IV Drugs

Systemic drugs that affect the entire body.

Benefits

  • Changes pain perception without loss of mobility.

Side effects

  • May slow labor if given too early
  • May lower mother's blood pressure and fetal heart rate
  • Dizziness, nausea, itchiness
  • Disorientation
  • Decreases endorphins so when pain comes back it may be more intense
  • Can cause drowsiness and slow reflexes in baby for a few days if given late in labor

Analgesia

Fentanyl is commonly used.

Pain relief. It takes the edge off the pain but you still feel the peak of each contraction. 

Useful if you need a break or longer rest between contractions due to exhaustion, long or slow progressing labor.

Takes effect within a few minutes.

Last 1-2 hours per dosage.

Typical drugs are in the 'caine family - Bupivicaine, Marcain, etc.

Blocks pain receptors. Takes away sensations, makes intense contractions seem very mild, more like early labor.

Takes effect within a few minutes.

Last 1-2 hours.

Anesthesia


EPIDURAL

Regional drugs which, in this case, affects the abdomen and lower extremities

The goal: to block nerve impulses in the lower spine to decrease sensation in the lower half of the body.

Typical procedure

  • Administered when the cervix is 4-5 centimeters dilated and the mother is in 'active labor'
  • Mother’s back is cleaned/prepped with an antiseptic, and a local anesthetic is administered to numb the area
  • Mother sits or lays on her side, curled up
  • Needle is inserted between the vertebrae and the catheter is threaded through
  • The needle is then removed and the catheter is taped down
  • The drug administered via the catheter is usually a local anesthetic (bupivacaine, chloroprocaine or lidocaine) and may be combined with a narcotic (usually epinephrine, fentanyl, morphine or clonidine) to prolong the epidural's effect or to stabilize the mother's blood pressure
  • Administration and monitoring is done by an anesthesiologist, obstetrician/midwife, or nurse anesthetist
  • Drug takes effect 15-20 minutes after inserted, with redosing every 1-2 hours

Benefits

  • Pain relief 
  • If anxiety is slowing down labor, the epidural may speed things up
  • Can transform exhaustion, irritability and fatigue, into relief, rest, comfort, focus and the strength to move forward, actively participating in the birth experience
  • Allows you to stay awake and actively participating during a cesarean section

Potential Risks

  • The success depends mostly on the anesthesiologist's skill set
  • Reduction of muscle strength, balance, and reaction times
  • Decreased mobility - restriction to bed depending on type of epidural and dosage
  • Numbness may continue for several hours after birth, limiting mobility or requiring assistance with movement
  • No food or liquids - ice chips only -
  • Fever
  • Severe headacke (1% of women)
  • Heart monitor to track mother's heart rate
  • Sudden drop in mother's blood pressure may require IV, medication, and/or oxygen
  • Routine blood pressure check to ensure baby is receiving adequate blood flow from mother 
  • Shivering, ringing in the ears, backache, nausea, difficulty urinating, severe headache (1% of women), soreness or permanent nerve damage a the needle insertion site
  • A urinary catheter (if labor is slow or if its the hospital policy) due to loss of feeling and control from waist down
  • Alternating sides while laying down and continuous monitoring of fetal heart rate
  • Interventions - forceps and vacuum (2-14 times more likely), episiotomy, or cesarean section (2-3 times more likely) - may be required should your baby become lethargic in utero, have difficulty getting into the proper birth position, experience respiratory depression, and/or show signs of decreased or unstable fetal heart rate
  • Slowed, weakened or ceased contractions will require a dosge of Pitocin to be administered which causes very intense, long and painful contractions
  • After birth, some babies struggle to latch on, causing breastfeeding difficulty

Questions to ask your obstetrician now

  • What combination and dosage of drugs will be used?
  • How could the medications used affect my baby?
  • Will I be able to get up and walk around?
  • What liquids and solids will I be able to consume?
  • Does taking this medication put  a time limit on the duration of my labor?
  • What percentage of epidural births you've attended result in interventions or C-section?