Friday, June 12, 2009

Pain Medications Used in Childbirth: Effects on Mother, Baby, Breastfeeding and Bonding

June 11, 2009 by

The medications most commonly used in hospital labor and delivery wards in the US are: Demerol (meperidine), Morphine, Stadol (butorphanol), Fentanyl, Nubain(nalbuphine). It should be noted that Demerol and Morphine are not commonly used as much as Stadol, Fentanyl, and Nubain. The anesthetics that are more common in epidurals are Lidocaine (xylocaine), and Bupivicaine (marcaine, marcain).

The benefits are obvious to the relief of pain in childbirth... relief of pain. If a mother has been in labor for a very long time and is exhausted, an epidural can make the difference between a vaginal birth and a cesarean section, by allowing her some relief so she can sleep and gain new strength. Pain relief can relax a laboring mother enough that her contractions become more effective and allow her labor to progress more efficiently. In the rare case of soft tissue dystocia that is purely physiological, pain medications may resolve it, as long as there are no emotional factors to consider.

Let us go over some of the general adverse effects of using pain relief and epidurals during labor and birth. Keep in mind that these are the adverse effects that are general among all of the more commonly used medications. Both mother and baby can experience these: sleepiness, sedation, dizziness, constipation, sleep problems, insomnia, nausea, vomiting, stomach pain, diarrhea, loss of appetite, memory problems, sweaty, clammy skin, headache, breastfeeding difficulties, bonding difficulties, and withdrawal symptoms.

These are the less serious side effects of the pain medications commonly used.

Some of the more serious adverse effects include: increased need to resuscitate newborns at birth, breathing difficulties in mother and newborn, very rapid heartbeat, very slow heartbeat, confusion, seizures, hallucinations, severe allergic reactions, numbing of face and extremities. These adverse effects are seen in both the mother and the baby.

It is known that these pain medications cross the placenta and affect the baby before birth. Most women who birth in the hospital will be offered these medications sometime during their labor, unless you have specifically requested that these not be offered. Some studies show that 90% of
healthy, low-risk women who birth in hospitals will have narcotic pain medications and/or an epidural during labor. This means that 90% of healthy infants born in hospitals are born drugged! Clearly information has not been shared with these mothers of the side effects of these medications.

Babies who are exposed to narcotics have stress put on their kidneys and livers as they try to metabolize the drugs. This can cause problems as well, considering that their livers and kidneys are still immature.

Physiological effects of Epidurals in labor

Epidurals are used to numb the nerves from the waist down during childbirth. An anesthetic/narcotic combination is injected into the dural space of the spinal column via catheter, which is in place throughout labor and delivery. Granted it can be an extreme relief during the pain of labor, but it is known to increase the length of labor and the second (pushing) stage, the need for forceps or vacuum assisted birth, episiotomy, and c-section. Those have an entire range of risks in and of themselves. It is also known to cause maternal fever and low blood pressure.
Because a woman is numbed by the epidural, she is not able to get up and move around during labor. This can cause labor to last longer and she may not be able to push as effectively because she cannot feel where to push.

Pain Medications and Breastfeeding

It is known that all of the narcotic medications used in labor and birth are exuded in Breastmilk. This means not only is the newborn baby getting an adult dose during labor, but also with the first feeding. Hence the sleepy baby that is more commonly seen in hospitals. Babies born without narcotics have a better latch during breastfeeding, are more alert and responsive during the first hours after birth, have less feeding problems and crying spells in the first 8 weeks of life, and are in general healthier, happier, and more content. American Academy of Pediatrics has taken the position that it is safe to breastfeed after receiving narcotics during labor, although they have stated that if a mother is prescribed these medications after birth, while still breastfeeding, it is recommended that the risks to the baby and the benefits to the mother should be weighed before taking these medications.

Some medications are known to actually hinder successful breastfeeding; in fact the drug Fentanyl is one of these.

Pain Medications and Bonding

To put it simply, it is hard to bond with someone who is so drugged that they can't respond in a normal fashion to us. This is not to say that women who use pain medications in labor love their babies less, it is just harder to get to know them.

Babies who are exposed to pain medications during labor and birth actually spend more time away from their mothers in the first hours of life than their non-drugged counterparts. This is due to the aforementioned adverse effects caused by narcotics.

This article is not meant to be a scare tactic. It is simply meant to educate, and hopefully encourage research by pregnant women as to the medications used to relieve pain during labor and birth.

Drugs in Pregnancy and Lactation, 5th Ed
Maternal-Newborn Nursing, 7th Ed.
Medications and Mothers Milk, 12th Ed.
Varney's Midwifery, 4th Ed

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