Pregnant women often hope for a drug-free childbirth. But it's not the only way to have a healthy baby. Whether they planned it or not, many women end up taking some type of medication during the birthing process. Some drugs help start or speed up labor; others ease the pain from contractions. Before you go into labor, you should talk to your doctor about different medication options.

Many babies need a little encouragement to get out into the world. If your baby is two weeks or more overdue, your doctor may suggest inducing labor. At this point, your baby may be getting too big for the confines of the womb, and she might not be able to get all of the nourishment she needs. Further, there is a risk of stillbirth at the 42-week mark. Your doctor may also recommend inducing labor if your water breaks before you go into labor or if you have high blood pressure, diabetes, a serious infection, or another condition that could threaten you or your baby if the pregnancy continues.

The two types of medications commonly used to encourage labor are prostaglandins and Pitocin (oxytocin). Both of these are copies of hormones naturally produced by the body.

Prostaglandins help soften or "ripen" the cervix in preparation for labor. If your cervix hasn't ripened naturally, your doctor can apply a prostaglandin gel (brand name Prepidil) or suppository (brand name Cervidil) through your vagina to the cervix.

If administered correctly, prostaglandins are generally considered safe for both the mother and baby but should not be used by women who have already had a caesarean section or uterine surgery, such as the type to remove a fibroid tumor. Prostaglandins can also make you nauseous and cause vomiting or diarrhea.

After the cervix has softened and opened up a bit -- either naturally or with the help of medications -- it's time for contractions to start. Again, doctors can use medications to speed up this process. In this case, the drug of choice is oxytocin, which is delivered through an IV. Doctors have been prescribing this naturally occurring hormone to induce or speed up labor for nearly 100 years, and it is now the most commonly used drug in the entire field of obstetrics. Oxytocin does not pass through to the placenta, so it has no direct effect on the baby. It can, however, cause overly strong contractions that can put your baby under stress. For this reason, a nurse or doctor will carefully watch your baby’s heart rate for any signs of distress.

If the hormone fails to start labor or if the contractions become too strong, you may need a caesarean section.

Caution: Some doctors have prescribed the drug misoprostol (Cytotec), a synthetic drug that mimics natural prostaglandins, to induce labor, but the US Food and Drug Administration has not approved Cytotec for that purpose. The FDA recently issued an advisory warning that Cytotec can cause uterine rupture, which the agency says "can result in severe bleeding, hysterectomy, and/or maternal or fetal death."

Folklore is full of methods other than medication for inducing labor, from sexual intercourse and hot baths to herbal teas. Some of these options aren't completely far-fetched -- sexual intercourse, for example, triggers the natural release of oxytocin. There are also prostaglandins in semen, which may help ripen the cervix and encourage labor. Another thought is that orgasm may trigger contractions. But none of these methods has been scientifically proven to speed up labor or delivery.

Once labor actually starts, women have a new set of needs. Above all else, they may need some help coping with the pain. The most popular choice for pain relief during delivery is an epidural block, also called simply an epidural. In this procedure, an anesthesiologist injects a numbing medication such as ropivacaine (Naropin) or lidocaine (Xylocaine) near the nerves in your lower back. This will block the pain but keep you alert and able to participate in the baby's birth.

Epidurals can have their drawbacks. For one, you may not be able to push as hard as usual. As a result, there's a greater chance that your doctor will have to use forceps or another device to pull your baby out. Also, you may not be able to walk around after the drug takes effect. Increasingly, however, laboring women are choosing something called a "walking epidural," which allows them to maintain enough muscle control to push and even to walk around. With the walking epidural, a narcotic such as Fentanyl is used, providing good pain relief without interfering with a woman's mobility.

With an epidural, your doctor or nurse may have to insert a catheter so you can urinate. The epidural can cause some unpleasant side effects, including headaches, dizziness, and itching. If pain medication gets into your baby’s system, his reflexes and breathing may be unusually slow at birth. The doctor can give him medicine to counteract these effects.

In recent years, doctors have found ways to reduce the complications of epidurals. Some hospitals also offer "patient-controlled epidural analgesia," which means the woman can control how much anesthesia she gets with the mere push of a button. Such innovations can give women pain relief without compromising their ability to push.

Another approach to pain relief involves an injection in the vagina shortly before delivery. This procedure, called a pudendal block, won't ease the pain of contractions, but it can relieve pain around the vagina and rectum at the end of a delivery. This type of pain relief may also be given before an episiotomy, a procedure where a surgeon makes an incision to widen the birth canal. A pudendal block will not affect your baby.

Many women receive narcotic drugs during delivery, sometimes in combination with an epidural. Drugs such as nalbuphine (Nubain), butorphanol (Stadol), and sublimaze (Fentanyl) effectively block pain throughout the entire body. The drugs are generally injected or delivered through an IV. They may slow the baby's breathing at birth, especially if he or she is born soon after the drug is delivered. Nalbuphine can cause withdrawal symptoms in women who are already addicted to drugs. Nalbuphine has also been associated with severely slowing fetal heart rate and causing permanent neurological damage. Butorphanol is a better choice for such women. Women having a caesarean section receive either an epidural or spinal anesthesia .

Every woman's labor is different, and no one can truly anticipate what she'll need. Even women planning a drug-free childbirth often find it comforting to know that doctors have many options for making delivery safe and (reasonably) comfortable.

-- Chris Woolston, MS, is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive and was a staff writer at Hippocrates, a magazine for physicians. His reporting for CHI on occupational health earned him an award from the Northern California Society of Professional Journalists.

References

First published February 3, 2005
Last updated January 30, 2007
Copyright © 2005 Consumer Health Interactive

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