Many women end up relying on some type of method to reduce the physical pain of childbirth. As you prepare for labor, it is important to become familiar with the different available pain medications, including how they work, their risks and their benefits. Your choice of method will depend on your personal preference, your health care provider’s recommendations, and their availability at your birthing facility.
What are Opiates?
Opiates are a type of analgesic given to relieve pain. When used during childbirth, opiates are considered the first option after less invasive or natural methods of pain relief such as laboring in water, deep breathing, and massage. Opiates are given in small doses and usually administered during the early stages of labor in an attempt to avoid potential side effects for both the mother and baby.
What are the advantages of using opiates during childbirth?
Opiates offer pain relief and do not interfere with a woman’s ability to push during labor. Unlike an epidural, an opiate does not numb the pain but instead it helps to take some“edge” off the pain. Opiates can help to reduce anxiety and improve the mother’s ability to cope with painful contractions.
What are the potential side effects of opiates?
Mothers can experience the following side effects:
- Decreased gastric motility
- Loss of protective airway reflexes
- Hypoxia due to respiratory depression
How will the opiates affect my baby?
Opiates cross the placenta during labor and can produce the following side effects in the baby:
- Central nervous system depression
- Respiratory depression
- Impaired early breastfeeding
- Altered neurological behavior
- Decreased ability to regulate body temperature
For these reasons, your baby might need other medication to counteract effects of the opiate. Naloxone is a medication given in small doses that can reverse the respiratory depression that opiates can cause in a baby. It is usually given intravenously and its effects can be seen within a few minutes and can last up to 2 hours.
What types of opiates are used during childbirth?
The most frequently used narcotic medications are:
Demerol is a popular choice for pain relief during labor. Demerol alters how the mother recognizes the pain she is experiencing by binding to the receptors found in the central nervous system.
The advantages of Demerol include:
- Can be given by injection into the muscle, the vein or by a Patient Controlled Analgesia (PCA) pump
- Fast acting – starts working in less than 5 minutes
How can Demerol affect me and my baby?
Demerol can cause drowsiness, nausea, vomiting, respiratory depression, and maternal hypotension (low blood pressure). If injected within 2-4 hours of delivery, Demerol has been found to cause breathing difficulties in some babies.
In recent years, morphine has not been routinely used as a method of pain relief during labor because it has been found to depress the baby’s ability to breathe.
Stadol has been found to relieve pain when given in the first stage of labor. This narcotic is considered more potent then Demerol. It is usually given intravenously in small doses, usually 1 to 2 mg. The advantages of using Stadol include:
- Starts working in less then five minutes
- Is a sedative
- Has minimal fetal effects
- Cause minimal nausea
How can Stadol affect me and my baby?
Stadol can cause the mother to have respiratory depression, dizziness and dysphoria (a state of feeling unwell and unhappy). Stadol can cause respiratory depression in the baby.
Fentanyl is a synthetic opiate that provides mild to moderate sedation. The advantages of using Fentanyl include:
- Begins working quickly (although, usually only lasts 45 minutes)
- Minimal sedation
- Minimal fetal effects
How can Fentanyl affect me and my baby?
You and your baby can experience some sedation and/or nausea. According to Danforth’s Obstetrics and Gynecology, baby’s born to mothers who used Fentanyl to relieve pain during labor were less likely to need naloxone (medication to help with breathing) than babies born to mothers who used Demerol.
Nubain is an opiate agonist-antagonist comparable to morphine. The advantages of using Nubain include:
- Begins working within 5 minutes of administration
- Minimal nausea
- Minimal fetal effects
How can Nubain affect me and my baby?
Nubain can cause the mother to have sedation and dysphoria (a state of feeling unwell and unhappy).
How will my pain medication be given?
Medication can be given in any of the following ways:
- A one-time injection into the spinal column
- IV or Intravenous placement into a vein on the back of the hand or arm. A needle is inserted into a vein with a plastic tube connected to a bag holding fluid that slowly drips into your body. In a hospital setting, an IV is typically placed to help you stay hydrated throughout labor and assure access to medications if they are needed.
- Patient Controlled Analgesia (PCA) pump is a way that a mother can control doses of pain mediation during labor by pushing a button. The advantage of having a PCA is that it can give a mother an increased sense of control and the mother does not have to rely on a nurse to bring pain medication. Fentanyl and Demerol are common narcotics that can be given using a PCA pump. The pump is pre-programmed to provide dosages small enough to relieve pain without releasing too much medication.
Compiled using information from the following sources:
Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 19.
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 3.