What are the Drug options (during labour)

What are the Drug options?

Yes you can go through labour quite successfully without any pain medications. However life doesn’t always turn out how you plan. Having someone explain to you the pros and cons of different medications in between contractions is not really the most ideal of situations. There are non-medicated options such as breathing, meditation and other coping strategies. Today the focus is on the medicated ones.

Hospital Policy on pain relief

The hospitals I have worked with have a policy that they will not offering you pain relief – you need to ask. This is done for many reasons and this is something that should be your choice. In addition, a labouring woman is vulnerable and suggesting that she might want pain relief, may suggest that medical staff don’t think she is coping. We also don’t want to unduly influence someone. Different hospitals may have different policies, just ask during that antenatal period what your hospital policy is.

Nitrous Oxide

This is also known as laughing gas. Dentists sometimes use it too. It is a mixture of nitrogen and oxygen. It has a short term effect and can be quite useful for managing the pain of contractions. It doesn’t influence baby and is safe. However some women find that it makes them feel nauseous.

It works by taking deep breathes of the Nitrous Oxide mixed with normal air. You start the breaths when the contractions are building and continue throughout the contraction. It is often mobile; so whether you are standing, pacing, sitting, or lying down it is useable.

It works for some people and not for others, if people ask for pain relief, this is the first medicated step people will suggest. Many women report that they feel nauseous when they use it – we do have bags – but it isn’t for everyone. There are of course, non-medicated coping strategies and I will write about them in a future post.

Sterile Water Injections

This is a non-medicated version where simultaneous injections of sterile water and injected either side (not into) the spine. They can hurt quite a bit at first – like a nasty ant bite – but this does settle. If you are having a lot of back pain, they can provide one to two hours of magical pain relief for many women. Whether you have back pain or not is often determined by where baby is sitting (for example if baby is posterior – baby spine contracting against your spine). Again, these have the advantage of not being chemical and have no influence on baby - after all it is just water.

Because this is a focus on back pain, if you aren’t having back pain then they won’t help. In addition, it does hurt initially.

Morphine

Morphine is an opiate and a strong pain relief option. It is normally injected into the muscle (often the upper arm). There are pros and cons for this drug too. It can help manage the pain throughout labour and also allow you to rest in between contractions. This is especially useful for those poor women who go into labour during the evening, after being awake all day. In this case, the ability to rest between contractions helps you save your strength for birth. It is also important to remember that people have different pain thresholds and anything that helps you keep your state of mind focused and strong can help.

Before you can consent to a drug, it is important to know both sides of the equation. Morphine does suppress the respiratory system (slows you breathing). This is fine for an adult (and helps you rest). However as morphine does cross the placenta, there is an effect on baby. Before birth this isn’t as important – let’s face it, baby isn’t breathing in there. If there is still morphine in the babies system at birth, you may notice a paediatrician and people taking special care of the neonatal equipment in case we have to support baby’s breathing.

As a general rule, we don’t like to give a dose of morphine within two hours of birth. The difficulty with that is that we don’t know exactly how long it will take until you birth. On top of that, the effect (on you and baby) will vary with dose, body size and metabolism. This is something you need to discuss with your medical professional about your unique situation.

Epidurals

Oh Hollywood, what have you done! This seems to be the first thing so many women ask for – yet they don’t really know what there is or the alternatives. This is our last resort pain relief. An anaesthetist injects a fluid into the area surrounding your spinal cord. Spinal Epidurals can be patient controlled (allows you a button to top up dose once every ten minutes), automatic (machine controlled) or commonly they have a mixture of both.

They work by blocking the pain receptors and they will get a piece of ice and test at which point on your body you can (or can’t) feel temperature changes. You may still feel some pressure, but the pain shouldn’t be there.

The potential list of side effects or things that can go wrong is quite extensive. While potential permanent paralysis is a rare occurrence, it is one you need to be aware of. They may also not work or not work properly. I’m not going to focus on all of the nasty things that can go wrong – your anaesthetist will go through those with you. I am going to focus on how they can influence your labour.

Recently I worked with a woman who had an epidural work only on one side of her body. An epidural will also mean that a urinary catheter needs to be insert, you will have decreased maternal ability to assist in pushing. You will also be unable to move from the bed. I believe statistically there isn’t a higher increase in caesareans with epidural pain relief however for first time mothers this may not be the case (I have the studies saved to my hard drive but I can find the links for people if you’re interested – just message me or comment below). In my (limited) experience, I’ve witnessed one incident of an epidural that did not ultimately result in caesarean. In that case the baby was birthed with assistance from forceps.

I do believe in providing a balance or pros and cons and so here they are for epidurals. They do take away most of the pain. This is really the main goal and it works quite effectively. If you are exhausted, pain doesn’t improve your frame of mind. In controlling the pain many women report they feel they are better able to cope with the trials of labour.

Overall

My experience is that the longer you can hold off on pain relief the better. My focus with women is always to keep the mind strong and focus on the positives. There is nothing wrong with pain relief but you do need to know what your options are. This whole birth and labour experience is supposed to be about you (not the midwives and doctors). Our role is to empower you throughout the process, not facilitate, control, dictate, judge or otherwise negatively impact you or your birth experience.

Most importantly I would like to stress that whatever pain relief you have, it won’t make your child any less wonderful. Just because the woman in the room next door gave birth to an 18 pound baby, no drugs, natural birth (that was the woman in the room next to me when I had my daughter), doesn’t mean that you shouldn’t have any drugs (she was 6”5’ and this was her fifth child).

I know my blog is still in its infancy stage but I always welcome feedback and comments! If there is a topic you’d like to know more about then let me know and I can try to prioritise it.