Systemic drugs that affect the entire body.
- 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
- Lasts 1-2 hours
- Changes pain perception without loss of mobility
Side effects / Potential risks
- May slow labor if given too early
- May lower mother's blood pressure and fetal heart rate
- Dizziness, nausea, itchiness
- 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
Regional drugs which, in this case, affects the abdomen and lower extremities
- 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
- Pain relief by blocking nerve impulses in the lower spine to decrease sensation in the lower half of the body
- 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
Side effects / 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 -
- Severe headache (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, if any?
- Does taking this medication start a time limit on the duration of my labor progress?
- What percentage of epidural births that you've attended have resulted in C-section or other interventions?