The Risks (and Benefits) of Medications During Labor
Curious about the risks of labor medications like epidurals, opioids, and Pitocin? This post breaks down the most common options—plus their pros and cons—so you can make informed choices that feel right for your birth.
This post may contain affiliate links to products. I receive a commission for purchases made through these links, at no extra cost to you. Read my full disclaimer here.
About 70% of women in the US have an epidural at some point during labor. Many people wonder why that number isn’t higher—after all, why would anyone choose to go without pain relief during one of the most intense experiences of their life?
It’s a fair question. And while pain relief is a valid reason for many, there are also valid reasons why some women choose to avoid medications during labor. One of the most common? Concern about the potential risks—for both mom and baby.
This post takes a closer look at the most commonly used medications during labor: epidurals, opioids, synthetic oxytocin (Pitocin), and IVs. Each comes with benefits and risks, and understanding both sides can help you make the choices that feel right for your birth.
What Are the Common Medications Used in Labor?
There are a few categories of medications often referred to when talking about a “medicated birth”:
- Epidurals – local anesthetic to block pain from the waist down
- Opioids – systemic (whole body) pain relievers that reduce the sensation of pain
- Synthetic oxytocin (Pitocin) – used to induce or speed up labor
- IVs – while not technically a medication, they’re used to deliver fluids and drugs and often come with hospital protocols that make them a routine part of birth
The Benefits of Medications in Labor
While this post focuses mainly on risks, let’s start with the benefits—because there are some real ones.
Epidurals and Opioids
These are the most common forms of pain relief. Epidurals can provide near-complete numbness in the lower half of the body, while opioids can take the edge off contraction sensations.
For some women, this relief is key to staying calm and rested during labor. (It’s worth noting, though, that opioids don’t always offer full relief and may just dull the pain.)
Pitocin (Synthetic Oxytocin)
Pitocin can be used to induce labor or to strengthen contractions when labor slows.
It can be helpful when there are concerns about the baby’s health, or when a woman chooses to be induced for personal or medical reasons.
IV Fluids
Common in hospital births, IVs help prevent dehydration and allow for quick administration of medications in case of emergency.
Some studies suggest that a combination of IV fluids and drinking liquids—i.e. highest fluid intake—may lead to shorter labor and better hydration. (Unfortunately, no studies have been done comparing only using IVs to only taking liquids by mouth.)
The Risks of Labor Medications
Now let’s look at some of the potential downsides. Not every woman will experience these, but they are worth knowing as you make decisions for your birth.
Epidurals
Epidurals are a local anesthetic injected into the spine to numb the lower body. While often effective at managing pain, they’re rarely a standalone intervention. Receiving an epidural usually comes with:
- IV fluids
- Continuous fetal monitoring
- A blood pressure cuff
- A bladder catheter
These can limit your movement, often keeping you in bed and possibly slowing labor progress.
Potential risks include…
Longer labor: Limited mobility and the lack of gravity can make it harder for the baby to move down, sometimes contributing to longer labor or more challenging positions.
Higher chance of assisted delivery: Epidurals can make it harder to feel when and how to push, increasing the chances of vacuum or forceps use—or possibly a c-section. (And if you experience assisted delivery, the chance of a perineal tear is much higher.)
Low blood pressure and fever: Epidurals can cause drops in blood pressure, which can lead to dizziness and nausea for mom and may affect oxygen flow to the baby. Fever is also a common side effect and can necessitate antibiotics during labor.
Heavy motor block: Some women temporarily lose the ability to move their legs.
Breastfeeding challenges: Research is mixed, but some studies suggest babies born after an epidural may be sleepier or slower to latch initially.
Opioids
Opioids like Fentanyl, Demerol, and Morphine are strong pain relievers that enter the bloodstream. Unlike epidurals, they affect the whole body—and reach the baby, too.
Potential risks include…
Baby’s breathing and heart rate: Opioids can affect fetal oxygenation and may contribute to signs of fetal distress. In some cases, babies may need breathing support after birth.
Side effects for mom: These can include nausea, drowsiness, itching, and difficulty focusing.
Impact on breastfeeding: Babies exposed to opioids may be more drowsy, which can make early breastfeeding more difficult.
Epidurals = Opioids?
Unbeknownst to many, most epidurals contain both a local anesthetic and a small dose of an opioid. This combo helps manage pain more effectively, but it also means some of these same risks apply to epidurals as well.
Synthetic Oxytocin (Pitocin)
Pitocin is commonly used to induce or augment labor. While effective at creating strong contractions, it doesn’t work exactly like the oxytocin your body naturally produces.
How It Differs
Natural oxytocin is made in the brain and affects both your uterus and your emotional state—reducing stress and increasing feelings of connection.
Pitocin is given through an IV and doesn’t cross into the brain, so it lacks the calming effects of your body’s own oxytocin.
Potential Risks
The “fetal distress cycle”: Pitocin-induced contractions are usually longer, stronger, and closer together. This can increase stress on the baby, sometimes leading to heart rate concerns and recommendations for a c-section.
Hormone desensitization: High doses of Pitocin can reduce your body’s response to natural oxytocin. This matters because oxytocin plays a big role in postpartum recovery—helping the uterus contract and minimizing bleeding.
Increased risk of postpartum depression/anxiety: Some research has shown a potential link between Pitocin use and a higher risk of postpartum mood disorders. More studies are needed, but it’s something to consider as the existing research suggests a possible increase in risk of 32%.
Uterine rupture: Prolonged use of Pitocin increases stress on the uterine wall and can lead to rupture. While serious, uterine rupture is rare and is more likely in women who’ve had a previous c-section and are given Pitocin during a VBAC attempt.
What About IVs?
While IVs can be helpful in some situations, especially emergencies, they do come with downsides.
Mobility: Having an IV often limits movement, which can affect labor progress.
Fluid overload: Occasionally, too much fluid from IVs can lead to swelling or electrolyte imbalances. (You can find a fascinating breakdown of the consequences of this here.)
Many hospitals require IVs “just in case,” but some moms prefer to stay hydrated by drinking and avoid unnecessary interventions.
An Overlooked Risk: Pain After Birth
One risk that isn’t often talked about is how pain medications can sometimes shift pain from labor to the postpartum period.
Some labor pain is normal—and your body is designed to handle it with natural tools like endorphins. But when medication interrupts that process, it can sometimes lead to more pain after birth, like severe headaches, back pain, and urinary incontinence or retention.
It’s something worth thinking about: pain during labor serves a purpose and your body is built to cope with it, but unexpected pain after birth can make recovery and those early newborn days harder.
Final Thoughts
This post isn’t meant to scare or shame—it’s here to inform. Every woman has different needs, priorities, and preferences in birth. For some, medication is the right call. For others, avoiding it is deeply important.
Either way, being truly informed helps you walk into labor knowing what to expect and how to advocate for the experience you want.
If you’re leaning toward minimizing interventions, know that it’s possible—and that preparation, support, and understanding your options make a huge difference. Your body is designed for this, and with the right tools and mindset, you can step into birth with confidence.
Until next time,
Allison
READ MORE:
Things You Can Refuse During Labor
Why You Need a Support Person at Your Birth.
