Childbirth Medications

As you may well know, there is a heated debate over medicated childbirths versus “natural childbirth.” Some say medication has no place in childbirth, while others say birth should not occur without some type of anesthetic. The best stance lies somewhere in between: though unmedicated birth is the ideal, there are times when it’s not in the best interests of the mother or her child. There are also times when the pain is unbearable and that pain relief medication can actually help the mother have a more natural childbirth.

Most mothers’ concern with medication is the effect that it may have on the child. Occasionally, a baby whose mother has been given medication during delivery may be born drowsy, sluggish, unresponsive or with some breathing or suckling difficulties. However, when drugs are properly used, these adverse effects can almost be completely avoided. Even if there is an effect on your child, it normally disappears shortly after birth. In the end, the decision of whether or not to use medication is one that is weighed with respect to risks and benefits. If your practitioner believes that the risks of medications clearly outweigh the benefits, then they won’t be administered.

When Is Medication Recommended During Labor?

- If the labor is long and complicated. These types of labors can be so taxing and painful that they can lead to chemical imbalances that can interfere with contractions and prevent the mother from pushing effectively.
- Sometimes the pain is just too much. If the pain is more than you can tolerate, it may hinder your ability to push and thus the progress of labor.
- If an assisted delivery is required. In some deliveries, forceps or vacuum extraction is used to help ease the baby out once its head is visible at the vaginal outlet. If one of these procedures is to be done, some pain medication is given to the mother.
- Sometimes labor is too rapid and needs to slow down. There are some medications that can help bring the labor more under control.

Common Types of Pain Relief
There are many different types of pain relief medications. They can exert their effects by producing a loss of sensation (anesthetics), relief of pain (analgesics), or tranquilizers (ataraxics). In determining which type of medication will be administered many things are taken into consideration. These include what stage of labor the mother is in, the patient’s preference, her past medical history, her present condition, the baby’s current condition, and doctor’s preference or expertise.

Epidural block
The epidural is the most commonly used anesthetic for relief of labor pain. More than half of the women delivering at hospitals receive one. Since small doses of the drug are needed to achieve the desired effect it is a relatively safe choice. Its safety, coupled with its ease of administration and immediate results are what make this medication so popular.

To deliver the epidural, the woman’s lower and mid-back are wiped with an antiseptic solution and a small area of the back is numbed with a local anesthetic. Then, while the mother lies on her side, a needle is placed through the numbed area into the epidural space of the spinal cord. The needle itself will cause no more than a little pressure or momentary shot of pain. Three to five minutes after the first dose of the epidural, the nerves of the uterus begin to numb and after ten minutes the woman should start feeling the full effects so that the entire lower part of the body will be numbed. This reduces pain drastically, but may interfere with the mother’s ability to push effectively, in which case the epidural can be stopped to allow the woman to push and then can be restarted after delivery.

Since there is a small chance of a sudden drop in blood pressure, epidurals generally aren’t used when the mother has a bleeding complication such as placenta previa, preeclampsia, or fetal distress. Thus, blood pressure is checked frequently and the fetal heartbeat is continuously monitored. Other potential side effects of epidurals include: only partial numbness without substantial pain relief, shivering, and post-delivery headaches. Also, since epidurals slow down labor, they may increase the risk of a cesarean. However, oxytocin may be administered to speed up things again.

Pudental block
This is another type of regional nerve block that is administered through a needle inserted into the perineal or vaginal area. It will reduce pain the region, helping with vaginal delivery, but won’t ease any uterine discomfort that the woman may be experiencing. It is particularly effective when forceps or vacuum extraction is used or if an episiotomy is required.

The most common pain reliever used in deliveries is Meperidine hydrochloride, more commonly known as Demerol. Demerol is injected with a needle into the buttocks or is injected slowly into an IV so that its effects can be controlled and monitored. Unlike epidurals, Demerol will not usually affect contractions and it may actually help to normalize contractions if the uterus is functioning abnormally.

The effects of Demerol can be wide ranging, from relaxation to drowsiness to increased ability to cope with pain to even a worsening of pain symptoms. A concern with Demerol use is that if it given too close to delivery, the baby may be sleepy and unable to suck or its respiration may be impaired. The baby’s heart is continuously monitored because of the small chances that Demerol may affect the baby’s heart rate.

Tranquilizers work to relax anxious woman so that they are more able to participate in the birthing process. The effects of tranquilizers are varied depending on the dose given. A small dose may help to alleviate some of the anxiety that the mother may be experiencing, whereas a large dose may cause slurring of speech and dozing between contractions. It’s a good idea to try relaxation techniques such as meditation, deep breathing or hypnosis before opting for tranquilizers.

General anesthetics
General anesthetics put the mother to sleep very rapidly and are usually only used for emergency surgical births. The anesthetic is administered through an inhalant and renders that mother unconscious for the span of the delivery. After wakening, the mother may experience some grogginess, disorientation, restlessness, cough or sore throat, nausea or vomiting and a temporary drop in blood pressure.

The most worrisome side effect with general anesthetic use is the effect it may have on the fetus. If the mother is sedated, so is the fetus. Thus, the anesthetic is administered as close to the actual birth as possible to minimize the effects on the fetus. If this is done, the baby can be delivered before large amounts of the anesthetic have reached her/him.

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Labour Topics  
Introduction Signs of labor
Stages of labor Childbirth medications
Breech birth  
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