Medications available during Stage I
Tranquilizer
Phenergan®
Given by injection; generally takes effect in 15 to 20 minutes and lasts about three to four hours; aids in muscle relaxation; may cause drowsiness; when used with a narcotic, a tranquilizer can enhance the effect and decrease the dosage of narcotic needed.
Narcotics
Demerol®, Nubain®
Given by injection either into the muscle (Demerol) or intravenously (IV) (Demerol, Nubain). When given intramuscularly, takes effect in 15 minutes and lasts about three to four hours; when given IV, takes effect in about five minutes and lasts one to one and a half hours; aids in muscle relaxation; decreases perception of pain; causes drowsiness and euphoria (high); not given within two hours of delivery because it can cause the baby to be very sleepy and to breathe too slowly.
Continuous epidural block
Given during labor and continued until after delivery. For most women, an epidural can provide good relief while the cervix is dilating . However, this is individualized, some only obtain partial relief.
To insert a continuous epidural, the anesthesiologist will inject small amount of local anesthetic to numb skin at the puncture site. A needle is inserted between the vertebrae into the epidural space outside of the spinal canal. This is injected below level of spinal cord and does not go into or near the spinal cord. A thin, plastic catheter is then threaded through the needle about 2 1/2" into the epidural space, outside the membrane. The mother may feel twinge or electric shock sensation in her leg; this is normal. A small amount of medication will be injected to make sure there are no adverse reactions. After 60 sec. the full dose will be given. It takes about 15 minutes for an epidural to become effective.
Usually, the anesthesiologist starts with a low dose which can be increased if necessary . This decreases the risk of side effects for mother and baby. The medication will infuse continuously. In addition, the mother will be given a button to push in order to occasionally give herself a "bolus" of medication if necessary.
Usually, the mother will feel no pain with contractions, although she may feel a pressure sensation, especially in transition. She may be numb from the umbilicus to the top of the thighs. She can usually move her legs; although sometimes her legs may feel weak. She may not feel the urge to void.
Since blood pressure can sometimes decrease temporarily, the blood pressure will be monitored carefully with an automatic blood pressure cuff the entire time the epidural is in. To prevent a decrease in blood pressure, the woman is usually left lying on one side or the other after the epidural is inserted. If the B/P does decrease, the anesthesiologist or nurse will increase IV fluids, and may give the mother some oxygen or some medication to increase the blood pressure.
Medications available during Stage II
Local block
Used for episiotomy or for repair of episiotomy or lacerations after delivery. Given by obstetrician in area of the episiotomy; numbs the perineum (area between vagina and rectum); takes effect in five to 10 minutes; lasts about one hour; does not interfere with urge to push.
General
Given by anesthesiologist; causes unconsciousness; generally not used for vaginal deliveries because it can cause the baby to be drowsy and to breathe too slowly; safe for emergency Caesarean deliveries because the delivery is accomplished quickly and minimal medication reaches the baby.
Continuous epidural block
Although given during labor, it can be reinjected with a larger dose to provide anesthesia for a Caesarean delivery.
Spinal block
Given by the anesthesiologist for a Cesarean birth; medication injected into spinal fluid; generally takes effect in a few minutes; lasts one to two hours; the woman is numb from under her breasts to her toes; spinal headaches are possible but rare.
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Last Updated: September 28, 2009