Intravenous pain medications are different than an epidural or spinal block. An epidural or spinal block will anesthetize, or numb, part of your body. Pain medications only reduce pain.
Many women choose to take medications to help with pain during labor and delivery. As you get closer to your delivery date it’s important to discuss a pregnancy plan. It’s also best to talk about what medications may be best for you and your baby.
Narcotic medications are often used for pain relief during labor. Early use is limited to the beginning stages of labor. This will prevent too much sedation in the mother and fetus.
These medications are useful in early, or latent labor. The mother may be uncomfortable but doesn’t yet require an epidural.
Narcotics are generally given by injection into a muscle or through an intravenous line (IV). An IV is preferred because the effects of the drugs are easier to monitor.
In some hospitals, the mother can control IV administration herself. An infusion pump is used to give a set amount of a drug on demand. The doctor or nurse programs the pump so the mother may only receive a prescribed amount of a drug over a certain period of time.
Some commonly used drugs include:
Morphine sulfate (Duramorph) is probably the best-known narcotic. It is a long-acting drug that is injected into a muscle. It typically takes affect in 10 to 20 minutes and lasts between two to five hours.
Morphine, like other long-acting narcotic medications, is often reserved for use during the latent phase of labor. It should not be used right before delivery because of the sedating effects it may have on the newborn.
Morphine is also used after a cesarean delivery. It may last up to 24 hours when given through an epidural. IV infusion takes effect more quickly (within three to five minutes) and lasts about two hours.
Potential side effects include respiratory distress, nausea, vomiting, and itching.
A narcotic commonly use during labor is meperidine (Demerol). It’s similar to morphine, but it’s a better alternative because it doesn't decrease the mother's breathing as much.
However, it may result in breathing problems a newborn may develop later. It’s also possible for meperidine to cause seizures in the mother. Doses of this medication should be used with caution during delivery.
Fentanyl (Sublimaze) is a short-acting narcotic. It breaks down very quickly in both the mother and baby. It’s used closer to the time of delivery, and it has less risk of causing respiratory distress in the newborn. Since its effect is short-lived, doses are given more often than other drugs.
Butorphanol (Stadol) has similar effects to meperidine. However, this drug has a ceiling effect for respiratory depression. This means butorphanol’s effect on respiratory distress evens out.
When a mother is given butorphanol, her breathing will slow a bit. However, once she hits the maximum effect she can be given more of the drug. This will relieve her pain, but her breathing rate won’t be affected.
Butorphanol is used less frequently because it may cause hallucinations and addiction in rare cases
Nalbuphine (Nubain) has effects similar to morphine and butorphanol. It also has a ceiling effect for respiratory depression. Few women report side effects such as nausea and vomiting.
However, it may also increase addictive potential or withdrawal in patients using chronic pain medications.
The most common side effect of narcotic use during labor is sedation, which can lead to respiratory depression in the mother and baby. The baby may also develop respiratory depression while the placenta and umbilical cord are still intact after delivery. Because of this side effect, the use of narcotics is generally limited to the early stages of labor.
If the mother or baby experience respiratory depression from narcotics, they should first be placed in a well-ventilated recovery area. There will also be additional oxygen supplies available.
Second, naloxone (Narcan), which counteracts narcotics, should be given intravenously. This drug cancels out the effects of any narcotics and relieves respiratory depression.
Other potential side effects in the fetus and newborn include abnormal heart rate and early problems with breast-feeding and behavior. Other symptoms some women may experience during labor include:
- low blood pressure
Before you go into labor, make sure you have discussed a delivery plan with your doctor. It’s also a good idea to discuss a plan B because sometimes things don’t go exactly as planned.
If you decide to use medications, make sure you talk with your doctor about all available options. Your doctor will help you pick the medication that will work best for you and your baby.