To drug or not to drug? That is the question...

January 27, 2008 6:48 PM

I want to hear from women who have given birth using narcotics and analgesics via IV as pain relief.

I am concerned about the risks associated with an epidural, not only with the risks associated with placing the epidural but also the risk of infection from needing to have a catheter placed. So for my impending labor and delivery in July I am re-thinking my pain management plan. My main concern is this is my first child, so I am anticipating a long labor, and I want to be rested and calm (as much as possible) to preserve my energy for the hard work.

In my life I have had some pretty painful events. I have fallen down the stairs and had a compression fracture (on a 0-10 scale, 4). I have suffered through appendicitis for about 12 hours (on a 0-10 scale, 7). I have had an ovarian cyst burst (on a 0-10 scale, 8.5-9). And I have had long, lingering, killer menstrual cramps for as long as I can remember (on a 0-10 scale, 3-7).

Any time I've been in the hospital, Demerol and/or Fentanyl have worked very well on me with no side effects. In all cases they cut the pain to a 1 or at least took the worst edge off. I am wondering if I will have the same experience with my labor and delivery. Did you have these types of medications for your labor and delivery? Would you do it again?

Also, I am curious if medications like Versed are ever used in the US for labor and delivery? I know Fentanyl has a sedative property. Is Versed too strong of a sedative for an active labor?

posted by FergieBelle to health & fitness (14 comments total)

Nubain is da bomb....I had demerol with my first, and that was okay, but I hear some folks get nauseated with it. I had nothing with baby number two, but with the third I was given Nubain (I guess that is how you spell it) and it would be my drug of choice were I to give birth again. Oh, and that labor was an INDUCTION so, double props to the nubain.

All this happened 20 or so years ago but I assume the meds are still out there.
posted by konolia at 7:22 PM on January 27, 2008

One thing to keep in mind is that your birth is probably not going to be anything like you expect, and whatever birthplan you make is likely to be irrelevant very quickly. It's not a process one is as much in charge of as one might expect.

That said, I have twice given birth without an epidural, the second time with grueling back labor and a galloping labor progressing so quickly I had no time to rest between contractions. Phew. Both times I did most of the labor with techniques I learned in birth hypnosis, which was very helpful for me for not freaking out during contractions and being able to rest (in my first labor, even sleep) in between them while in active labor.

My first labor lasted about 8 hours altogether and was not painful for the most part.

Toward the end of the active phase of labor for the second (hellish) birth, I had a dose of a narcotic pain reliever by IV. It helped tremendously in managing the pain and also in managing my emotions; by that time (about 4 hours in; it was a short labor overall) I was feeling pretty overwhelmed from the intensity of it. On the down side, it was given to me too late and my head hadn't really cleared by the time I started pushing; it made focusing to deliver a bit harder.

On the one hand, it helped; on the other hand, if I'd known I was going to deliver in another hour, I'd have soldiered on without it. One bit of advice that I was given that was very helpful is that your labor is likely to feel most overwhelming and impossible just before the pushing stage, especially if you have a dramatic transition stage, so the moment when you think, "I can't do this without drugs" might very well be near the end of the process. But of course YMMV.

The drug they gave me was called Nubain. I don't know the dose. I had no nausea or other troubles with it, and I am generally very sensitive to meds--if there's a side effect, I tend to get it.
posted by not that girl at 7:27 PM on January 27, 2008 [1 favorite has favorites]

I eventually had an epidural. I did about 3 months of hypnobirthing practice which carried me to a certain point, but after 24h of 3-5min contractions and no further dilation, my midwife suggested it. In my condition, that alone was enough to make me say yes. I did a fair amount of research beforehand, and also had two friends who'd had spinal headaches and/or back pain due to an epidural, but they were the minority. Far, far, far more people went on to have c-sects than problems with epis, so to me there were bigger fish to fry: I'm fairly anti c-section. That said, I've read that any intervention increases your chances for a c/s. So the name of the game was to do things as incrementally as possible if it came to interventions (including no monitors or internal exams unless there was a cause for concern). I think because the midwife anticipated another 10-12h of labor for me (it ended up being 10), she thought sleep would help everyone a lot and that the epi would allow for that. I don't know if that would have been possible with something like Nubain or Demerol--whether it would have dulled the pain enough to sleep. I know another concern with narcotics is the extent to which they pass to the baby, thus sedating him/her and slowing down labor. I had no side effects from the epidural, though pushing without sensation to guide me was very difficult, and went on to a vaginal birth (the only on the L&D floor that day of a busy city hospital).

As reference, I had kidney stones a year before pregnancy, and before childbirth would have said that was the most painful thing by far I'd experienced (including reckless offroad motorcycling accidents and menstrual cramps that I took prescription painkillers for). So kidney stones moved down to 9.5 and labor comes in at a 10 out of 10.
posted by cocoagirl at 7:52 PM on January 27, 2008

I had an epidural and Nubain with my first, and the only problem I encountered was being so comfortable that labor proceeded much more quickly than my doctor expected. The nurses very nearly did the entire delivery.

On my second, I only had an epidural, and it seemed a lot harder- those contractions that were dulled by the epidural were still very, very, very painful. But! I'd opted not to have the Nubain. Even though I've taken a lot of narcotics and barbituates for migraines, there was something about the Nubain the first time around that made me uncomfortable.

Perhaps because it was put into my IV rather than slowly taking effect from an oral dose, but the prickly heat that often comes with narcotics was almost instantaneous with Nubain. It was also really overwhelming- I briefly felt dizzy and disconnected. (Let's face it, I was high as a kite for a good five minutes or so.)

Even though my son had no complications, perfectly pink, perfect apgar, no stalled labor, I just didn't like the way the Nubain made me feel- not quite in control of the situation.
posted by headspace at 8:03 PM on January 27, 2008

I had fentanyl for a while, which probably would have worked reasonably well had the nurse controlling the supply not been an idiot.

I'd get a dose, she'd get lost. I and Mr Kmennie tried explaining to her over and over that going up and down was making things worse, not better, and it was important for me to get on top of the pain for a sustained period, after which I would be far less interested in the fentanyl. She indicated great understanding each of the seventy-two times we explained this, and kept disappearing each time it started to wear off. (Fentanyl being very short-acting.)

Eventually things (read:I) got very unpleasant, and she finally came out with the idea that I had a limited amount of Fentanyl available to me, and she was, you know, helping by spacing it out so it'd last longer. Jesus...

Er, sorry. Pay a lot of attention to not that girl's opening paragraph.

I think I had experiences with pain before giving birth similar to yours, and similar nice experiences with narcotics in hospital, but there was just no way the fentanyl, even if unlimited, would've done it. The epidural started looking like a godsend, and I got it. It didn't even work very well, and it was still a pleasure. IV insertion is way worse than getting an epidural set up.

That was a nightmare, hospital-harassed thirty-hour labour, though, so...so, I suppose the answer is 'Yes, narcotics are good and will take the edge off, so long as they are not administered by a bozo.' Well, that and that Fentanyl didn't work like it did when I had it when I was not in labour. There was no neat floaty feeling, no fun part, just dull, slight relief.
posted by kmennie at 8:07 PM on January 27, 2008

Just as a data point, I was given IV Fentanyl prior to my epidural (at a point when I had planned to forgo the epidural and "just take the edge off" with IV drugs even though I'd already been in labor for 24-48 hours). It was about as effective as a Tylenol as far as pain relief. I mean, it made me feel AWESOME but the contractions still hurt like a motherfucker. Hard to explain. Anyway, I ended up getting the epi and then a C. Classic.
posted by peep at 8:09 PM on January 27, 2008

I was given Nubain after my labor was induced with Cervadil. It was supposed to take the edge off and help me to sleep, but it just made me feel groggy and gross. I was given another dose later on in my labor, because I was delaying an epidural as long as possible to ensure it didn't slow things down. Again, I felt groggy and nasty. I ended up having the epidural at about 5cm, felt amazingly awesome (zero pain -- I actually thought my contractions had stopped), was able to nap, and progressed to 10cm within an hour. I don't plan on having any Nubain next time around.
posted by justonegirl at 8:45 PM on January 27, 2008

Consider getting a doula, to help you and your birthing partner work through all the questions that you're going to have to answer if you go into labor with any specific ideas of what type of medication you are willing to be given. Obviously you'll also speak to your midwife or doctor in advance, but they won't necessarily be there when it's time to get drugs and you may not be in a position of advocating for yourself. L&D nurses can be, and usually are, fantastic, but someone who is well-educated in the ins and outs of childbirth, who has a huge bag of tricks for helping women and their partners through the process, and who has the hospital situation totally wired in a way that a first time mother can't possibly.

A doula is trained to help you get the best possible birthing experience no matter what curves it throws you. Check dona.org for more information.
posted by padraigin at 9:01 PM on January 27, 2008

I had Nubain with my first labor. It damped the pain a bit and it took me into a sort of doze that I could still feel the contractions quite hard but I couldn't really react to them. I didn't like how it felt. It only lasted less than two hours. I wouldn't use it again. With my second labor, I tried for a homebirth, and I was offered nitrous at home and at the hospital. It did not affect me at all, but other women told me it helped them dull the edges of the pain effectively. It seems commonly offered here (Canada) but I don't know about in the US.

I was scared to get an epidural for similar reasons to yours, plus I really hate needles. After almost a day and a half of labor (back labor, he was facing up and never turned down) I was afraid I'd be too tired to push once the baby finally came and I (very reluctantly, but in a great deal of pain) asked for one. I didn't even feel the needle/insertion, the hardest part at that point was holding still long enough for the anesthetist to do it (getting the IV when I checked-in to the hospital was actually worse!). I had no pain at all after it was in, and my labor progressed quite fast after that; I was able to push without issues.

I had epidurals with my second and third deliveries as well with similar experiences. My body seems to be very tense and slow to dilate until I get the epidural, then it relaxes and everything moves fast. I did have some strange back pain at the epidural site, like a sort of weakness and intermittent twinging pain, after my third delivery. That lasted a couple weeks. I still get flashes of it (almost seven months later) but I think I probably just need to go and get an adjustment from the chiropractor.

I have heard stories like mine in that the epidural made labor go faster, and I have also heard epidurals slowing down labor to the point more intervention is necessary (C-section; this is one thing I was worried about, so I held out until I honestly just couldn't take it any longer). I have not heard of anyone getting an infection, or having anything other than the back pain I got, although I have heard a couple women tell me their epidurals didn't "take", i.e. it did not make labor pain-free, although it did cut some of the pain.

Oh, also, my experience with epidurals is that they can make the baby pretty sleepy and not want to nurse for some time after the birth. My babies were quite big, almost 9 lbs, so this wasn't an issue for the most part. My first two didn't really nurse for almost a full day after delivery. It bothered the nurses a lot the first time but I found a study saying that it was common so I knew not to worry about it with the second.
posted by Melinika at 11:20 PM on January 27, 2008

I had to have a c-section- so I had the IV narcs- obviously there was no pushing for these to affect- but for what it's worth- my son was fine and alert and did not show any adverse effects. I nursed him right away continued to nurse for the 3 full days that I was on strong pain killers (morphine and then percoset)- no adverse effects whatsoever.

I had catheters - no infection. I'm not sure if you are referring to a urinary catheter or the catheter that is used for epidural med delivery- but I had no infection or problems with either one.
posted by mistsandrain at 5:56 AM on January 28, 2008

I'm going to sing the praises of medicated deliveries until the day I die. For my daughter's delivery in 2002 I was induced & given Nubain after I had my first contraction & felt no pain thereafter. One of my main concerns was not being able to remain completely still during the epidural if I was having a contraction so Nubain took care of that for me.

I had an epidural at 4 cm, fell asleep right after & they woke me a couple of hours later to tell me it was time to push. I pushed for about 20 pain-free minutes & then out she came. No screaming, no cussing, no thrashing about. It was a beautiful, easy delivery thanks to drugs. I was alert, calm & at ease the entire time. The drugs made it all very surreal because I knew what was going on but I couldn't feel any of it.

I do not remember having any ill side effects. I was up moving around within an hour & nursed my daughter from the get-go. I did not have any complications from my epidural or the Nubain.
posted by peacelovecoffee at 6:37 AM on January 28, 2008

I was induced and did not feel any contractions until my doc broke my water. The third contraction after she did so was sudden and horrible PAIN. I had never felt any Braxton Hicks and was completely unprepared. I was given Nubain and that helped for about 2 hours. I could still feel the contractions. They were uncomfortable but not debilitating. When the Nubain stopped working, I asked for an epidural even though I had planned to not have one. After about 5 hours of pushing, I ended up having a C-section because my son was so big his head got stuck on my pelvic bones.

My experience was nothing like I had planned and hoped. However, it was still a positive experience. The staff was great. It was all calm and supportive. Ok, except for the part where I was gripping my husband's shirt so hard I pulled out some chest hair as I calmly told him "GIVE ME DRUGS!"
posted by onhazier at 7:09 AM on January 28, 2008

And I'm going to sing the praises of a fear-free birth experience until the day *I* die. Drugs, no drugs, epidural, doula, hypnosis, music, whatever. It's all about eliminating fear. Evolution is a marvelous thing. As has been discussed both in the blue and in the green, fear or upset really slows down labor - your body doesn't want you to give birth if there's a potential threat nearby. So: whatever YOU have to do get unafraid and calm and stay that way, do it. For me, reading lots of powerful birth stories, finding the right doula, getting present to how badass my fat, stubby body was, and not even telling anyone we were at the hospital until after the baby was born did the trick. I had privacy, power, support, and a well of positive stories to draw from.
Do whatever you need to do to create a safe place for yourself and your baby and it will all work out.
posted by pomegranate at 7:10 AM on January 28, 2008 [8 favorites has favorites]

I jsut wanted to pop in to say that I have had horrible menstrual cramps since I was a teenager (literally passing out from the pain) and I was extremely worried I could not give birth without it being a horrible experience but after three pain-free natural births (at home with midwives but no doulas) I no longer have that fear with this pregancy. I am not sure why menstrual cramps (which I always thought were the same as labour contractions) are painful, I wonder if it is because the uterus has nothing to contract against? I just wanted to throw out that anecdote in case you were also basing your expectations on your cramping. This has been a very imformative thread. I love hearing each womans personal birth stories because they are all so unique. Good luck with your birth!
posted by saucysault at 5:52 PM on January 28, 2008