Taking the Edge Off: Pain Relief During Labor

Taking the Edge off: The rebound effect of drug dependency
“Even though drugs initially ease pain, when the analgesia or anesthesia wears off, the pain re-experienced will be (suddenly) greater and more difficult than before. This is because when the drugs were first administered, natural endorphins were still present, easing the pain somewhat."

"However, analgesics and anesthetics send a message to the brain that it no longer needs to produce endorphins. So when the pain medication wears off, there are no endorphins available to buffer the intensity of the returning pain. Once a mother accepts drugs “to take the edge off” (especially in early labor), it is difficult to move away from dependency on drugs for pain relief during the rest of labor.”

- Birthing From Within by Pam England and Rob Horowitz

Not only do these drugs cause a physiological cascade, but in many cases when nurses say it will take the edge off, they mean just that. Taking the edge off does not mean completely removing the pain. "The pain was the same, but for 30 minutes, I cared a little less," is how several of my clients review these drugs that "take the edge off." I’ve also had clients say, "Had I known it didn’t actually alleviate pain I would never have agreed to the medication."

These opiate-based narcotics, such as, Stadol, Fentanyl, Nubain, and Demerol, have a short pain relieving life. The first dose may last 45 minutes, the second will last less time and the diminishing effectiveness of the drug continues for each dose.

“Opiates cross the placenta during labor and can produce the following side effects in the baby:
    Central nervous system depression
    Respiratory depression
    Impaired early breastfeeding
    Altered neurological behavior
    Decreased ability to regulate body temperature

For these reasons, your baby might need other medication to counteract effects of the opiate. Naloxoneis a medication given in small doses that can reverse the respiratory depression that opiates can cause in a baby. It is usually given intravenously and it's effects can be seen within a few minutes and can last up to 2 hours.”*

If you are laboring naturally, without pitocin, trust in the perfection of your body.  Know that your body can and will produce natural pain relievers to ensure that pain levels are manageable. There are so many ways to receive support and relief during labor, many of which can be offered by your partner or labor support person (doula). These include breathing and positioning techniques, use of heat, cold, water, touch and massage.

If you are being administered pitocin, a synthetic (manmade) version of oxytocin, know that often the method of pitocin administration does not mimic what your body would naturally do.  The contractions are often longer, stronger and closer together. The same natural labor support techniques are still available to you, but if the pain is not manageable, then this is a good time for an epidural.

*http://americanpregnancy.org/labornbirth/narcotics.html

Written by Bea Wilds, Enso Prenatal co-owner, prenatal yoga teacher, and doula.

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