The use of medications can be helpful to you in labor. The decision to use them depends on the situation, the level of discomfort you experience, and your progress during labor. The decision to use them is totally a personal one! Your physical reaction to medications will also be an individual one.
Drugs should be used as a last resort after all other measures have been tried, and have not been successful. They should also be used in an emergency, or when labor is lasting a long time, and you are exhausted. In this case, if you have labored a long time, for many hours, and are exhausted, an epidural could be a good choice. It would allow you to rest, to sleep, and regain some strength, and energy to cope better with discomfort caused by the contractions. Drugs should never be used just because they are available. ( Read pgs 48, 49, & 98, in book ) What book?
Drugs have side effects, and yes, your baby will be medicated also because drugs are transfered to the baby through the placenta. How much baby will get depends on when the drug was given, the dosage, and the route the drug was given ( injection or Intravenously ). What the side effects will be for you will be varied, and also depend on the medication taken, route, dosage, and your body weight.
Once you introduce a drug into your system, it alters the chemistry in your body influencing the function of your muscles. Remember, your uterus is a muscle and it must contract for the baby to be delivered! Drugs will interfer with the uterus's ability to contract. Also, if you have been medicated, you will receive Pitocin, the man-made oxytocin to stimulate contractions.
Your book has a good outline of medications used, when used, and a list of side effects. I will briefly discuss narcotics and epidurals here.
Narcotics: Demerol, Nubain, and Morphine, are the ones more commonly used in labor. They are usually administered by an injection into your buttocks, or more commonly through an IV line which feeds directly into a vein in your arm. Thus, the drug prescribed and preferred by your doctor, enters your body through the vein and circulates throughout your vascular system, or bloodstream. You Healthcare provider also determines when, and how often you may be medicated.
Drugs cross the placenta, so baby will be medicated also. When the medication is given during a contraction, less of it seems to pass through the placenta because blood flow is temporarily halted during a contraction. When the contraction is over, there is a surge of blood flow to the uterus. Also, narcotics will not be given if close to delivery. If given close to delivery, the baby will have more of the medication in its system. Narcotics work by relaxing the muscles.
When given: Ideally between 4cm - 7 cm. If given too early in labor, your labor may slow down. If given too close to delivery, baby will receive more of the medication.
Side effects:
Mother: Vomiting, nausea, drowsey, disorientated, sleepy, woozy, loss of control over contractions, dizziness, respiratory depression, dry mouth. Your reaction is totally individual. Also, your will still feel the contractions.
Baby: Respiratory depression, decreased sucking ability, sleepy baby, trouble with breasfeeding. Note: Traces of narcotics can remain in baby's system up to six days!
Epidurals: Some of the medications used in epidurals are in the "caine" family. PLEASE, if you have ever had any kind of reaction to novacaine, which is a drug dentists use, please let your doctor know! You may not get an epidural. Narcotics are also used with epidurals, such as Fentanyl. Epidurals work by numbing the nerves in your body at the level where the injection of the medication was given: In the lower part of your back. There is often numbing of the legs as well. So, here the medication does not directly circulate in the blood. Baby does receive traces of the medicaion, but does not appear to experience the respiratory depression as associated with narcotic use.
When Given: Usually NOT before 4cm (depends on your doctor), and as late as 9cms (again, this is a decision made by your doctor as to how early, or late in labor you can recieve one) Given too early may slow labor, and may increase
the use of other medical interventions such as forceps, and vacuum deliveries.
Side effects:
Mother: Headache, backache, low blood pressure, "spotty" distrubution of medication, ringing in the ears, rare -> temporary or permanant paraylsis.
Baby: Drop in heart rate in response to low blood pressure in mother, possible subtle neurological changes.
Remember the following:
* Your baby is not able to metabolize drugs like adults can. Baby's organs, such as the liver, is immature and still developing. A newborn baby is not prepared to handle the by-products of drugs in its system, which is why they stay in their system for several days.
* Medications can interfer with your control over your labor experience, and the ability to work with your contractions. They also alter the ability of muscles to function properly because they are chemically relaxed. Have you ever had a muscle relaxant? How did you feel?
* Medications can prolong labor, and epidurals may interfer with your ability to "push" in the second stage of labor.
* You will still feel the contractions with narcotics.
* You will receive Pitocin to stimulate contractions if you have received an epidural, and most likely with narcotics as well. This is because you need contractions to deliver your baby, and the muscles are.....relaxed.....and will not function like they normally would in an unmedicated state.
* Prolonged discomfort is very stressful to you and the baby, and can be alieviated by pain medication.
* Overall fatigue in labor can lead to fatigue in your muscles which will impact on your ability to "push" when the time comes, as well as the ability for your uterus to contract efficiently. Also, the diaphram (a muscle that is neccessary for breathing, located in the abdomen) may tire and compromise adaquate oxygenation to you and baby. Medications, such as the epidural, could be helpful in this case, again, if all else failed, and of course depending on the situation.
Hot Debates:
* That epidurals do not increase the rate of c-sections.
* Epidurals do lead to an increase in c-sections.
* Epidurals increase the rate of medical interventions, such as the use of forceps, etc.
* Walking epidurals. What's the difference? It is the dosage of medication given, and it is usually given in early labor, not in the active stage (4 -7cms). Ask your doctor for more information, and if you will actually be able to walk with the epidural. Some hospitals view this as a safety risk. Because you have been medicated, they will watch you closely to ensure you do not fall, or just very simply, keep you in bed. There is a new Epidural technique that combines a spinal injection of medication WITH an epidural, using a catheter. Ask your doctor, midwife or anesthesiologist about it. (1/27/00)
Read all you can, Talk to your doctor, and keep an open mind. Medication has its place when there is a medical need for it. Nature does her best work during the process of childbirth. It is an amazing event.
Try trusting yourself and your own ability to give birth first. Explore your options in alternative methods of relaxation, such as hypnosis, and /or the other techniques discussed. If the question to medicate or not should arise, make an educated decision. Knowing what your options are, you will do what is best for you when the time comes.
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