Anesthetics And Drugs During Childbirth

Until the mid-nineteenth century, childbirth was a completely natural experience, in which women would endure the tiresome pain of labor without the use of anesthetics or drugs to get her through birth (Hyde & DeLamater 2014). The use of anesthetics and drugs during childbirth was a controversial topic then and even to this day, with women outweighing the short-term and long-term costs and benefits of the drugs on themselves and on their children. While natural childbirth is still an option chosen by some, there are now many options to reduce the pain of labor and to ease the tension of the mother through anesthetics and drugs such as tranquilizers, narcotics, regional, local, and general anesthetics, and natural methods to control pain and
tension. Tranquilizers, such as Valium are one option for woman in labor who are having a particularly difficult time with labor and childbirth. They are given when labor gets very tough for the woman although they do not get rid of the pain and last for a few hours (Mayo Foundation for Medical Education and Research 2006). The purpose of tranquilizers is more to relax the mother and ease her tension (Hyde & DeLamater 2014). They may also provide relief from nausea and vomiting for some and have other side effects including dizziness, confusion, and change in blood pressure (Eden 2006). While these effects may seem minor on the mother in comparison to the benefits of relieving tension, the baby may also be affected by the tranquilizers because the medication may make its way through the placenta, resulting in possible loss of muscle tone and activity at birth as well as a lowered fetal heart rate (Eden 2006), which is a sign of fetal distress. Narcotics given through intravenous fluid, injection, or pump may also help alleviate pain in a woman who is going through labor and childbirth. These types of drugs are also known as “opiates” and may be used interchangeably. Narcotics work during labor by reducing anxiety and tension in the mother; they do not reduce pain or feeling of the mother (American Pregnancy Association 2015). Since they do not actually reduce pain or feeling by numbing the woman from the waist down such as epidural anesthesia or spinal anesthesia for example, which will be discussed later, it does not prevent the woman from pushing the baby out of her vagina, make the process of giving birth more difficult, or slow down the process of labor. This may be a good option for woman who want to ease their tension in labor, but do not want interference with the actual process of giving birth in terms of being able to use their strength effectively. However, there are some potential side effects of opiates to the mother and baby since they can go through the placenta to the child just as other drugs can.
Some short-term effects on the mother may include dizziness, nausea and vomiting, and even sedation where the woman may fall asleep from the drug (American Pregnancy Association 2015). Some other side-effects include respiratory issues that can limit oxygen flow throughout the body and a decrease in gastric motility, which is usually lowered in woman who are going through labor to begin with (American Pregnancy Association 2015). Due to these respiratory effects on the mother, opiates may also have negative respiratory and breastfeeding effects for a short time after birth on the baby in which another drug may need to be given to the mother to counteract the effects of opiates (American Pregnancy Association
2015). A few common narcotics include Demerol, Stadol, and Fentanyl. These all work very fast after administered; however, they all may cause nausea, sedation, and breathing difficulty in the baby once born because they can pass through the placenta and affect the baby and can also affect the mother’s respiratory rate (American Pregnancy Association 2015). Local and regional anesthetics are one of the most common anesthetics used and only numb one part of the body. These include local infiltration, a pudendal block, and a paracervical block. Local infiltration involves numbing the perineum, commonly with Lidocaine during the second stage of childbirth for example, which is the area between the vagina and the anus where an episiotomy may be performed by making an incision in this area to help ease the baby out during delivery (Eden 2014). The downside to this is that it only numbs the spot in which the drug was injected so woman still experience the pain of contractions and other pains associated with delivering her baby (Levine 2012). Also, while side effects are generally rare for local infiltration of the perineum, it is possible for the drug to come in contact with the baby and therefore cause poisoning (Levine 2012). A pudendal block again only numbs a certain portion of the body through injection to that specific part. This portion is typically the birth canal during the second stage of childbirth and “it works specifically on the pudendal nerve, which carries pain signals from the perineum (birth canal and surrounding tissues) to the brain” (Levine 2012). The risks typical for any drugs given to the mother during pregnancy is that it can cross through the placenta and affect the baby, especially the fetal heart rate and a higher amount of medication is usually needed for a pudendal block to take full effect (Eden 2014). Paracervical blocks are not commonly used due to their high drug dosage and frequent negative effects on the baby, specifically bradycardia which is an abnormally slow heart rate (Eden 2014).
The anesthesia is administered through injection into the cervix and is especially helpful in relieving pain from cervical dilation because it is given during the first stage of labor and can also be administered frequently (Levine 2012). In rare cases due to the need for the mother to be conscious in delivering her baby, general anesthesia may be used, although it poses a dangerous threat to the health of the mother and her baby. General anesthesia is administered to the mother through both intravenous fluid and also through inhaling the drug, such as nitrous oxide (Levine 2012). The drugs work very fast and are effective especially in the case that there is an emergency cesarean section or breech birth because they put the woman completely out of pain, usually causing the woman to be put to sleep (Levine 2012). Although general anesthesia completely puts the mother out of pain, it can have very harmful effects on her and her baby. The doctor may have trouble or be unable to put in a breathing tube and in the event of aspiration, the drug can be very toxic and cause brain damage (Levine 2012). Small doses and precautions should take place because the drug may also affect the baby by causing respiratory depression (Levine
2012). The most commonly used anesthetic procedure during childbirth is epidural anesthesia (American Pregnancy Association 2015). This is also said to be the most effective type of anesthesia for pain relief in the mother (Buckley 2014). The procedure for epidural anesthesia involves injecting a local anesthetic into the area around the mother’s spinal cord to numb the lower part of her body, specifically from her stomach to her thighs (Hyde & DeLamater 2014). This