Using Narcotics for Pain Relief During Childbirth-Opiates also cross the placenta during labor

Using Narcotics for Pain Relief During Childbirth

Many women use some type of method to deal with pain during childbirth. As you prepare for your labor experience, it is important to become educated on different pain medications, how they work, and the risks and benefits. Which method you decide to use (if any at all) depends on your preference, your health care provider’s recommendations, and the availability at your birthing facility.

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

What are the advantages of using opiates during childbirth?
Opiates offer pain relief and do not interfere with a woman’s ability to push during labor. Unlike an epidural, an opiate does not numb the pain but instead it helps to take the “edge” off. Opiates may help to reduce anxiety and improve the ability to cope with painful contractions.

What are the potential side effects of opiates?
Opiates may have the following side effects on the mother:

Nausea
Vomiting
Itching
Dizziness
Sedation
Decreased gastric motility
Loss of protective airway reflexes
Hypoxia due to respiratory depression
How will the opiates affect my baby?
Throughout pregnancy, you were probably aware that medications you consumed could potentially affect your baby. Opiates also cross the placenta during labor and can cause the following side effects to your baby:

Central nervous system depression
Respiratory depression
Impaired early breastfeeding
Altered neurological behavior
Decreased ability to regulate body temperature
For these reasons, your baby may need medication to counteract the opiate effects. Naloxone is a medication that when given in small doses can reverse the respiratory depression that opiates may cause in the baby. This drug is usually given intravenously to your baby. The effects of naloxone can be seen within a few minutes and can last up to 2 hours.

What types of opiates are used during childbirth?
The most frequently used narcotic medications are:

Morphine
Stadol
Fentanyl
Nubain
Demerol
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, the vein or by a Patient Controlled Analgesia (PCA) pump
Demerol starts working in less than 5 minutes
How can Demerol affect me and my baby?
Demerol can cause drowsiness, nausea, vomiting, respiratory depression, and maternal hypertension (low blood pressure). If injected within 2-4 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 considered more potent then 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
Has minimal fetal effects
Cause minimal nausea
How can Stadol affect me and my baby?
Stadol can cause the mother to have respiratory depression, dizziness and dysphoria (a state of feeling unwell and unhappy). Stadol can cause respiratory depression in the baby.

Fentanyl:
Fentanyl is a synthetic opiate that provides mild to moderate sedation. The advantages of using Fentanyl include:

Begins working quickly (although, usually only lasts 45 minutes)
Minimal sedation
Minimal fetal effects
How can Fentanyl affect me and my baby?
You and your baby may experience some sedation and/or nausea. According to Danforth’s Obstetrics and Gynecology, baby’s born to mothers who used Fentanyl to relieve pain during labor were less likely to need naloxone (medication to help with breathing) than babies born to mothers who used Demerol during childbirth.

Nubain:
Nubain is a opiate agonist-antagonist that is comparable to morphine. The advantages of using Nubain include:

Begins working within 5 minutes of administration
Minimal nausea
Minimal fetal effects
How can Nubain affect me and my baby?
Nubain can cause the mother to have sedation and dysphoria (a state of feeling unwell and unhappy).

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. In a hospital setting, an IV is typically placed to help you stay hydrated throughout labor and assure access to administer medications if they are needed.
Patient Controlled Analgesia (PCA) pump is a 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 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.
LAST UPDATED: 12/2006
Compiled using information from the following sources:

Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 19.

Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 3.

http://www.americanpregnancy.org/labornbirth/narcotics.html