Medications in Labor

For the majority of women, labor is a natural process that requires only a safe environment, emotional support, patience, and trust in the process of birth. Medications in labor are not without risks to both the mother and her baby. Despite the fact that nearly 90% of women receive some type of medication during labor in the United States, this does not imply that they are necessary or even beneficial for every labor. Much evidence exists demonstrating how interference in the process of labor with one medication quite often necessitates further interventions requiring more medications, and so on, even leading to forceps/vaccuum assisted deliveries and increasing the need for surgical deliveries. However, some situations, such as a malpositioned baby or medical complications requiring restriction of the mother's mobility during labor make labor abnormally painful or cause the progress of labor to stall. There are responsible uses of both pain medications and other common drugs to correct abnormal progress of labor. Learning about these medications can help you make informed decisions regarding the risks and benefits in your individual situation.

Note: The information on this website should not be interpreted as medical advice. All of the information compiled here has been referenced where possible, and as with any information obtained from the internet you should verify the information for yourself. If you have questions please consult your health care provider.

There are several categories medicines used in labor fall into. These can be generalized into the following:

• Prostaglandins
  ex. Cervadil (dinoprostone), Prepidil (dinoprostone), Cytotec (misoprostol)
  These drugs are used to soften the cervix in preparation for labor induction. In some cases these drugs can be used alone to artificially stimulate uterine contractions. In other cases, they are used in combination with other medications.
• Uterine Stimulants
  ex. Pitocin (oxytocin)
  Pitocin (synthetic oxytocin) is used most commonly to stimulate uterine contractions, either for the purpose of artificially inducing labor, or to augment or strengthen contractions in spontaneous labor. It is also used commonly following the birth of the baby to control postpartum bleeding or prevent/treat postpartum hemorrhage. Other uterine stimulants such as Methergine (ergonovine) or Hemabate (carboprost) may also be used for postpartum hemorrhage.
• Narcotic Analgesia
  ex. Demerol (meperidine), Stadol (butorphanol), Nubain (nalbuphine)
  Narcotics are commonly administered for pain relief and sedative effects during labor. These drugs are all opiates and quickly cross the placenta and can affect the fetus, so they are not usually given close to delivery because of the risk of respiratory depression in the infant. If a baby is born shortly after the administration of one of these drugs, s/he may require respiratory support or the administration of Narcan (naloxone) to counteract the narcotic.
• Regional Analgesia/Anesthesia
  Usually a combination of an opiate analgesic (commonly Sublimaze (fentanyl) or Sufenta (sufentanil)) plus an anesthetic agent such as Marcaine (bupivacaine) or Naropin (ropivacaine)
  Regional pain relief is achieved by injecting medications through a needle inserted into the area surrounding the spinal nerves. This can be done either by injecting medication through a needle into the fluid surrounding the spinal cord, the intrathecal space (a "Spinal"), or via a catheter inserted into the space surrounding the fluid, called the "Epidural Space." There is also a method that combines these two options called a "Combined Spinal-Epidural (CSE)" which is done to provide pain relief more quickly, while allowing further doses of medication to be administered via the epidural catheter later in labor.