse rapidly.
Just as important, are natural pain relief options. Which include:
- Touch and massage
- Warm baths
- Walking, swaying, and movement
- Focus, hypnosis
I will be doing a write up describing those options and their benefits very soon.