Comfort Measures During Labor and Delivery: Pharmacologic Methods
Non-pharmacologic comfort therapies along with medical interventions may enhance the effectiveness of a lower dose of medication, which will limit side effects for you and your baby.
Narcotic analgesics are usually given directly into an IV (intravenous catheter). Effects are felt within two to four minutes and are often described as “taking the edge off ” of pain. Narcotic analgesics do not require you to restrict movement. You can stand, walk, and shower during labor. You may feel relaxed and mildly drowsy. Labor may speed up, especially if there has been slow progress due to tension and fear. At other times, narcotic analgesics may cause a temporary slowing of progress. Doses may be repeated every couple of hours and the effects on the baby, such as respiratory depression, are generally minimal.
Your physician or midwife can inject a local anesthetic into your vagina or the area surrounding it to ease pain. These numbing medications usually affect a small area and are especially useful prior to an episiotomy or the repair of a laceration. It rarely affects the baby and after it wears off, there are usually no lingering effects. The main limitation is that they do not relieve the pain of labor contractions.
Epidural anesthesia is the most effective method of pain control during labor. Epidural anesthesia involves the placement of a small catheter into the lower back by an anesthesiologist. A continuous infusion of medication is administered through the catheter to provide a constant level of anesthesia.
Epidural anesthesia has some side effects. They may cause the mother’s blood pressure to drop, which in turn may slow the baby’s heartbeat. Preventive steps are taken to avoid this occurrence. Before receiving the epidural, fluids are given through an IV and the mother is positioned on her side to improve circulation. Blood pressure and heart rate, as well as the baby’s heart rate, are continuously monitored. Epidural anesthesia may also slow your labor progress. A medication called Pitocin is given to stimulate uterine contractions.
At Newton-Wellesley Hospital, we are using a new form of epidural anesthesia delivery called Patient Controlled Epidural Anesthesia (PCEA). PCEA is delivered using a special pump that allows laboring women to self-medicate. These intelligent pumps record the amount of anesthesia received and prevent overdosing while providing women with control of their pain.
A spinal block is given as an injection into the lower back. No catheter is required because the medication is injected into the spinal fluid. Spinal blocks are most often used for Cesarean births or procedures where it is not necessary for the mother to help push her baby out. A spinal block numbs the lower half of the body, provides excellent relief from pain, and starts working more quickly than an epidural. It also has the same possible side effects as epidural anesthesia. Spinal block is traditionally used for scheduled Cesarean births.
General anesthetics are medications that cause a loss of consciousness. They are rarely used except for emergency Cesarean deliveries or in the very rare case when anatomy of the spine does not allow for spinal insertion.
General anesthesia works very quickly and results in almost immediate loss of consciousness in the mother. Women are told to not eat anything if the use of general anesthetic is understood in advance.
After general anesthesia wears off, women may feel woozy, tired, and nauseated for several hours. This feeling usually fades within a day.