Please note that all narcotics cross the placenta and take more time to be get out of the baby’s circulation than the mothers. There is an increased need to assess the baby at birth. The Neonatal Intensive Care Unit (NICU) Team will be called to the birth if the baby shows signs of needing respiratory assistance (help with breathing) or if the narcotic was given within 4 hours of birth.
Alternatives
There are a variety of coping techniques you can use to manage the pain you experience during labour. Comfort measures do not involve the use of medications for pain relief. They allow you to have a better sense of control, can result in a shorter labour with fewer medical interventions. Using comfort measures to avoid unnecessary interventions also supports your birth hormones. This will help you to have a labour that feels less intense and progresses more quickly. It also sets you up for better breastfeeding success. There is also no risk for you or your baby. See our Comfort Measures webpage for more information.
Procedure
Narcotics can be given by an intramuscular (IM) injection or an intravenous (IV) infusion. The route is often determined by the type of narcotic as well as the stage of labour.
Intramuscular Injections
During labour, you can receive narcotics for pain relief by an injection given in your upper arm muscle, upper thigh muscle, or gluteal (buttock) muscle. This is called an intramuscular (IM) injection. This form of medication will last from 2 to 4 hours.
Advantages of receiving pain medication by an IM injection include:
- Can be given quickly
- No need for an Intravenous (IV) line
Disadvantages of receiving pain medication by an IM injection include:
- Delayed pain relief compared to intravenous (IV) infusion
- The need for high doses of medication
- An unpredictable rate of release of medication from muscle tissue that can result in uneven distribution of the medication
- The inability to give medication close to birth with this method. There may not be enough time for the medication to get out of the baby’s circulation before birth, this can lead to sedation (sleepiness) and/or respiratory depression (slowed or shallow breathing).
Intravenous Infusion
During labour, you can receive narcotics for pain relief by Intravenous (IV) infusion called patient-controlled analgesia (PCA). For this, an IV pump is programmed to allow you to push a button to give yourself a small dose of a narcotic (e.g. fentanyl) when needed. Most of the time there is also a constant, small amount of medication given and you top this up as needed. An IV PCA allows you to have more control of pain management during labour. It is also sometimes reserved for women who cannot get an epidural.
Advantages of receiving pain medication by IV (compared to IM) include:
- Starts working sooner than intramuscular (IM) injections
- Smaller doses of medication
- A more predictable effect
Disadvantages of receiving pain medication via an IV, (compared to IM) include:
- Restricted movement due to the IV set-up.
For more information, decision aids & tools:
If you have specific questions:
- Speak with your healthcare provider
