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These are
medications that are given either intravenously or
intramuscularly to decrease the amount of labor pain.
These medications are usually ordered by the
obstetricians and midwives, and given by the nurses.
Opioids are the most effective medications for the
relief of pain. The have a long history of use in
obstetrics for the relief of the labor and delivery
pain. Although there are a great number of narcotics available today, only a few are commonly used for
childbirth: meperidine (Demerol), morphine, fentanyl,
butorphanol (stadol) and nalbuphine ( Nubain). These
medications enter the blood stream and allow you to
better tolerate the pain of labor and delivery. They do
not normally provide complete analgesia. The amount
of pain relief from these medications does vary, but
they can take the "edge" off the pain and make
your labor more tolerable. The vast majority of
women who do not have a regional anesthetic for labor do
opt for one of these medications. There is no problem
with receiving such medications prior to receiving an
epidural or spinal anesthetic.
If the
medications ordered by the obstetrician are not
enough to provide satisfactory pain relief, the
anesthesiologist can arrange these medications
administered via an intravenous infusion pump. Here, you
are provided with a button that can be activated whenever you desire pain relief. The pump is programmed to
push a certain (set) amount of medication into your
system. This method of administration pain relief is
called 'patient controlled analgesia' (PCA). You have
control over how much medication you need
depending on the degree of your perception of the pain
of uterine contraction. The anesthesiologist and your
nurse will monitor the intravenous medications being
administered by you.
A major
disadvantage of I.V medications is that these
medications make you drowsy and sleepy. In
addition, there may be other side effects that include
nausea, vomiting, decreased respirations, itching,
constipation and urinary retention. If you are planning
to breast feed, initial efforts may be difficult.
Effect
on the baby:
Another
side effect of narcotics is due to the fact that they all
cross the placenta and enter the baby's circulation. As a
result of this, the baby may also show some effects. In
utero, the baby's heart rate may change slightly in
pattern. There is no deleterious effect known due to
this change in heart rate pattern.
The baby
has the ability to metabolize the medications, but it
does so more slowly than the mother. After the baby is
born, the baby may be slightly sleepy. Again, it is
unlikely that the baby will be affected adversely as a
result of small amount of mother's medication, but it is
important to realize that the medication is getting to
the baby. The chance of seeing an effect of mother's
medication in the baby may be dependent on the dosing of
medication in relation to the time of birth.
If the baby has adequate time to break down the
medication, only a minimal effect may be seen.
Most practitioners feel that it is safe for the baby
when narcotics are given to mother to relieve labor pain.
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