Tuesday, August 27, 2013

Medications in Pregnancy Vs. Medications in Labor: Why is One Frowned on, but Not the Other?

I think I still have the paper my midwife gave me in my second pregnancy that lists the medications that are safe to take during pregnancy. The strongest one listed is Tylenol, followed by antacids and some nausea medications. I remember being told to call with any questions regarding unlisted medications and homeopathic remedies, because some are unsafe during pregnancy and could potentially have side effects for me or the baby. I was also instructed to limit my caffeine intake, eat a balanced diet, cut out alcohol (except for the occasional sip), avoid fish that might contain mercury, not lift anything heavier than my toddler, and to be sure to get plenty of rest (especially once I started experiencing prodromal labor at 37 weeks).

And you know what? That was all good advice! It is best to not smoke, drink, have caffeine, eat questionable fish, and lift anything too heavy while pregnant. It's best to avoid most medications and herbal treatments, because they carry risks. Why risk anything while carrying a child, right? Sure, I may have had a sip or two of alcohol here and there, I had small amounts of caffeine, and getting enough rest was next to impossible with a huge belly, a toddler to chase, a household to run, and the process of house hunting/packing/cleaning/moving, but I still took it easy as much as I could and didn't take any real chances, because my health and the health of my baby came first.

So why, then, if we take all of these precautions during our pregnancies (who avoided mayo and lunch meat while pregnant?), why then do we accept all kinds of medications and procedures and the like during labor? Why is that somehow okay? Why is it that we will endure endless headaches, backaches, and the like during pregnancy and not take anything too strong because of the potential risks, but we're so quick to induce, take pain medications such as epidurals, routinely have iv's, and so on, without talking about the possible risks? Why is one a no-no, but the other is just fine?

Do you know the risks of having an epidural as well as you know the risks of, say, drinking alcohol during pregnancy? At least 60% of women in labor will have an epidural, but I wonder how many of them know what the risks are, how likely they are to occur, and what effect they can have on the path of their birth experience. They aren't a miracle drug that takes away the pain with no consequence. If you would check into medications during pregnancy, why not those used in labor?

Then there's pitocin. Did you know that it is not indicated by the manufacturer for use in elective inductions? Do you know why? Do you know what risks it carries to both mother and baby? If you refuse vaccinations for your child because you are concerned about vaccinations causing autism and such, you should also look into the recent studies that are showing a possible link (at the very least an association) between pitocin and autism. Is it definitive? No (but neither are a lot of the studies/findings linking vaccinations to autism, etc). If you're concerned about taking anything stronger than Tylenol while pregnant, and you intend to not vaccinate, you should at least look into pitocin, too. The risks are greater than most doctors would lead you to believe.

The same goes for any medication used during, or to induce, labor. Prostaglandins like cervidil (the use of which is contraindicated in patients who are already receiving intravenous oxytocic drugs such as pitocin), cytotec (which the manufacturer recommends against using to induce labor), stadol (which carries a slight risk of infant respiratory distress and will make you loopy), demerol (which can also depress the fetal respiratory system), and nitrous oxide (which is essentially the laughing gas your dentist uses to get your through dental procedures, and can cause dizziness, decreased memory, and even unconsciousness).


Medications don't magically stop crossing the placenta and affecting baby just because you are in labor. The hypocrisy of doctors handing out pamphlets of all the foods, medications, and activities you should avoid during pregnancy and why, but then turning around and pumping you full of drugs once you're in labor (or to start/augment it) without discussing the side effects or offering alternative, natural, risk-free forms of pain management (such as walking, massage, acupressure, water immersion, etc.), is astounding.

You have to do your research before you go into labor. Know what the risks are. Know what side effects any drugs in labor may have. And then, once you're there, you can decide for yourself if the benefits outweigh the risks, with all the pertinent information in hand. But I repeat: if you're so terribly worried about taking anything during pregnancy and/or vaccinating your baby, you should think twice about things like pitocin, epidurals, and other forms of pain management and labor induction/augmentation. The risks are real, and you should know them so that you can make the best choice for yourself and your baby.

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