Systemic Pain Relief

A. Systemic Medication

Pain relieving medications injected into blood stream that may alleviate, but not eliminate, pain during labor.

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: fentanyl, Remifentanil, 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.  

Next: Nitrous oxide



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