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How do systemic medications work?
Systemic painkillers, such as narcotics, dull your pain but don't completely eliminate it. You may also be given a tranquilizer – alone or in combination with a narcotic – to reduce anxiety or nausea, or to relax you.
Systemic drugs are either delivered through an intravenous (IV) line to your bloodstream or injected into a muscle. They affect your entire body rather than concentrating pain relief in the uterus and pelvic area. They may make you feel sleepy, but unlike the general anesthesia that's often given for surgery, they won't make you unconscious.
You may also be able to use patient-controlled analgesia. In this technique, a pump is hooked up to your intravenous line, and you can self-administer pain medication when you feel it's necessary. The pump is programmed to limit the amount of medication you can receive, so the possibility of an overdose is very small.
What are the advantages of systemic medications during labor?
- Milder pain relief. Systemic pain relief may help if you can cope with some pain but need something to take the edge off and help you relax.
- Less invasive. It's easier and less invasive to be given an IV or an injection than it is to have an epidural or a spinal block, and it doesn't require an anesthesiologist.
- Lower risk for assisted delivery. Women using systemic medication are less likely to end up needing Pitocin or a delivery assisted with forceps or a vacuum than those who get an epidural.
What are the disadvantages?
- Less effective than epidural/spinal. In the doses commonly used for labor, systemic medication is much less effective than an epidural or a spinal block for pain relief. (The dose must be relatively small, because systemic medication crosses the placenta and can affect your baby.)
- Side effects. Systemic medication can cause a variety of unpleasant side effects, such as drowsiness, dizziness, and disorientation. Because of this, you'll have to stay in bed. Some of these drugs may also cause nausea and itchiness.
- Can slow labor. Sometimes, especially if they're given too soon, narcotics slow labor (compared to laboring without medication).
- Possible breathing issues. In large doses, narcotics can interfere with your breathing. (This very rarely happens, in part because it's unusual to get high doses of narcotics during labor. If it does happen, you'll need medication to reverse the effects of the narcotic.)
- Might affect baby's heart rate. Systemic pain medication can affect your baby's heart rate in such a way that your practitioner or labor nurse will have trouble interpreting the results of fetal heart rate monitoring.
- Baby's breathing may be impacted. Narcotics sometimes make it harder for your baby to start breathing on his own after birth, particularly if you've had multiple doses during your labor or you're given a relatively large dose within a few hours of delivery. For this reason, your practitioner will be stingy with narcotics late in your labor. Sometimes, though, labor will progress much more quickly than expected. If that happens, your baby will need medication to counteract the effects of the narcotic. If your baby is premature or otherwise at risk, your practitioner may recommend an epidural instead of systemic pain relief.
- Can make baby sleepy. Systemic narcotics may make your baby less alert at birth and may cause him to nurse less effectively early on, making your first attempts at breastfeeding more difficult.
What about nitrous oxide?
Nitrous oxide is another type of systemic pain relief, commonly used in Europe but increasingly available in the United States for labor. (It requires more intensive monitoring, and there are concerns about its environmental impact and the exposure of healthcare providers to ongoing trace levels).
Nitrous oxide doesn't provide complete pain relief, but it can take the edge off contractions. It's inhaled and self-administered, and, because it acts quickly, it can be used in any stage of labor.
Nitrous oxide doesn't affect the progress of labor or complicate early breastfeeding. It may, however, cause drowsiness and nausea. Later, memory of labor may be foggy.