How great is it that we live in a world of modern medicine, with knowledge and resources readily available to help us when we are in pain and when we are sick? It's a blessing to live in a time where medical technologies are advanced and doctors and nurses are skilled and able to save lives!
How does this fit in with birth though? Culturally speaking, in America, women prefer to have medications and epidurals during labor to ease some of the discomfort that comes along. One study put out by the CDC in 2008 reports that 61% of women use an epidural or a spinal during labor, and medicated births are more and more becoming the norm. Of course, there are women who want to have an unmedicated birth in hospitals, birth centers, and home births, and this is possible. But today I want to give a brief overview of various medications given during birth for pain management and other reasons to help us better understand what is offered, why, and the possible implications for the mother and baby.
There are many options available to manage pain during labor, details about those options will come in a future blog, but for now I want to give a brief introduction to what is available.
Medicine names: Fetanyl, Epidural, Lortab (Hydrocodone/Acetaminophen), Morphine, Nubain, and Percocet (Oxycodone/Acetaminophen).
Possible side effects: Confusion, delirium, constipation, dizziness, drowsiness, rash/itching, upset stomach, hypoxia (inadequate supply of oxygen). For Epidurals there is a risk of sudden blood pressure drop, severe headache, and longer pushing stage.
How might it affect my baby? Opiates can cross the placenta and impact your baby in the following ways: central nervous system and respiratory depression, impaired early breastfeeding, altered neurological behavior, and decreased ability to regulate body temperature.
Used to treat or prevent infections and they are typically given when the mother is GBS+, 24 hours after ruptured membranes, or the presence of fever, and they are recommended by ACOG and American Academy of Pediatrics in these cases.
Medicine names: Amoxicillin, Ampicillin, Azithromycin, Cefazolin, Clindamycin, Erythomycin, Gentamicin, Penicillin, Vancomycin, and Zidovudine.
Possible side effects: Diarrhea, headache, rash, flushing, and upset stomach.
How might it affect my baby? We see the increased chances of thrush and yeast infections, and antibiotics impact the bacterial colonization of the newborn baby which has been shown to increase the risk of other infections and resistance to antibiotics in the future.
*The following antibiotics are considered unsafe to take during pregnancy: Bactrim Ciprofloxacin Doxycycline Furadantin Macrobid Macrodantin Minocycline Septra
Queasiness or Throwing Up
Most common during the transition phase (7cm-10cm), as a result of an epidural, or from pain.
Medicine names: Metoclopramide, Zofran, Compazine, and Phenergan.
Possible side effects: Confusion, dizziness, drowsiness, and headache.
How might it affect my baby? They are safe to use during delivery, but some studies have shown that use during the first trimester can increase the risk of a cleft palate.
An induction may be brought up by you or your doctor for the following reasons: health problem such as diabetes, placental abruption, infection, water breaks but contractions do not begin, pregnancy lasting more than 42 weeks, or a baby growth problem.
Medicine names: Cervidil, Cytotec, and Pitocin (Oxytocin).
Possible side effects: Headache, queasiness, vomiting, risk of bleeding, stronger contractions, and increased risk for postpartum hemorrhage.
How might it affect my baby? These medications can lower the baby's heart rate, if baby's head is still high there is a risk of umbilical cord prolapse, and baby may turn breech - although these are more risks associated with induction and not the medications themselves.
Stop or Prevent Contractions
There are some reasons that your doctor may want to stop labor if your body starts it naturally, some of these reasons include: placenta previa (if still around at the end of pregnancy will require a c-section), premature labor, when you are expecting multiples, or a short umbilical cord (<35 CM).
Medicine names: Indocin and Procardia
Possible side effects: Headache, rash, swelling, upset stomach, blurred vision, and tinnitus (ringing in your ears).
How might it affect my baby? Usually these medications are given to help the baby, so risk and reward need to be discussed with your doctor. However, some side effects to your baby could include: bleeding in the heart, high blood pressure, kidney problems, jaundice, certain types of brain injury, and necrotizing enterocolitis.
Stop or prevent bleeding
Postpartum hemorrhage is excessive bleeding after the birth of a baby and most commonly occurs after the placenta has been delivered, PPH occurs in 1-5% of women. Pitocin is the "go-to" medication to prevent and stop bleeding, but if it's ineffective doctors may try the other medications available.
Medicine names: Carboprost, Methylergonovine, Cytotec, and Pitocin.
Possible side effects: Diarrhea, headache, upset stomach, mild fever, chills, cramping, breast pain, and tinnitus.
How might it affect my baby? These are given after the baby has been delivered.
Blood thickens during pregnancy to protect women from hemorrhaging during delivery, but this also increases the risk of developing blood clots. Depending on individual health and history it may be necessary to take blood thinners during pregnancy and/or labor.
Medicine names: Levonox and Heparin
Common side effects: Redness or bruising at injection site, swelling in hands and feet, and fever.
How might it affect my baby? These medications do not cross over into the placenta and out of all the anticoagulants these are considered the safest for women to take during pregnancy.
Diarrhea is a common early sign of labor, but not everyone's bowels will clear about before labor begins, and some women have so many bowel movements that they risk dehydrating. It's important to talk to your provider if you worry there is "too much" or "too little" movement going on.
Medicine names: Lomotil, Colace, Fleet Enema, Milk of Magnesia.
Possible side effects: Diarrhea and stomach cramping (the things we are hoping to take care of!), lethargy, confusion, and loss of appetite.
How might it affect my baby? Lomotil is opiate like and should be used under the direction of a provider as it is excreted in breast milk and the implications to a baby are unknown at this time. The other medications are generally safe during pregnancy and labor.
Lower Blood Sugar
If you have diabetes it is likely that your birth team will be closely monitoring your blood sugars while in labor by checking once an hour. If your sugars are too high leading up to your baby's birth it can increase their glucose levels and upon delivery they can have a sudden drop in sugars causing hypoglycaemia, so it's important to have your sugars in a healthy range.
Medicine names: Insulin and Metformin.
Possible side effects: Diarrhea, low blood sugar, headache, flu-like symptoms, and itching.
How might it affect my baby? These medications do cross into the placenta but they affect baby's in different ways. Women taking Insulin tend to have a heavier placental weight and larger babies and women taking Metformin tend to have more preterm labors.
Low Blood Sugar
Hypoglycemia can leave you feeling tired, hungry, and even sick, which is not how you want to feel during labor! But low blood sugar can also impact babies in the first few days after they are born, so it's important to monitor blood glucose levels throughout pregnancy and during labor (especially in women with diabetes).
Medice names: Hydralazine, Labetalol, Magnesium, and Procardia.
Possible side effects: Dizziness, drowsiness, and headache.
How Might it affect my baby? These medications do cross the placental barrier and pass into milk but the American Academy of Pediatrics says they are safe during pregnancy and labor, depending on dose your doctor may recommend a slight delay from taking the medication to when you breastfeed (3-4 hours).