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Labor Pain Medications
IV MEDICATIONS:
These medications are given intravenously, which means you will have an
IV inserted in your arm. IV medications (instead of pills or
intramuscular injections) are useful in labor because they start working
immediately. The most common medication our doctors order are Nubain and
Stadol, and these drugs can be given in early or active labor. Each
dose lasts about one hour, and begins working immediately. You can
often have several doses if needed during labor. Most women report
that IV medications “take the edge off” of the contractions, and allow
them to rest and relax more in between. They do not take away pain
completely. Narcotics are safe for you and your baby and many laboring
women find that one or more doses of narcotic are all they need to make
it through to delivery. These medications may be withheld if requested
within one hour of expected delivery.
EPIDURALS:
The epidural is
another option for pain relief in labor. It can be given either after
or instead of IV medications. It is important that labor be progressing
before the epidural is used, because it can slow things down if labor is
not well established. The epidural won’t make you feel sleepy or
sedated, but most women are able to nap after getting comfortable, which
is a great way to regain the energy needed to push during delivery.
Epidurals take away pain, but not pressure, because you’ll need to know
when contractions are coming so as to push effectively. The most common
side effect of the epidural is a drop in blood pressure. Giving IV
fluids before inserting the epidural usually counteracts this. You must
have an IV to have an epidural. Having the epidural
put in is not
painful for most women, and once it is in place you will not be aware of
it (the needle is removed as soon as the epidural is placed and only a
tiny catheter that looks like fishing line is left). The actual
procedure only takes 5-10 minutes to complete, but you need to be aware
that it will take ~30 minutes from when you ask for the epidural until
you are comfortable. This is due to travel time for the anesthesia
staff to come to the hospital, getting the IV fluid, having the epidural
actually inserted, and then letting the medication start to work. Some
women don’t like feeling numb from the waist down, but most are relieved
to be pain free. Shivering not associated with being cold is common
after getting the epidural, and will often come and go until delivery.
After receiving the epidural, you probably won’t be able to get out of
bed, and often it is necessary to empty the bladder with a small
catheter (you will not feel this) before delivery. Pain relief lasts
until about an hour after delivery. Most epidurals can be used if a
C-section is necessary. You will be asked to sign a consent form to
have an epidural, and both an Anesthesiologist (MD) and the Nurse
Anesthetist will talk with you before the procedure to make sure that
you understand everything.
PUDENDAL BLOCK:
This is an option for patients who only need pain relief at the very end
of pushing, while the baby’s head is descending in the vagina.
Lidocaine, (a local anesthetic) is injected near the pudendal nerves in
the vagina. This numbs the external genital area, which greatly reduces
the burning sensation when the baby begins to deliver. It is also
useful to prevent pain with episiotomy and subsequent repair. It does
not numb the abdomen, and you will still feel contractions. The
procedure can be uncomfortable for a few seconds, but only takes about a
minute to perform. The medication works very quickly and has no effect
on the baby.
LOCAL ANESTHESIA:
This medication (also lidocaine) is injected at the vaginal opening just
before the baby is delivered. It serves to numb a small area where the
episiotomy will be, and will last throughout whatever repair is
necessary. The medication stings for a moment, but due to the pressure
of the baby’s head delivering, women usually don’t notice it. Like the
pudendal block, and the epidural, local anesthesia will wear off about
an hour after delivery.
GENERAL ANESTHESIA:
This type of anesthesia, “being put to sleep” is only used in a true
emergency, or if an epidural or spinal block cannot be inserted, and
where time is most important in delivering the baby by C-Section. It
works immediately. The baby is sometimes sleepy when it is born because
it may receive some of the medications used to induce anesthesia.
General anesthesia is not used frequently as our anesthesia staff is
very skilled at administering epidurals and spinal blocks.
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