Labor pain: Medications for relief

Introduction

Many types of medication can be used during labor and delivery.

Epidural and spinal blocks can reduce the pain of contractions, and local anesthetics and pudendal blocks can numb the vaginal area in preparation for a surgical procedure during delivery. Occasionally, tranquilizers or barbiturates can be used during labor to relieve anxiety and promote relaxation, but not to relieve pain. Trust your health care provider to help you make the best choice based on the course and progress of your labor.

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Epidural block

Description
A mixture of an anesthetic such as chloroprocaine, lidocaine or another "-caine" drug and a narcotic such as fentanyl (Sublimaze), meperidine (Demerol), morphine or nalbuphine (Nubain) may be used during active labor or for a Caesarean birth. The medication is injected into the lower back just outside the tough sac (dura) that surrounds the spinal cord. It takes about 20 minutes to administer and another 20 minutes to take effect. A form called a walking epidural provides pain relief but leaves you enough muscle strength to walk during labor.

Pros

• Blocks most pain in the lower body and alters pain perception
• Can be used continuously for several hours
• Allows you to remain awake and alert
• Doesn't cause significant slowing of labor

Cons

• May provide uneven pain relief, affecting one side of the body more than the other
• May decrease blood pressure, which can slow baby's heart rate
• May make pushing more difficult
• May, rarely, affect your chest muscles (You may have the sensation of difficulty breathing. Although your breathing isn't actually affected, the sensation may cause anxiety.)
• Possible severe headache (spinal headache) due to leakage of spinal fluid if the dura is perforated
• Possible allergic reaction

Spinal block

Description
A mixture of an anesthetic such as chloroprocaine, lidocaine or another "-caine" drug and a narcotic such as fentanyl (Sublimaze), meperidine (Demerol), morphine or nalbuphine (Nubain) may be used during active labor or shortly before a Caesarean birth. As with an epidural, the medication is injected into the lower back. Since it's injected directly into the tough sac (dura) surrounding the spinal cord, however, it takes effect in seconds, providing relief for up to two hours.

Pros

• Provides complete pain relief from the chest on down
• Allows you to remain awake and alert

Cons

• May decrease blood pressure, which can slow baby's heart rate
• Rarely, causes lightheadedness and nausea
• Higher risk of spinal headache, compared with epidural blocks
• Loss of bladder control (There's usually a temporary need for a bladder catheter.)

Analgesics and narcotics

Description
Medications such as butorphanol (Stadol), fentanyl (Sublimaze), meperidine (Demerol), and nalbuphine (Nubain) may be used in labor. They're injected into a muscle in your thigh or buttocks or injected into an intravenous (IV) catheter. In some instances, you may be able to control your dosage by pressing a button that injects a fixed dose of the medication into your IV. The effect usually lasts two to six hours.

Pros

• Decrease pain perception
• Promote rest
• Don't cause muscle weakness

Cons

• May cause sleepiness
• May temporarily depress respiration for you or the baby
• May decrease your memory of labor

Local infiltration anesthetics

Description
A medication such as chloroprocaine, lidocaine or another "-caine" drug may be injected into tissue at the vaginal opening shortly before or after delivery. This is done to temporarily numb the vaginal area before an incision is made to enlarge the opening (episiotomy) or a tear is repaired.

Pros

• Localized pain relief
• Negative effects on mother or baby are rare

Cons

• No pain relief from contractions
• Rarely, a fall in blood pressure, if medication is injected into a vein
• Possible allergic reaction

Pudendal block

Description
A medication such as chloroprocaine, lidocaine or another "-caine" drug may be injected into the vaginal wall shortly before delivery. By blocking pain between the vagina and anus (perineum), a pudendal block is useful if a forceps-assisted delivery or vacuum extraction is necessary. It also relieves the pain of an episiotomy or a tear during delivery. The effect lasts for several minutes up to an hour.

Pros

• Localized pain relief
• Usually no negative effects on mother or baby

Cons

• No pain relief from contractions
• May slightly decrease urge to push
• Rarely, a fall in blood pressure and possible fainting if medication is injected into a vein
• Possible allergic reaction

Tranquilizers and barbiturates

Description
Tranquilizers such as diazepam (Valium), promethazine (Phenergan) or propiomazine (Largon), and barbiturates such as amobarbital (Amytal), pentobarbital (Nembutal) or secobarbital (Seconal) are used — but only rarely — to relieve anxiety and promote rest in early labor. They're given by mouth, by injection into a muscle in your thigh or buttocks, or by intravenous (IV) catheter. The effect usually lasts four to eight hours.

Pros

• Relieve anxiety
• Promote relaxation

Cons

• Don't relieve pain
• May cause drowsiness
• May decrease your memory of labor
• May decrease baby's muscle tone and activity at birth