Using Narcotics in Labor - What Does the Evidence Say?
Average Read Time: 5-6 minutes
Many people don’t know that IV narcotics are an option for pain management during labor! They have their own unique benefits and risks, so I’ve used EBRAINS (broken down more in my blog here) to help you understand a bit more about narcotic use during labor. I hope this helps you make an informed decision for yourself and your family!
Explanation: Narcotics are typically delivered via an IV, although they can also be administered through an injection. They provide relief from the pain and sensations of labor for a temporary amount of time. There are many different types of narcotics that hospitals use for pain management during labor. Each provider and clinic will have their own protocol, so find out what your provider typically uses and ask EBRAINS questions for that specific narcotic! The American Pregnancy Association has a more detailed list of the pros and cons of specific narcotics used in labor.
This article will go over the general benefits and risks from all most of the major narcotics used - Dilaudid, Pethidine, fentanyl, and stadol. In many countries around the world, providers also use demerol, but use of this opioid is no longer recommended by the American College of Obstetrics and Gynecology (ACOG) due to its adverse effects.
Benefits: Because narcotics are administered via IV, they enter the bloodstream quickly and start working fast - within 5 to 10 minutes generally. They only last for 2-3 hours, so they are a good choice if you’re needing some pain relief but don’t want the longevity of an epidural. They can allow the birthing person temporary relief from the pain and sensations of contractions, potentially allowing for a nap or rest - something that can help both with pain management and labor progression in the long term! Narcotics can be used during spontaneous labor or during an induction - some providers will recommend a narcotic to help navigate pain that may come with a foley balloon used in an induction. (What is that you ask? Send me an email to chat more!)
Risks:
Narcotics cross the placenta and enter the baby’s bloodstream. In labor, this can affect the baby’s heartrate, leading to higher chance of a cesarean. After delivery, this can cause a baby to be born feeling drowsy, with a slower heartrate, struggling to latch and suck, and have lower APGAR scores. (Note: one way to mitigate these effects on baby is to opt for a narcotic earlier in labor. That way, the narcotic has time to wear off before baby is born!)
Chance that the narcotic doesn’t give enough relief, or that the medication doesn’t work at all.
Rare chance of cardiac or pulmonary arrest, so all narcotic use requires more intense monitoring by healthcare providers and nursing staff.
Alternatives: Non-medical comfort measures, such as movement, hydrotherapy, counterpressure, etc. Medical pain management tools, such as an epidural (see my blog here for the EBRAINS all about epidurals!) or nitrous oxide (EBRAINS on nitrous use linked here!).
Intuition: Checking in with your intuition is something that you’ll do once you’re in labor. Right now, your intuition may be telling you one thing, and that thing may change once you’re in labor. Remember, it’s OK to change your mind!
Nothing: You can always say no to using narcotics in your labor! You can also ask for time to decide. “I think we are going to discuss narcotic use as a family. Do you mind coming back in 30 minutes and checking in?”
Side Effects:
Itching
Nausea
Vomiting
Dizziness
Drowsy feeling
Stuck in bed through administration (your healthcare team doesn’t want laboring people to fall while on a narcotic! Remember, while I’m labeling this a side effect, it’s important to continue to move throughout labor! Motion is lotion, as Britta Bushnell says, so using a narcotic will change the way you’re moving in labor.)
Choosing to use IV narcotic to support your birth is something only you can ultimately decide! I hope the information above was helpful as you navigate your journey through childbirth, and if you need more help, don’t hesitate to reach out to me here!
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