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IV Pain Meds in Labor – An Epidural Alternative

IV pain meds in labor are the go-to epidural alternative for parents looking for a less invasive pain medicine. In my experience as a doula, IV pain meds in labor are a mixed bag – some like them and some don’t. Here we’ll explore the ins and outs of IV narcotics in L&D – the benefits, risks, and what parents like and dislike. Let’s get started!

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5 minute read
Types of IV Pain Meds in Labor
Who uses IV pain meds in labor?
IV Pain Meds vs Epidurals
As Effective as DIY Pain Relief Methods
I’ve Heard Mixed Reviews
What was your experience with narcotics in labor?

Types of IV Pain Meds in Labor

When a woman requests IV pain meds in labor she will receive one of the following medications, typically whatever the hospital has on hand.

Who Uses IV Pain Meds in Labor?

IV pain meds are far less commonly used since epidurals are so popular. Because of that, parents who choose an IV pain med usually fall into one of these two groups.

A Long, Exhausting Early Labor

False labor, pre labor, prodromal labor, early labor, and/or long pitocin inductions can sometimes last for hours and hours, or even days. When this happens, parents are often exhausted in early labor because the pain of their contractions makes it nearly impossible to rest, even between contractions. Parents become tense, which causes more pain, which then leads to more fear, which causes more tension, and so on. This snowballs into the fear, tension, pain cycle – not fun!

IV pain meds are used in hospitals with parents that aren’t far along enough for an epidural, but want pain medicine to cope through early labor. These narcotics help moms relax, the uterus relax, and gives them an opportunity to doze off between contractions.

NOTE: In these exhausting early labor scenarios, some parents find a glass or two of wine to be helpful. Wine has a similar relaxation effect between contractions, but without the side effects of a narcotic, which we’ll discuss below.

Parents that Really Don’t Want an Epidural

The other group of parents that choose IV pain meds in labor are those that really, really don’t want an epidural. These parents likely had their heart set on a natural/unmedicated birth, maybe even a homebirth, but now find themselves in an unexpected situation needing some medical help. Sometimes nurses offer smaller doses or a “half dose” of IV pain meds to these parents to have them see what they think. I jokingly say that IV narcotics are the gateway drug to the epidural, because this group usually ends up with an epidural anyways.

The spectrum of labor explaining early labor, prodromal labor, pre labor, false labor, and Braxton kicks - all happen before active labor.

IV Pain Meds vs Epidurals

To better help us understand IV pain meds in labor, I find it helpful to compare and contrast them to an epidural. The following are a few takeaways about narcotics vs. epidurals.

Administered Quickly

Compared to an epidural, IV pain meds are administered quickly. There are likely standing orders for narcotics already, so all a nurse has to do is get and administer the medicine. With IV pain meds there is no waiting for an anesthesiologist, or waiting for a whole procedure, so it can happen fast, which parents appreciate.

Less Invasive than an Epidural

The administration of IV pain meds is a much less invasive procedure than an epidural. These narcotics are given through the IV, which has likely already been started in the hand or arm. Therefore, no extra procedure is needed to receive a dose.

Takes the Edge Off

The tagline for IV pain meds is that it “takes the edge off”. #takestheedgeoff 😉 This means that parents will still feel their contractions, but they will be somewhat dulled. Between contractions moms may even fall asleep. An epidural, on the other hand, completely numbs the pain of contractions.

Affects Mental Clarity

IV narcotics affect mental clarity, whereas epidurals do not. Parents will feel very drowsy, high, or drunk. Some parents find this to be helpful because it allows them to relax, but some find it frustrating because now they have to cope through contractions while drunk. This can feel overwhelming to parents and sometimes make things worse.

Side Effects for Baby’s

Both epidurals and IV pain meds get in baby’s system, but IV narcotics interact differently than an epidural. IV narcotics depress a baby’s respiratory system and if the medicine is still in their body at birth they may be more apathetic about breathing. Because of this, doses will not be given within three hours of delivery. Obviously, it’s impossible to exactly predict when baby will be born, which is why sometimes Narcan may have to be given to baby to counter the affects of the narcotics.

Side Effects for Mom

Besides what’s already been discussed, when using IV pain meds for labor women may experience nausea, vomiting, dizziness, and itching. Read more about this here.

IV Pain Meds as Effective as DIY Pain Relief Methods

In the book Labor Pain by Henci Goer (below), Goer quoted a study showing DIY pain management for labor (tub, shower, ball, massage, relaxation techniques, breath work, etc) to be just as effective as IV pain meds in labor. Cool, right?

Labor Pain: What's Your Best Strategy?: Get the Data. Make a Plan. Take Charge of Your Birth

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04/13/2024 11:36 pm GMT

I’ve Heard Mixed Reviews

In my experience as a doula, many of my clients have disliked their experiences with IV pain meds. Some felt satisfied with the narcotics, but most did not. For them, the side effects outweighed the benefits of pain relief. That being said, most of my doula clients do not use IV pain meds for labor, but have unmedicated births. If pain medication is needed, most get epidurals.

What Was Your Experience with IV Pain Meds?

Did you use IV pain meds in labor? Leave a comment and share your experience. I’d love to hear from you!