Pain Meds During Labor Other Than Epidural

It’s hard to predict how your birth will play out.  The process may be more intense or take significantly longer than anticipated.  At times like this, pain medication can be a valuable option to help you have a positive birth experience.  Maybe the idea of an epidural freaks you out, or maybe you have a medical condition that prohibits you from receiving an epidural.  If so, you’re probably wondering what other options there are for pain meds during labor other than epidural medication.

What are Analgesics?

Analgesics are pain medications that cause a reduction in the sensation of pain.  Unlike an epidural, analgesics will not bring about a complete lack of feeling.  Instead, they decrease the sensation of pain by creating a feeling of sedation.  The type of analgesics that are used in labor are opiods or narcotics.  About 16% of women use opiods for pain relief during their vaginal birth (1).

Although analgesics won’t eliminate the feeling of the contraction, they can help to take the edge off the pain and make you less aware of the contraction when it is happening.  Analgesics may also help to decrease your anxiety and enable you to completely relax between contractions.

What are some common pain meds during labor other than epidural medication?

• Fentanyl
• Demerol
• Stadol
• Nubain
• Morphine

What side effects are common with narcotic analgesics?

Every woman will respond differently to pain medications in labor.  What bothers one woman may cause no side effects in another.  What follows are a list possible risks and side-effects caused by narcotic analgesics during labor (2).

• Itching
• Nausea
• Vomiting
• Drowsiness
• Hallucinations
• Dizziness
• Lower heart rate, respiratory rate, and blood pressure
• Temporary slowing of labor progress
• Constipation

Will narcotics taken during labor effect my baby?

Any pain medication that enters mom’s blood stream will pass through the placenta and on to baby.  So if you’re feeling sleepy from a pain med, chances are that your baby is too.  As with all pain meds during labor other than epidural medication, research has shown that their use is associated with negative effects on baby’s heart rate, lower Apgar scores, and respiratory depression at birth (3).

Given the fact that a newborn’s liver is immature, your little one won’t able to metabolize medications as quickly as you can.  Thus, a medication that has left your system might still be active in the baby.  Your provider will try to ensure that your baby is alert and active at birth by carefully timing the administration of any pain medication.  Since analgesics can slow down the baby’s respiratory system, your provider may discourage narcotics at any given point in your labor if he/she thinks birth in imminent.

How will the pain medication be given?

Oral pain meds (pills that you swallow) are not used during labor.  Instead, IV (intravenous) pain medications are much more common.  It is typically injected into an IV that is placed in a vein on your hand or arm.  Medication may also be given through a shot in your muscle, know as IM or intramuscular.

It seems like oral narcotics would be a lot easier than an IV, so why don’t they use them instead?  For starters, medications given through an IV provide pain relief much more quickly than ones given orally in a pill (4).  Most laboring women want immediate pain relief and are not interested in waiting for half an hour for a pill to kick in.

Additionally, medications given through an IV tend to last for shorter periods of time and leave your system more quickly than oral medications.  This can be beneficial because it will leave your baby’s system more quickly, too.  This decreases the risk to baby at birth.  And if you were experiencing unpleasant side-effects from the narcotic,  such as itching or drowsiness, those will likely subside more quickly as well.

Narcotic analgesics can be a helpful option for moms who are searching for pain meds during labor other than epidural medication.  If analgesics are a choice that you want to you consider during birth, be sure to discuss it with healthcare provider during your pregnancy.  Ask which medications are most commonly used at your birth facility, and be sure to ask about the pros and cons of each one.  By researching your options for pain medication beforehand, you’re empowering yourself to make choices during labor and setting yourself up for a positive birth experience.

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References:

(1) Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to MothersSM III: Pregnancy and Birth. New York: Childbirth Connection, May 2013.

(2) Simkin, P., Whalley, J., Keppler, A., Durham, J., Bolding, A.  (2010).  Pregnancy, childbirth, and the newborn:  The complete guide.  Minnetonka, MN:  Meadowbrook Press.

(3) Sekhavat, L. & Behdad, S. (2009).  The Effects of meperidine Analgesia during Labor on Fetal Heart Rate.  International Journal of Biomedical Science:  IJBS, 5(1), 59-62.

(4) Miner, J.R., Moore, J., Gray, R.O., Skinner, L., & Biros, M.H.  (2008).  Oral versus intravenous opioid dosing for the initial treatment of acute musculoskeletal pain in the emergency department.  Acad Emerg Med: 15 12): 1234-40