Sometimes birth doesn’t go the way we expect even though the end result is the best one- a healthy baby and mom. Below is a breakdown of common medications and interventions given during and after labor. Our hope is that by sharing why medicines may be administered, and common side effects, expectant parents are empowered with information. We want to help take some of the worry out of birth and the postpartum phase, should the unexpected arise.
Epidurals, Anesthesia and Spinal Blocks
An epidural is the local anesthesia administered just outside the membrane that surrounds your spinal cord and spinal fluid. Epidurals are the most common pain relief for laboring mothers and while there are differing opinions on the effect epidurals have on baby, they are overwhelmingly considered safe for baby’s health. There are reports of babies born to moms who have had epidurals being more “sleepy” during early nursing but again, epidurals are considered safe and baby’s sleepiness subsides naturally.
Common side effects of epidurals are heavy shivering, a ringing of the ears, backache, nausea or difficulty urinating. These side effects are temporary and considered harmless. Because they are used to dull the intense sensations of labor, an epidural may also slow labor.
Spinal Block – A spinal block is regional anesthesia, where mother is numb from the belly down and cannot move. This is the intervention used for c-section birth.
General Anesthesia – General anesthesia is different than an epidural and very rare but we’re including it here so parents will know the difference between general and local anesthesia. General anesthesia means mother is completely asleep and does not have sensation or consciousness. An example of when this intervention would be appropriate is if mother was in an accident and baby is affected; again, very rare. Early nursing would be impacted as mom needs time to physically wake up from the anesthesia.
Because mother will be numb from the belly down with an epidural, spinal block or general anesthesia, a Foley catheter will also be inserted into the bladder to drain urine.
Oxygen, administered through an oxygen mask to laboring moms helps mother deliver oxygen to baby. The oxygen mask might be given quickly if baby’s heart rate is dropping due to fetal distress and this can be scary. The good news is that giving oxygen is common and It has not been shown to have adverse effects on baby or nursing. It only helps.
Pitocin is a synthetic version of a natural hormone and a uterine stimulant commonly given to induce or strengthen contractions. It may be given after an epidural because the epidural has slowed labor. It may also be given after birth to ensure mother does not hemorrhage to help the uterus contract back to its non-laboring state. Pitocin is generally considered safe for mother and baby when administered correctly. It is given through an IV.
Common side effects may include nausea, stomach pain and runny nose or sinus pain. Rare side effects may include confusion, slurred speech and headache. The doctor must be notified immediately if any of these are present. Pitocin has not been shown to adversely affect milk production or baby’s own health.
When Pitocin is administered, Labor & Delivery nurses watch to be sure that contractions are not occurring too severely or too frequently. Contractions that are too strong or occurring too quickly can cause uterine rupture so there is typically a 1:1 nurse to mom ratio when Pitocin is administered to ensure the laboring mom is safe and monitored correctly.
Percocet is the most common medication given to help mothers with pain management after delivery. It is an opioid. Most opioids are not advised for nursing newborns, so when possible, sticking to NSAIDs (nonsteroidal anti-inflammatory drugs) for pain relief is preferred. The most common NSAID is ibuprofen; commercially known as Advil or Motrin.
For moms who have undergone a cesarean, or moms who’ve had a difficult vaginal birth however, Percocet is appropriate to help with pain.
For mom’s whose goal is to nurse right away, the best thing to do is to nurse before Percocet is administered. If mom and her doctor decide that nursing on demand is okay on Percocet, the main thing to do is to watch baby for marked drowsiness. For a full term, healthy baby there will be side effects like sleepiness, but no lasting effects.
A nursing mother may also choose to pump while Percocet is in her system and store the milk for baby’s use when baby is 6 months or older. Once baby is past the newborn phase, the effects of opioids decrease.
It’s important to note here that if parents choose early formula supplementation, many, many mothers who choose to nurse go on to have exclusive breastfeeding relationships.
Blood Pressure Control and Gestational Hypertension
Magnesium sulphate, also called “Mag”, is administered via IV and sometimes pills. Mag is used to treat Pre-Eclampsia from advancing to Eclampsia manifested as seizures. When a mom is given magnesium sulphate it’s perfectly normal that she may be feeling too sick to nurse right away.
Hypertension meds like Procardia or Labetalol are beta-blockers that mom will take after birth and discharge for however long the doctor prescribes to keep blood pressure down. These do not affect nursing or the healthy full term newborn.
Our hope is that this list helps parents-to-be become familiar with the terminology and basics of common interventions and medications given during birth so they can feel confident, in control and prepared should the unexpected arise. This blog was written under the direction of present and former Let Mommy Sleep Labor & Delivery and NICU Registered Nurses but as always mother's primary care physician is the authority on her care.