In a normal, uncomplicated labor and delivery, the use of medication is often unnecessary. Relaxation, breathing patterns, and other comfort measures can be very effective in combating the sensations of pain. The presence of a loving support person is probably the best tranquilizer available. In addition, the support given by the hospital staff and your caregiver may affect your need for medication. If you are given positive reinforcement (“You’re doing great!” “It’s almost over!”), are permitted to move about freely, and receive a minimum of medical interventions, you will probably experience very little need for medication. On the other hand, if you are frequently asked if you need something for pain, if you are made to lie in one position, or if medical interventions are used, you may have an increased desire for some type of medication.
Nature has provided its own painkiller for laboring women. Labor prompts the pituitary to release endorphins, called natural painkillers.
Endorphins are narcotic-like pain relievers that are said to be several times more potent than morphine. They produce a sensation of enormous pleasure after a tremendous exertion such as labor. Scientists have found that if a woman is given any kind of drug during labor, production of this natural painkiller is disturbed.
Knowledge of the labor and birth process can also enhance a woman’s ability to cope with labor. During labor, before you decide to take a medication, find out how far along you are. Even if it has been only a short time since you were examined, get checked one more time, just to make sure you are not progressing rapidly. If you are in transition, your labor is almost over and you may have just a few more contractions left before completing the first stage. By the time the nurse goes out, prepares the medication, and returns with it, you may have reached 10 centimeters and no longer need it. Medication taken at this time may make you sleepy, interfering with your ability to push during delivery and to bond immediately after birth, plus it may have a strong effect on the baby. If you request an epidural, it may take approximately 30 minutes to be administered and take effect, and you do not want to be numb for the pushing stage.
Before you go into labor, you should discuss with your caregiver which medications and types of anesthesia you will be offered if the need arises. You must also make sure that your labor partner is aware of your desires long before your due date arrives. Labor is stressful and is not the time to decide which medication or anesthesia is best for you. If you wait until you are in active labor or transition, you may agree to something that is really not acceptable to you.
Know your alternatives and how they will affect both your and your partner’s participation in the labor and birth. When you discuss medications with your caregiver prior to labor, or when you are deciding whether to accept a medication or any prescribed treatment during labor, you should ask the following questions:
□ How will this medication (or treatment) affect my labor, me, and my baby?
□ What are the benefits and the risks?
□ If I decide not to accept this medication (or treatment), what will happen?
□ Is there an alternative form of treatment?
Even though relaxation and breathing work extremely well for many women, some find that these tools do not provide enough relief of pain or promote adequate relaxation. You may want to try some of the other techniques suggested in section 5 on this website. Then, if you are still experiencing unbearable pain, medication or anesthesia is available. In a prolonged or difficult labor, some women feel they need medication to help them cope with their contractions. During a complicated delivery, in which forceps or a vacuum extractor is necessary, anesthesia may be beneficial. For a cesarean section, anesthesia is a necessity.
No one perfect medication exists for all circumstances. Since you cannot foresee what your labor will be like, except in the case of a planned cesarean, you must remain flexible in your attitude. Every medication and anesthetic has benefits and risks, and you need to be aware of them to make an informed decision. Only when the benefits outweigh the risks should you consider using a particular medication.