Sedation during Labor: Understanding your Choices

Childbirth is one of few life experiences that is as thrilling the third and fourth time as it is on the first. You’d be hard-pressed to find a woman who wouldn’t want to be mentally and physically present for the birth of her every child. Yet underneath the anticipation lies a tinge of apprehension about the ease of labor and delivery. Horror stories from well-meaning friends and family may add to these fears, not to mention all the drama seen in movies and television. Understanding your options for pain relief as well as the risks and benefits involved in sedation will help to give you a reality check so that you make decisions not out of fear, but out of logic and good common sense.

Being fully sedated may seem like a good idea initially, particularly if you’re terrified of needles and intimidating medical equipment, or have an extremely low tolerance for pain. “Quick and painless” seems ideal, but realistically, full sedation takes the mother- a key player in this process- out of the equation. This is no insignificant point, considering that women’s bodies are equipped with all the right materials and necessary biological processes to ensure ease and safety (albeit painful) of a natural birth. In other words, you’re not just designed to give birth - you’re designed to be able to endure it.

Ob-Gyne Karen Ty-Torredes, MD, FPOGS, of St. Luke’s Hospital at Global City, is a proponent of active participation in labor. She states, “The climax of the past nine months is reached and it is always important for a woman to experience this. Once a woman is given sedation to relieve pain during labor, she will not be awake to live through this moment. Her last memory will be of the pain of her contractions.” Dr. Torredes explains that full sedation may also alter a woman’s mental status, make her groggy and fog her memory. In fact, according to American Pregnancy Association, women who are fully sedated during labor tend to have no memory of the labor and delivery whatsoever, even if the sedatives allowed them to be physically awake during the process.

For this reason, Dr. Torredes prefers that her patients receive a spinal anesthesia (epidural or saddleblock), which ultimately allows them to be both mentally and physically aware of the process. “With this type of anesthesia, the woman is awake and conscious during a very important event in her life but she is free from any pain.” Importantly, she adds, “[The mother] is aware of everything around her and everything that is being done to her. I like that I am able to talk to my patients during delivery and that they are able to participate and experience this moment in their lives.” Furthermore, if fatigue sets in from a prolonged labor, you’re likely to become more irritable and anxious, which can ruin your focus and make the pain seem more unbearable. A mild sedative can help you relax so that you can muster up that last bit of strength needed to push through. An epidural anesthesia can also provide pain relief during recovery after a C-section.

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Keep in mind, however, that whether you use low-dosage epidural or are fully knocked out, the use of any sedative comes with the risk of side effects. Depending on the type of sedative and the amount administered, side effects can and will vary per person. Demerol, a popular sedative for labor, can cause nausea, vomiting, hypotension, and respiratory depression (difficulty breathing) in the baby. Stadol, on the other hand, can cause dysphoria (feeling unwell and unhealthy) as well as dizziness. Other reported side effects of sedatives include shivering, backache, severe headache, difficulty urinating, soreness where the needle is inserted, ringing of the ears, itching, and fever. Some epidurals can cause your blood pressure to drop significantly, affecting blood flow to the baby. Other effects on the baby, as cited by the American Pregnancy Association, is difficulty “latching” onto the breast to feed, and improper positioning for birth due to the baby becoming lethargic from the sedative, thus increasing the likelihood of interventions such as the use of forceps or an episiotomy. Other studies suggest that epidurals cause difficulty breathing for the baby and decreased fetal heart rate. Be sure to discuss these risks and your concerns with your doctor beforehand.

Today, sedatives come in a variety of formulations, allowing you to be anywhere from awake and partially alert to being completely knocked out. Full sedation in labor may be necessary with certain complications; on the other hand, there are certain conditions, such as platelet issues or a history of back infections, that contraindicate (meaning a patient should not receive) sedation. Based on your medical history and your labor preferences, your doctor should have several options for you to choose from. Do your own homework before making a decision. For instance, understand the difference between a regular epidural versus a “walking” epidural. Even if you expect smooth sailing ahead, it won’t hurt to ask your physician for details of sedation, in case you have to be knocked out during labor. This kind of mental preparation is key to staying calm throughout the birthing process. Ask if your sedative is made of narcotics, anesthesia, or both. Here are a few other questions you may want to ask:

- What combination of drugs will be used and what are the dosages?
- Will it be given during labor or right after the baby is born?
- How will this specific drug affect my baby?
- Will I be able to move around? Eat?
- How is it going to affect me after I deliver?

More powerful than any sedative on the market is your will to deliver your baby safely into the world. Have confidence in the natural processes of birth, and your innate ability to safely deliver your child. Don’t discount this power you were blessed with, the power that makes you uniquely woman.

Special thanks to:
Dr. Karen Ty-Torredes, MD, FPOGS
St. Luke's Hospital Global City
+63 2 789 7700 local 7912

Photo by yanivba from flickr creative commons