We research our blood pressure medications, our supplements, and our food. Why, then, do we go into labor and birth without an understanding of our pain medication options? Furthermore, what are the effects of the medications on labor, birth, breastfeeding, baby, and recovery?
Medication options:
Epidural
Epidurals are a very common medication for labor pain. Epidurals are named after the epidural space that is parallel to the spine where the medication is administered. A catheter is placed in the back so medication can be given as frequently as needed. Epidurals block pain signals below the waist, yet many people still feel pressure sensations.
Risks: There is a fair bit of variability in the quality of the epidural. Not every person will feel it evenly on the left and right sides. In addition, in a small group of women (1 out of 100), some will not feel the effects at all. Epidurals can limit the mother’s freedom of movement, they also require IV fluids and a urinary catheter. There is a risk of various side effects including, low blood pressure (12 out of 100), itching, headache, difficulty urinating (15 out of 100), nausea and vomiting, fever (12 out of 100), back pain. More rarely side effects of severe headaches (1 out of 100), breathing problems, infection, seizure, and nerve damage may occur. Labor with an epidural typically lasts longer than unmediated. There is an increased risk of assisted delivery (14 out of 100), episiotomy, and c-section associated with epidurals.
Nitrous Oxide
Nitrous oxide, sometimes referred to as laughing gas, is an inhalant administered through a mask. The goal is to inhale the gas 30-45 seconds before a contraction starts. Many describe the effect of the gas as allowing you to ignore the pain, rather than unable to feel it. This is less invasive than IV medications and epidurals, it takes less than a minute to work, and is often quickly made available.
Risks: Side effects include, drowsiness, nausea, dizziness, and vomiting. May not have the freedom to move about during use.
Opioids
Opioids are pain medications administered via IV into the bloodstream. This generally allows for the laboring parent to move about freely.
Risks: Opioids can cause nausea, vomiting, decreased respiration, itching, constipation, urinary retention, and may make the mother drowsy. Some of this medication will cross the placental barrier and cause side effects on the baby including, changes in the baby’s heart rate, drowsiness. These side effects on the baby can impact the baby’s ability to breastfeed after birth.
Types of Opioids:
Fentanyl
Demerol
Nubian (nalbuphine)
Morphine
Stadol (butorphanol)
Natural pain relief:
The following are natural ways to promote relaxation and therefore pain relief. These can be used with little to no side effects or risks to the mother or baby.
Doulas or continuous labor support
Relaxation
Herbs
Aromatherapy
Hydrotherapy
Positioning
Food/drink
Intimacy
Massage/ comforting touch
Verbal reassurance
Cascade of interventions
Each intervention that disturbs the normal physiology of labor and birth increases the risk of adverse outcomes for both mother and baby. This includes common interventions like continuous electronic fetal monitoring, IV fluids, restriction of movement, restriction of food or water intake, limitation of labor positions, induction or augmentation, episiotomy, instrumental delivery, and c-section. A common example used is a laboring woman who is not given anything but ice chips to consume begins to have labor slow down. To combat this she is given a medication called Pitocin to augment (increase) her labor contractions. Often Pitocin can make labor more painful and harder to adjust to. Understandably that woman will likely request an epidural. The combination of the Pitocin and the epidural may lead to a dropping heart rate in the fetus during contractions. For the safety of both mom and baby, a c-section is usually done. This is how the small intervention of restricting food can end up in a c-section. The moral of the story is to avoid medical interventions unless they are medically necessary.
Resources & References
Informedhealth.org. (2018). Pregnancy and birth: Epidurals and painkillers for labor pain relief: https://www.ncbi.nlm.nih.gov/books/NBK279567/
Lothian, J. (2014). Healthy birth practice #4: Avoid medical interventions unless they are medically necessary: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235054/
