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Medications During Labor: Is It Worth the Risk?

Medications can make labor more comfortable, but they aren’t without risk. This blog post explains the risks of epidurals, opioids, synthetic oxytocin, and IVs during labor so that you can make a truly informed choice about your birth.

epidural and IV medications during labor

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About 70% of women in the US have an epidural at some point during labor. Many people wonder why that number isn’t 100%. Why would anyone want to go without pain relief while giving birth, they wonder?

Well, the pain of childbirth is a whole subject on its own. But there’s validity to the people’s question: why would anyone choose to go without an epidural or other pain medications during labor?

In short, it’s because medications come with risks – to mom and baby – that women want to avoid. And that’s exactly what this blog post is all about.

The Medications of Labor and Birth

You might be unsure which medications people are referring to when they talk about unmedicated labor. In a general sense, there are four:

  • Epidurals, 
  • Opioids, 
  • Synthetic oxytocin, and 
  • IVs.

“Opioids” is a category that includes a few different medications, but they all have pretty much the same benefits and risks so I lumped them together.

IVs aren’t technically a medication. But they are used to administer fluids and medications and they too can have risks that make them undesirable for many women, so I included them in this blog post.

Benefits of Medications During Labor

Before getting into the risks of each category, I do want to acknowledge the benefits of using medications during labor.

The main benefit of epidurals and opioids is clear: they can minimize pain. 

An epidural is an anesthetic that numbs sensation in the lower half of a woman’s body, removing most or all of the sensation of contractions and birth.

Opioids are drugs that are meant to lessen the pain. They work by entering a woman’s bloodstream and blocking pain signals from the body to the brain. (It’s worth noting here that a lot of women don’t experience total relief from pain with opioids but rather more of a slight lessening of discomfort.)

Benefits of Synthetic Oxytocin (Pitocin)

As I’ll explain later, synthetic oxytocin (usually Pitocin) is used during labor for one (or both) of two purposes: 1) to induce labor to begin or 2) to speed up labor. Both can be beneficial.

For women who choose to be induced early, the benefit is that they know the day labor will start and they know when their pregnancy will be over. Occasionally, inducing labor helps to avoid complications or dangerous circumstances for mom or baby.

Using synthetic oxytocin to speed up labor can seem like a positive thing – who wants to labor for hours and hours? – but, as you’ll learn later, there are risks and those risks can lead to worse things than a few extra hours of labor.

Benefits of IVs

IVs are standard during hospital births. The reasoning doctors give for the use of IVs is 1) to prevent dehydration and 2) in case of an emergency later on.

When it comes to hydration, IVs do help.

Unfortunately, no studies have been done comparing only using IVs to only taking liquids by mouth. Still, studies comparing IV fluids alone to IV fluids plus liquids by mouth showed that the combination of both (the highest fluid intake) led to shorter labors and was more effective at preventing dehydration than IVs alone.

As far as being available for emergencies, it is a valid argument.

If you already have the needle in your arm, they will be able to give you pain medication or Pitocin faster (in the case of postpartum hemorrhaging, for example). That said, most emergencies arise because too many interventions are used, so getting an IV for this reason is somewhat counterproductive.

Risks of Medications During Labor

The rest of this article is about the risks of medications during labor, not because I want to focus on the negative but because people need to know.  We mothers need all the facts so that we can make the best choices for ourselves and for our babies.

Risks of Epidurals

An epidural is a shot that is injected into the space around your spinal nerves in your lower back. It is a local anesthetic that is supposed to make you numb from the waist down. The dosage can be adjusted for more or less numbing. 

It’s important to know that an epidural isn’t a standalone offering.

If you get an epidural, you’ll also be hooked up to an IV, continuous fetal monitoring, and a blood pressure cuff, if you aren’t already. You’ll probably also have to get a bladder catheter since you won’t be able to get up to go to the bathroom on your own.

Longer Labor

Because you are connected to so many wires and machines, epidurals usually keep you in bed. When you’re in bed, you’ll likely be reclined or lying flat on your back.

That presents the first problem with epidurals: they can make labor more uncomfortable and are linked to longer labors. Without gravity to help, your baby will likely take longer to descend through the birth canal.

It’s also more likely that your baby will get stuck in a less-than-ideal position.

The longer labor, the higher chance of getting stuck, and mom’s inability to feel what’s going on can lead to another risk: increased likelihood of assisted delivery or cesarean section. 

Assisted Delivery or Cesarean Section

Assisted (or instrumental) delivery is when the doctor uses forceps (kind of like large salad tongs) or a suction device that attaches to the baby’s head to help pull your baby out along with contractions. It is most often done when mom is exhausted and can’t push anymore or when there are signs of fetal distress.

If you experience assisted delivery, it’s much more likely that your perineum will tear.

The alternative to assisted delivery is a cesarean section (c-section). To do a c-section, the doctor has to cut through 7 layers and then stitch you back up. It is a major abdominal surgery.

It is true that studies are inconclusive about whether getting an epidural directly increases your chance of c-section.

That said, Evidence Based Birth points out that clinical studies are not the real world and therefore the stats may be more favorable during a study than they would be otherwise because the doctors in the studies know they are being studied.

Low Blood Pressure, Fever, and Heavy Motor Blockade

A 2018 study found that women who received an epidural during labor were much more likely to experience low blood pressure and a fever during labor.

Low blood pressure can cause dizziness and nausea for mom and can also affect oxygen flow to her baby. Decreased oxygen flow to the baby is one of the most common symptoms of fetal distress (more on that later).

Some women who get an epidural also experience what is called “heavy motor blockade.” When this happens, a woman’s legs feel so heavy that she is unable to move the lower half of her body. It usually goes away on its own after the anesthetic is stopped or the dosage decreased.

Breastfeeding Initiation

A more complex risk of epidurals is that they may make breastfeeding more difficult. This is because any drugs taken by the mother reach her baby by crossing through the placenta. The amount of any drug that reaches the baby varies and may or may not be harmful.

Studies and opinions on whether or not epidurals affect babies are contradictory. I personally believe that epidurals do affect the baby. Many studies and organizations agree.

Generally, babies of mothers who received an epidural seem more lethargic when they are born. Because they are less alert, these babies have a harder time finding their mother’s nipple and latching on well.

Sometimes these mother and baby pairs stop breastfeeding much sooner than pairs who did not have an epidural.

For more information on epidurals and breastfeeding, check out this article from Evidence Based Birth.

Risks of Opioids

Opioids are a category of drugs known for being the strongest painkillers available. The illegal drug heroin is an opioid and so the prescription drug morphine.

Interestingly, our bodies produce natural opioids to help us cope with pain. (Endorphins, which I’m sure you’ve heard of, are one type of natural opioid.)

The opioids commonly used during labor are Fentanyl, Demerol, Stadol, Nubain, and Morphine.

Baby’s Breathing and Heart Rate

One of the biggest risks of opioids is that they affect your baby’s breathing and heart rate. Decreased oxygen flow can lead to your baby developing birth asphyxia.

Birth asphyxia is when a baby’s brain and other organs do not receive enough oxygen and cells cannot work properly. Birth asphyxia can have short- and long-term consequences.

Immediately after birth, signs of birth asphyxia may be weak breathing, bluish-gray skin color, low heart rate, poor muscle tone, and weak reflexes. If a baby was without sufficient oxygen for a longer period of time, permanent damage can occur.

Possible results of permanent damage include requiring dialysis for kidney support and needing breathing support from a machine.

When a baby’s heart rate drops or is abnormal, doctors start to get worried. In the US, “non-reassuring fetal heart tones” is the second most common reason for first-time cesarean sections.

Side Effects

Opioids have lots of side effects. As listed on the website of the American College of Obstetricians and Gynecologists (ACOG), “side effects…include itching, nausea, vomiting, feeling drowsy, or having trouble concentrating.”

Some of the side effects can be resolved by taking another medication. 

If high doses are given, opioids can cause breathing problems for mom. 

Breastfeeding Initiation

Like epidurals, opioids can affect your baby and make it harder to breastfeed immediately after birth. ACOG states that if you are given opioids during labor “your baby may be drowsy, which can make it harder for your baby to breastfeed in the first few hours after birth.”

Risks of Synthetic Oxytocin (Pitocin)

Synthetic oxytocin – most often in the form of Pitocin – is one of the most commonly used drugs in the United States. Somewhere around 50% of women who give birth in the US are given Pitocin at some point during their labor.

As mentioned earlier, Pitocin is used in the labor process to induce labor or to speed it up. It can also be used as a treatment for postpartum hemorrhaging. 

The Fetal Distress Cycle

The most significant risk of using Pitocin during labor is what I call “The Fetal Distress Cycle.” It has to do with combining an epidural and Pitocin, which is very likely because most women who get Pitocin want an epidural. 

The cycle goes like this:

A laboring woman goes to the hospital. Labor isn’t progressing very fast, so the doctor gives the woman Pitocin to speed things up. (The same cycle applies if Pitocin is used from the start to induce labor.)

Contractions stimulated by Pitocin are longer, stronger, and closer together and the uterus doesn’t ever fully relax, so the woman is in pain. She asks for an epidural.

The epidural relieves the pain but also causes labor to slow. When labor slows, the doctor speeds it back up by increasing the dosage of Pitocin. Despite the epidural, the laboring woman feels the sensations increase and asks for the epidural dosage to be upped as well. 

And the pattern continues – more Pitocin, higher epidural dosage – and everything seems fine because Mom isn’t feeling the pain.

The problem is what is happening to the baby.

Those artificially-stimulated contractions put pressure on the baby, more than non-augmented contractions would. The increased pressure leads to decreased blood flow and oxygen flow to the baby.

The monitors that mom is attached to pick up signs of this distress – slow or abnormal heart rate – and, often, a c-section is recommended.

READ MORE >> C-sections: Why and How to Avoid Having One

Disturbing the Natural Hormones + Postpartum Hemorrhaging

Natural oxytocin, a hormone produced by a woman’s brain, is perhaps the main driving factor behind labor. Pitocin is synthetic oxytocin and, though it is chemically identical to natural oxytocin, it does not act the same in the body.

Put simply, oxytocin has a natural positive feedback cycle that is self-perpetuating, and that cycle is what keeps contractions going. In addition to stimulating contractions, oxytocin naturally relieves stress and reduces your perception of pain.

After your baby is born, oxytocin continues to tell your uterus to contract. That continued communication is necessary so that you can deliver the placenta and so that your uterus can start to shrink down to pre-pregnancy size.

So here’s the problem with Pitocin.

Pitocin is introduced directly into your bloodstream through an IV. That means it does not cross your blood-brain barrier. And that means that it doesn’t enter your brain and won’t have the same stress-reducing or pleasure-inducing effects on you.

When combined with an epidural, you’re likely getting high amounts of Pitocin in your bloodstream. Prolonged use of high levels of Pitocin can desensitize the uterus to oxytocin, whether that be natural or synthetic oxytocin.

Other than the fetal distress cycle (which I just explained above), the biggest concern with this desensitization has to do with what happens after your baby is born.

Generally at the time of birth, your body is flooded with hormones, including oxytocin. Like explained above, that oxytocin tells your uterus to contract and shrink. If your uterus doesn’t contract and begin to shrink, like it wouldn’t if it’s been desensitized by too much Pitocin, you bleed more, and that’s when postpartum hemorrhaging happens.

Postpartum Depression and Anxiety

It’s common and normal for new mothers to experience a roller coaster of emotions in the first few days and weeks after birth. But struggling with any of the following symptoms for more than 2 weeks is likely a sign of postpartum depression or anxiety:

  • depressed mood
  • severe mood swings
  • extreme worry that something will happen to your baby
  • difficulty bonding with your baby
  • withdrawal from family and friends
  • debilitating fear of not being a good mother

Though more research is needed on the causes of postpartum depression and anxiety, one study found that synthetic oxytocin – Pitocin – plays a role.

Even after restricting the data to only women who did not have previous experience of depression or anxiety, the use of Pitocin during or immediately after labor increased the risk of postpartum depression and anxiety by 32%.

Though help is available for women who experience postpartum depression and anxiety, it’s far easier to do what you can to minimize your risk in the first place.

Uterine Rupture

Uterine rupture is when the uterus tears open spontaneously. It is dangerous but, thankfully, is not very common. Uterine rupture most often occurs in women who have had a previous c-section and are trying for a VBAC (a vaginal birth after cesarean).

Studies have shown that prolonged use of synthetic oxytocin increases stress on the uterine wall and can lead to rupture. In one retrospective study, more than half of the rupture cases examined had been preceded by use of Pitocin. 

Risks of IVs

If you give birth in the hospital, you’ll most likely be required to have an IV throughout the entirety of labor. That means you’ll have a needle in your arm and you’ll be attached to an IV stand the whole time.

Though most of what is given through an IV is water-based fluids, they still carry risks.

Effect on Breastfeeding

Interestingly, taking in too many fluids during labor – which is far more likely with an IV – can lead to a decreased likelihood of exclusive breastfeeding. (And if you aren’t exclusively breastfeeding, for whatever reason, your milk supply can diminish or even disappear.)

One factor that contributes to this decreased intent to breastfeed is that excess fluids can cause painful swelling for mom. In addition to being painful, the swelling can also cause a woman’s breasts to be over-full, and that makes it harder to breastfeed.

The baby has a harder time latching on and it’s more uncomfortable for mom when he or she does.

In addition to causing swelling in mom, excess fluids affect her baby too. It’s easiest to understand the resulting chain of events with a table that Rebecca Dekker, founder of Evidence Based Birth, created based on her research.

To summarize, your baby can take in an excess of fluids during labor, as well as you. That means they will weigh more at birth. Which means they’ll lose more weight quickly in the days after birth. 

That fast weight loss can cause doctors and moms to worry, leading to supplementation with formula. That in turn will decrease a mother’s milk supply and possibly lead to an early end to breastfeeding.

Inability to Move

Another downside to having a continuous IV during labor is the simple fact that now you are attached to something and your freedom to move around is restricted. An IV alone won’t confine you to bed but it will make it harder to move in the ways you want.

Does Medication Create More Pain?

The final risk of medication that I want to point out is about labor medication in general and the effect it all can have on a woman after birth.

Using medications during labor may help labor go faster and can dull the uncomfortable sensations. But what about after the baby is born?

When medications are used during labor, the potential for lasting pain, which can inhibit the postpartum period, is far more likely.

For example, IVs, as we covered above, can cause swelling that makes breastfeeding difficult and uncomfortable for the first few hours or days. And like we talked about, an epidural may cause a fever, which likely won’t go away until a while after your baby is born.

In addition to those kinds of things, using medication during labor also often leads to other interventions – like instrumental delivery and c-sections – which can cause injury to mom and baby, making recovery that much harder.

So when you’re deciding whether or not to use medication, remember that your choice will likely affect you even after your baby is born.

TL;DR

To sum up, there are benefits to using medications during labor but there are also many risks.

When it comes to risks, epidurals can…

  • cause labor to be longer,
  • increase the likelihood of a c-section,
  • cause fevers and low blood pressure in mom, and
  • make it harder to initiate breastfeeding.

Opioids…

  • pose a danger to the baby’s breathing and heart rate,
  • have unpleasant side effects for mom (such as itching and nausea), and
  • make it harder to initiate breastfeeding.

Synthetic oxytocin (Pitocin)…

  • often leads to the fetal distress cycle
  • disrupts the hormones that naturally direct labor,
  • increases mom’s chance of having postpartum depression and anxiety, and 
  • makes uterine rupture more likely.

IVs…

  • can start a chain of events that leads to ending exclusive breastfeeding and 
  • often make it harder to move freely during labor, which has its own implications.

And medications in general – and the interventions they can lead to – can create pain after birth, preventing you from fully enjoying the first moments with your little one.

Conclusion

Clearly, these labor medications and their associated risks can cause real problems, short-term and long-term. And for the 95% of women and pregnancies that are low-risk, these medications really aren’t necessary.

Pregnancy and birth are normal, safe processes that, if left alone, will most often proceed as they are supposed to, without causing harm to mom or baby.

That said, stuff happens. If for whatever reason you feel that you should utilize one or all of the medications offered during labor, do it!

Ultimately, you need to make an individual decision based on your circumstances and what you feel is right for you and this pregnancy, regardless of the risks. 

Knowing the facts – the benefits and the risks – will allow you to make your choice from a place of knowledge and intention. That’s what I want for you.

Until next time,

Allison

P.S. If you’re worried about the pain, medication isn’t your only option. You can learn more about natural pain management in How to Cope With Contractions: Natural Pain Relief During Labor.

READ MORE:

Why You Need a Support Person at Your Birth.

The Cascade of Interventions [Explained].

The Vitamin K Shot vs Vitamin K Drops: Pros and Cons

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