Ask the Midwife: Can a midwife administer pain medications during labor?

Childbirth, Choices, Midwifery

doppler smallCan a midwife administer pain medications during labor?

Midwives who attend births in hospitals are able to order pain medication for clients in labor.  What types of pain relief are available may vary, so it is important to ask your midwife what s/he can offer you.  If you are planning to birth at home or in a free-standing birth center, talk to your midwife about what is available in that setting.

In general, there are analgesics, which relieve pain but do not eliminate it, and anesthetics, which take away the pain. Narcotic-based analgesics like Demerol, Nubain, or Stadol can be given as an intramuscular injection, which will begin to ease the pain in about 15 minutes.  If the woman has an IV for some reason, the medication can be given through the IV line and will take effect within a minute or two, but will wear off sooner.  Often these drugs are given with an anxiolytic medication that promotes relaxation, like Phenergan or Visteril.  The combination gives more pain relief without using more of the narcotic component.  This type of pain relief lasts about an hour or two for most women, but people metabolize drugs at different rates, so it is impossible to predict exactly how much or for how long this will help the laboring woman.

The timing and dosage of injectable or IV analgesia is important.  We don’t want to give this medication too close to the delivery, or in such a large dose, that the narcotic could depress the baby’s respiration at birth.  Also, there needs to be 4 hours between doses, to allow the baby to eliminate the drug.

Epidural is the most common type of anesthesia for childbirth and is administered by an anesthesiologist or certified nurse anesthetist.  It will take away the pain from the upper abdomen to the toes.  Because it can cause the mother’s blood pressure to drop, she must have an IV in place before the epidural, and must have continuous fetal monitoring until delivery.

Epidurals today do not take away all motor sensation, so most women are able to push effectively with an epidural.  However, she would not be able to sense a full bladder, so a catheter is placed to empty the urine (a full bladder will impede descent of the baby into the pelvis).  Research does not support the idea that modern epidurals slow down labor, but the mother is stuck in the bed and not able to move around much, although she can change positions in the bed. Since a mother can sleep during labor if she has an epidural, it can be very helpful when labor has been prolonged and the mother is exhausted.  When a woman with back labor has not been able to get the baby to rotate with position changes, etc., sometimes an epidural will allow complete relaxation of the pelvis and the baby will then rotate.

 

Barbara Sellars, CNM attended Vassar College, gave birth to her daughters Amy and Jennifer, and then became a certified childbirth educator. She received a BSN from the University of Texas at Austin, and graduated from Yale University’s Midwifery Program. She is privileged to have delivered all three of her grandchildren, Kendall, Kieran and Clementine Rose.

Submit your questions to askthemidwife@choicesinchildbirth.org.