Using Narcotics for Pain Relief During Childbirth

Many women choose to use some type of method to deal with pain during childbirth. As you prepare for your labor experience it is important to become educated ahead of time on what different pain medications are available, how they work, as well as what the risks and benefits are. What you decide to use (if any at all) depends on your preference, your doctor’s recommendations, and what is available at your birthing facility.

What are narcotics?

Narcotics are a type of analgesic given to relieve pain. When used during childbirth, narcotics are considered the next step up from the less invasive or “natural” methods of pain relief such as laboring in water, deep breathing, and massage. Narcotics are given in small doses and usually during the beginning stages of labor in an attempt to avoid potential side effects for the mother and baby.

What are the advantages of taking narcotics during childbirth?

Narcotics offer pain relief and do not interfere with a woman’s ability to push during labor. Unlike an epidural, a narcotic does not “numb” the pain but instead it helps to take the “edge” off. Narcotics help to reduce anxiety and improve the ability to cope with painful contractions.

What are the potential side effects of narcotics?

Narcotics may have the following side effects on the mother:

  • Nausea
  • Vomiting
  • Itching
  • Sedation
  • Decreased gastric motility
  • Loss of protective airway reflexes
  • Hypoxia due to respiratory depression
  • Your doctor may give you a medication called Sparine to prevent nausea.

How will the narcotics affect my baby?

Throughout pregnancy, you were probably aware that medications you consumed could potentially affect your baby. Narcotics also cross the placenta during labor and can cause the following side effects to your baby:

  • Central nervous system depression
  • Respiratory depression
  • Impaired early breast-feeding
  • Altered neurological behavior
  • Decreased ability to regulate body temperature

For these reasons, having medication to counteract the narcotic is essential for your baby. Naloxone is a medication that when given in small doses can reverse the respiratory depression that narcotics cause without creating more problems. This drug may be given intravenously, through the muscle, or through an endotracheal tube (small opening in the throat) to your baby. The effects of Naloxone can be seen within a few minutes and can last as long as 2 hours.

What types of narcotics are used during childbirth?

The most frequently used Narcotic medications are:

  • Demerol (also referred to as meperidine or pethidine)
  • Morphine
  • Stadol (Butorphanol)
  • Fentanyl (Sublimaze)
  • Nubain (Nalbuphine)

Demerol: Demerol is a popular choice for pain relief during labor. Demerol alters how you recognize the pain you are experiencing by binding to the receptors found in your central nervous system. The advantages of Demerol include:

  • Can be given by injection into the muscle, given intravenously or by a Patient Controlled
  • Analgesia (PCA) pump
  • Demerol also starts working in less than 5 minutes

How can Demerol affect my baby or myself?
Demerol can cause drowsiness, nausea, vomiting, respiratory depression, and maternal hypertension (low blood pressure). If injected within five hours of delivery, Demerol has been found to cause breathing difficulties in babies.

Morphine: In recent years, morphine has not been routinely used as a method of pain relief during labor because it has been found to depress the baby’s ability to breathe.

Stadol: Stadol has been found to relieve pain when given in the first stage of labor. This narcotic is also considered more potent than morphine and Demerol. It is usually given intravenously in small doses, usually 1 to 2 mg. The advantages of using Stadol include:

  • Starts working in less then five minutes
  • Is a sedative
  • Minimal fetal effects
  • Minimal nausea

How can Stadol affect my baby or myself?
Stadol can cause the mother to have respiratory depression and a dysphoric reaction (a state of feeling well and unhappy).

Fentanyl: Fentanyl is a synthetic narcotic similar to Morphine or Demerol and provides moderate to mild sedation. The advantages of using Fentanyl include:

  • Begins working quickly, (but only lasts usually 20-30 minutes)
  • Minimal sedation
  • Nausea
  • Minimal fetal effects

Intrathecal Fentanyl is the placement of fentanyl, into the fluid surrounding the spinal cord. This is different from an epidural in which medication is placed into the epidural space. Intrathecal Fentanyl is a one-time injection into the spinal column similar to an epidural.

How can Fentanyl affect my baby or myself?
You and your baby may experience some sedation and/or nausea. According to Danforth’s Obstetrics and Gynecology 9th edition, baby’s born to mothers who used Fentanyl to relieve pain during labor were less likely to need Narcan (medication to help with breathing) then babies born to mothers who used Demerol during childbirth

How will my pain medication be given?

Medication can be given in any of the following ways:

  • A one time injection into the spinal column
  • IV or “Intravenous” placement into a vein on the back of the hand or arm. A needle is inserted into a vein with a plastic tube connected to a bag holding fluid that slowly drips into your body. An IV is typically placed to help you stay hydrated throughout labor and assures access for the administration of medications as they are needed.
  • Patient Controlled Analgesia (PCA) pump is way a mother can control when she receives pain mediation during labor by pushing a button. The advantage of having a PCA is that it provides a sense of control and the mother does not have to wait for the nurse to bring pain medication. Fentanyl, Remifentanil (a narcotic that is too new for long term studies on side effects), and Demerol are common narcotics that can be given through a PCA pump. The pump is pre-programmed based on the drug dosage into amounts small enough to relieve pain without releasing too much medication.

Reprinted with permission from American Pregnancy Association