Benefits Of Medications And Anesthesia
In a difficult labor, a small amount of medication can decrease some of the pain sensations and may aid relaxation, especially between contractions. You should realize, however, that an analgesic will not take away all your pain, although it may lessen it enough to enable you to better cope.
An epidural offers the most effective pain relief for labor, hence its popularity. If a woman previously had a cesarean after a long, hard labor and is afraid to attempt a vaginal birth, an epidural may give her the reassurance to go through labor again. For a woman who is delivering a breech baby vaginally, an epidural may provide both the pelvic relaxation and the anesthesia
that would be necessary if the use of forceps is suddenly required.
In a prolonged labor, Demerol, or another narcotic, may relax the cervix, helping to speed up labor. It may also provide some needed rest if the woman has been in early labor for many hours without sleep.
If an intervention such as the use of forceps or a cesarean section becomes necessary, a regional anesthetic can relieve pain, while allowing you to be awake for your baby’s birth. Epidural anesthesia also presents fewer risks to the woman and baby than general anesthesia does. In addition, after surgery, further pain relief can be provided by an injection of narcotics through the epidural catheter. This provides excellent pain relief for 24 hours without the disadvantages of repeated narcotic injections, intravenously (IV) or intramuscularly (IM). These disadvantages include drowsiness, intermittent pain relief, pain of an intramuscular injection, and transfer of the medication to the baby via the breastmilk.
Risks Of Medications And Anesthesia
When weighing the risks of accepting a medication or anesthesia, you must take many factors into consideration. While the dosage of a medication is geared to the woman, two individuals are involved, one much smaller than the other. All medications affect the fetus in one way or another. The American Academy of Pediatrics’ Committee on Drugs has warned that there is no medication that has yet been proven safe for the unborn child.
The fetus may be affected either directly or indirectly by medication used during labor or delivery. Both effects are highly influenced by the dose of the medication and the time it is given before birth. If enough time passes between the administration of the medication and the birth, much of the medication will be metabolized by the woman, thereby decreasing some of the side effects in the infant. But, if the baby is born while a large amount of the medication is in his system, his immature liver will have to excrete the medication on its own. Liver enzyme activity is immature in the fetus and newborn, taking 4 to 8 weeks after birth to reach adult capacity. In a premature infant, the effects of a medication are even greater.
The direct effects of medication on the baby include toxicity or alteration of the central nervous system, respiratory system, or temperature regulating centers, and change in muscle tone. The indirect effects are caused by a medication’s influence on the woman’s physiology. If the medication depresses the woman’s respirations or blood pressure, the infant receives reduced amounts of oxygen.
The use of a medication or anesthetic may increase the need for additional interventions. For example, oxytocin used during labor intensifies the contractions, thereby increasing the possibility of needing pain medication. Stronger contractions may decrease the amount of oxygen the fetus receives. Conversely, some medications slow down or prolong labor, thus increasing the need for oxytocin. Certain anesthetics dull the urge to push, which can increase the need for a forceps delivery.
The decision to accept or refuse medication is not an easy one. You must learn what is available, and then, if the need arises, you can choose the medication with which you are most comfortable. If you have an allergy to a medication, make sure you tell your caregiver, who should note it on your chart.
Also, before accepting any medication, ask, “What are you giving me?” If you are very sensitive to medication, tell your caregiver and ask him to order a reduced dose. If the smaller dose is not sufficient, you can always ask for more. If the dose is too strong, however, you may not be able to handle the contractions effectively. Remember, once a medication has been given, it cannot be taken back.