What are the most popular labor pain relief drugs, and what do I need to know about them?
Laboring moms today have more pain-relief options than ever before. Your doctor can work with you to tailor your pain relief so that you may feel as much -- or as little -- of your labor as you want.
Pain-relief drugs for labor can be separated into two major categories: regional and systemic.
• Regional medication, most commonly an epidural, is infused into your back via a thin, flexible tube. A specialized doctor, called an anesthesiologist, uses the tube to administer medication directly to nerves near the spinal cord. Most anesthesiologists use a combination of local anesthetic medication, which blocks nerve impulses (so your brain doesn’t sense pain), and narcotic medication, which provides pain relief. The local anesthetic “numbs” your lower body (though not entirely); it may also decrease your ability to move your legs, though medical advances over the last few decades have allowed doctors to use lower doses of the drugs. A women is no longer “mentally disconnected” from her lower body, says William Camann, MD, an anesthesiologist at Brigham and Women’s Hospital in Boston and coauthor of Easy Labor: Every Woman’s Guide to Choosing Less Pain and More Joy During Childbirth. You should still be able to sit up, move around and help with the pushing process. The narcotic blocks pain sensations without affecting movement. The two drugs work together to provide maximum pain relief with minimal side effects.
Many hospitals now use patient-controlled epidurals, which allow patients to push a button to get a dose of pain medication when they need it. For safety, the machine is set so that the patient can’t receive more than a set dose of medication. “Everybody has different pain tolerances and thresholds,” says Dr. Camann, MD. “By using the patient-controlled technique, we allow patients to control exactly how much pain relief they get.
Ever heard of a “walking epidural”? It’s a fairly common term, but don’t count on actually being able to walk around. While you probably will be able to move your legs with an epidural, most hospitals don’t allow you out of bed, since you’ll be hooked up to an IV, a blood pressure monitor and a fetal monitor to make sure you and baby are doing okay.
• Systemic medications affect the entire body. While epidurals are officially considered a form of regional anesthesia, because they only affect one region of the body, systemic medications are injected into either the bloodstream or a muscle and travel through the bloodstream to the entire body. The most commonly used systemic meds for labor are morphine, Demerol, Stadol and Nubain. They’re all narcotics and work similarly. “Systemic narcotics don’t provide the same kind of complete pain relief that an epidural will,” Dr. Camann says. “They just kind of take the edge off things.”
Because narcotics affect the entire body, they may make you feel sleepy or nauseated. Narcotics cross the placenta too, so your baby may also get a little sleepy or sluggish.
So how do you decide which kind of pain relief is for you? Consider this:
• Epidurals can relieve most of your labor pain; systemic meds take the edge off.
• Epidurals can be given throughout labor. Some systemic meds only last for a short while, though some last longer than others. Additional doses may be given, but if multiple doses are needed, an epidural might be a better choice, as less medication gets to the baby from an epidural.
• Systemic meds can help moms-to-be relax and get some rest. A dose of a narcotic in early labor, for instance, may help a woman get some sleep, so that she’s energized when it’s time to push.
• All medications have side effects. Epidurals and systemic narcotics may cause itching and nausea in the mother. These are normal, nonharmful side effects that actually indicate that the medication is working properly, Dr. Camann says. If the side effects are bothering you, tell your doctor. He may be able to help with additional medication or distraction techniques.
• Remember too, that some moms forgo the drugs altogether and use breathing techniques and other natural methods to deal with the pain of labor.
Plus, more from The Bump:
How does an epidural work?
Ways to Make Labor Easier
How do Labor Meds Work and What Are the Risks?