Using Medication



What advance preparations should I make?


How should I plan if I would like to have an epidural?

How should I plan if I would like to use other pain medications?

How can I minimize the likelihood of having problems with narcotics?

How can I minimize the likelihood of having problems with narcotics?



What advance preparations should I make?

You will need to look at the options and decide about your preferences. Narcotics and epidurals (and nitrous oxide, if it is available to you) pose very different benefits versus risks. Epidurals come in several varieties, each with its own pros and cons. (See Options: Labor Pain and Best Evidence: Labor Pain for information about your options with and without medications.)

You will also want to learn ways to reduce the chances of having a drug- or procedure-related complication (see below).

You should also be prepared to cope with labor without medication. Things don't always go as planned. Pain medication may be inadvisable in your particular case. You may arrive at the hospital too late in labor to start medication. An anesthesiologist might not be readily available. The staff may encourage you to wait until your labor is better established before using medication. You may be one of the women who find an epidural doesn't take or leaves "windows" of pain. Finally, because of the wide variation in women's experience of labor pain and the difficulty of predicting your experience in advance, you may find that labor isn't as hard as you thought it would be.

How should I plan if I would like to have an epidural?

If you think you will probably want epidural analgesia, make sure you have chosen a hospital where anesthesiologists or nurse-anesthetists are on the premises at all times. Otherwise, you may not be able to get an epidural when you want it. If your plan is to delay an epidural, you will want to investigate whether the hospital provides comfort measures (showers, rocking chairs, etc.) and has policies that encourage their use (such as freedom to be up and around in labor and no routine intravenous drips).

Even if you expect to have an epidural, consider arranging for a doula or other labor support companion. This person can help with comfort measures and mental strategies until the time when your epidural takes effect, and can provide critical help if the epidural doesn't work for you. Many women find that a doula continues to be helpful after an epidural takes effect. Relief of pain doesn't mean you and your partner cease to need emotional support, information, or ideas to promote good progress and minimize adverse effects. Take care, however, to choose a doula who is comfortable working with women who plan to have an epidural.

How should I plan if I would like to use other pain medications?

You cannot expect complete relief from labor pain medications other than epidurals, and a doula or other labor support companion can help with remaining discomfort, as well as many other needs.

If you expect to use narcotics, they should be generally available in U.S. hospitals. If you have an interest in nitrous oxide, you will need to make some inquiries. It may not be available in any hospital maternity units in your community.

How can I minimize the likelihood of having problems with narcotics?

Avoid narcotics in situations where the baby might already be compromised. This would include: preterm labor, underweight baby (small for gestational age, intrauterine growth retardation), and your high blood pressure. Narcotics depress your respiration and thereby decrease the level of oxygen in your blood. Although a healthy, full-term baby may be able to handle this, it could be challenging for a compromised baby.

Anticipate that the baby might have difficulties suckling in the first few days. Narcotics have known adverse effects on newborn behavior — including ability to breastfeed. These effects will pass as the baby gradually metabolizes the drug and its breakdown products. Recognizing this can help prevent frustration or discouragement if breastfeeding doesn't go well the first few days. To maximize your chances of early breastfeeding success and avoid making any difficulties harder to overcome:
  • start breastfeeding as soon as you and your baby are settled and ready
  • have your baby stay with you at the hospital ("rooming in") so that you can nurse on demand, including at night
  • be sure that you have continuing access to support from someone who is knowledgeable about breastfeeding.

How can I minimize the likelihood of having problems with an epidural?

  • choose a doctor or midwife with low rates of cesarean section and of using vacuum extraction or forceps, and be sure that there is a clear medical reason before agreeing to any of these procedures (as epidurals may make pushing difficult and lengthen labor, caregivers who are comfortable waiting or trying other ways to promote labor progress may avoid these interventions)
  • to reduce your chance of developing fever and of your baby being evaluated and perhaps treated for infection, delay having an epidural until your labor is well-established (usually around 4 or 5 centimeters dilation if this is your first baby and 3 or 4 centimeters if you have had a baby before); although we need better research, this may also help you avoid vacuum extraction, forceps, or cesarean section
  • empty your bladder before having an epidural, as you may not be able to do so or sense that it is full after the medication takes effect
  • stay off your back after having an epidural; try lying on your side or staying in an upright position
  • changing positions, and moving about if you can, may help with the progress of your labor
  • rare but serious warning signs that call for immediate staff attention include having difficulty breathing or, if you have had a spinal narcotic, feeling extremely groggy.
Most recent page update: 11/16/2012


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