LABOR & CHILD BIRTH Labor and birth is one of the most memorable moments in a parent's life. Learning to work your way through can help you enjoy the experience and relax. This section helps you prepare better for this experience.

Labor and Child Birth

Pain Relief with Medication

INTRAVENOUS INJECTIONS OF ANALGESICS:

OPOIDS

This is the most frequently used analgesic especially if epidural is contraindicated or not available. But since increasing doses can cause side effects in the mother and child, it can be used only in low doses and so is a pain reliever only in the first and early second stage of labor.

Side effects on the mother:

• Sedation - It may make you very sleepy and dizzy
• Respiratory depression
• Orthostatic hypotension
• Nausea and vomiting
• Delay in the gastric emptying time

Side effects on the baby (since all opoids can cross the placenta)

• Decreased APGAR scores
• Respiratory acidosis
• Abnormal response in the baby after birth
• It crosses the placenta and may affect your baby's breathing
• Your baby may need to have an injection as soon as she is born to reverse the effects of the pethidine in her system
• She may be very sleepy for a few days and might not be interested in feeding

In spite of this, it is the most widely used method of analgesia.

PETHIDINE (MEPERIDINE)

Usually given either intramuscular (50 -100 mg) or intravenous (25 -50 mg), it starts acting after 40-50 minutes or 5-10 minutes respectively and its action remains for 2-4 hours. The delivery should be done fast after this injection to avoid fetal depression after 2 hours.

When should I have Pethidine?

It is given in the first stage of labor when the cervix is dilating.

It can cause good pain relief only in early pregnancy and the side effect profile is same as all opoids.
 
FENTANYL

This is also an opoid derivative with a peak action within 30 minutes and lasting 30 - 60 minutes. The last dose is given 2 hours before delivery.

MORPHINE

If used judiciously, it provides excellent analgesia with minimal maternal and neonatal side effects. Its effect contrary to the other drugs can last for 5-6 hours.

DIAMORPHINE

Intramuscular diamorphine or heroin is used extensively but there is limited data on its efficacy.

REMIFENTANIL

Potent short acting opoid is as good as 505 nitrous oxide and as effective as pethidine. It can be used widely.