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| |    Using Medication to Provide Comfort in Labor by Lisa Rodriguez, R.N. and Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Many healthcare providers will encourage you to combat the stress of early labor with conventional measures--by using breathing exercises, for example, or taking a warm shower. However, if after trying natural measures you still need relief, rest assured that help is available. Various situations require different types of medications. Some work throughout labor and delivery, some provide relief only during the delivery, and still others are used for caesarean sections. Systemic analgesia Narcotic medications, such as Demerol, morphine, and Nubain, are generally administered through an IV (intravenously), but occasionally they're given as a shot in the buttock. Narcotics take the edge off contractions so that, while you may still feel some pain, you won't care about it as much. They often cause drowsiness and may help you to get some rest. These medications can also cause nausea, so your practitioner may order an anti-nausea medication as well. Although narcotics do cross the placenta, your metabolism removes the medication from the baby's system before birth, so no harm is done. Systemic medications generally are not given close to the time of delivery, because being born with medication still in his system poses a danger to the baby, such as shallow breathing and slowed reflexes. If a baby is born with narcotics in his system, certain medications can reverse these effects. Epidural anesthesia If you have chosen to have an epidural during labor, you're not alone: It's used to relieve pain in childbirth more often than any other anesthetic. An epidural works by distributing small amounts of medication into the nerves around the spinal cord through a small catheter in your back. It removes the pain of your contractions but still allows you to feel touch. You might experience some numbness in your legs, but you'll likely be able to move them. In most cases, you must remain in bed when you have an epidural because of the loss of feeling in your legs. Because an epidural numbs the birth canal, it also might lessen the pain of pushing as the baby descends during delivery. Although the pushing stage might last longer with an epidural, most women still feel the urge to push and are able to do so quite effectively. In some cases where the urge to push is not strong, the baby may have to be helped out with vacuum or forceps. An epidural is the most common anesthetic for cesarean deliveries as well, because pain relief is excellent and the medication doesn't reach the baby. With increased dosage of the anesthetic given through the epidural catheter, you can become numb from the abdomen down. Sometimes women having caesareans feel touch or a pushing sensation, but there should be no pain. After surgery, many hospitals leave the epidural catheter in place to provide pain relief without drowsiness; lower doses are given so that you regain normal strength and sensation in your legs and can walk around. Spinal block A spinal block (also called a saddle block) is similar to an epidural in that a small amount of medication is injected into the fluid around your spinal cord. It completely numbs the lower half of your body for about 90 minutes, thus preventing pushing of any kind. A spinal block is given for C-sections or if a vacuum or forceps delivery is planned. Pudendal block The anesthetic--a numbing medication, such as lidocaine or marcaine--is injected through the wall of the vagina into the pudendal nerve on each side to relieve pain at the vaginal opening as the baby comes out. It works well and is extremely safe. Local anesthesia Numbing medications (most commonly lidocaine) are injected directly into the area between the vagina and the rectum just before an episiotomy is performed or before the baby is born. Most practitioners also will use local anesthesia when repairing a tear in the perineum (the area between the vulva and the anus). General anesthesia General anesthesia usually is reserved for emergencies--the baby needs to be delivered immediately with no time to place an epidural or a spinal block. In rare cases where the mother cannot undergo epidural or spinal block medications for medical reasons, it's the only option. General anesthesia typically is used only for cesarean births. You may receive oxygen by mask before the anesthesiologist administers the medication through an IV. Sleep comes within seconds, so you'll feel no pain. Doctors will insert a tube into your throat to help you breathe during surgery. Because general anesthetics cross the placenta, the baby is delivered quickly once you're asleep.
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