Sleep: if a woman has early labor that goes for days, sometimes she will be
given a sedative to help her sleep, a barbiturate such as Nembutal or
Phenobarbital. These can relieve anxiety and induce sleep only in the
absence of pain. If the woman is experiencing pain, sedatives without
analgesics increase anxiety, may make her hyperactive and disoriented.
Sometimes morphine is used for sleep; one study of morphine use found that
after sleeping for several hours, 2/3 of the women woke up in active labor, but
1/3 woke up to find their labor had stopped.
High anxiety; mom experiencing excessive fear and apprehension which may
complicate early labor. May be given sedatives or tranquilizers, such as
Thorazine. (See side effects chart at the bottom of this page.)
Most common use: Pain relief.
with your partner about pain medications
time in late pregnancy you and your partner should sit down and really talk
about what your preferences are regarding pain medication so that when you’re
in labor, your partner will know what your preference is. (See Simkin, Whalley,
and Kepler for the Pain Medication Preference Scale, a good starting point for
agree on how you will communicate that the time has come for pain medication. I
had a client who really wanted to have a birth without pain medication, but
knew there would be times in labor she would feel discouraged, and was likely
to say things like “I can’t do this anymore, it’s too painful.” We agreed ahead
of time that if she said things like that, it was a call for more active
emotional support and reassurance, and some suggestions about positions and
comfort techniques to try, and that we should not discuss pain medications.
However, she wanted to know that she could choose pain medications if
necessary, so we agreed that if she said “I’m done”, we would know to begin
discussing medication with her.
Analgesia (e.g. Morphine, Fentanyl)
- Usually given by I.V. Sometimes given as
- Generally given at least 2 hours before
baby is expected, takes effect in minutes, lasts a few hours. You can get
additional doses, but not as effective.
- Note that narcotics are not anesthesia:
they do not take away pain sensations. They are analgesia: they make you
less sensitive to pain, or “raise your pain threshold”, by depressing the
central nervous system. They may alter your reaction to the pain.
- Benefits: May help with relaxation and
rest between contractions.
- Some people refer to narcotic effects
as “taking the edge off the contraction.” Be aware that they are not
referring to the peak of the contraction: narcotics generally don’t
reduce the intensity of the peak of the contraction. Instead, they may
take off the beginning “edge” and the ending of the contraction.
you feel like you’re handling peak, and just need some rest in between,
may be good option
- If you’re expecting relief from the
most intense part of the ctx, you may be disappointed, and may turn to
- Side effects on mom: Vary, depending on
which medicine is used. Generally: Drowsiness, hallucinations, dizziness
(3-32%), nausea (0-40%), itching, respiratory depression (100%), lowered
blood pressure. May slow early labor.
- Side effects on baby: Before birth: may
make fetal heart less reactive, causing concerns about fetal distress.
After birth: reduced alertness because of depression of central nervous
system, decreased sucking reflex. Effects may last for several days.
- If narcotic effects are causing significant
problems, they can be countered by giving a narcotic antagonist, which
cancels out the effects of the narcotics.
- An alternative to pure narcotics are
combinations of narcotics and antagonists (e.g. Stadol, Nubain) which help
to minimize the side effects, especially reducing the euphoria narcotics
- Environmental factors: To maximize the
effectiveness of sedatives, tranquilizers, or narcotics, it’s best to make
your environment as calming, safe, and soothing as possible. Turn down the
lights, turn on quiet music, minimize interruptions.
The most common pain
medication during labor and birth is epidural anesthesia. It is covered in a separate article.
By Janelle Durham, 2002. Sources: Pregnancy,
Childbirth, and the Newborn by Simkin, Whalley, and Keppler (2001 edition).
Maternity & Women’s Health Care by Lowdermilk, Perry, and Bobak (6th
Edition, 1997). Family-Centered Maternity and Newborn Care by Celeste R.
Phillips (Fourth edition, 1996).
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