COMMON DRUGS IN THE LABOR ROOM AND DELIVERY
Antiemetics
ROOM
I. Pregnancy Risk Categories
a. Category A
- Controlled studies in women fail to
demonstrate a risk to the fetus in the first
trimester
b. Category B
- Animal studies do not indicate a risk to the
fetus and there are no controlled studies in
humans, but controlled studies in humans
have not shown a risk to the fetus.
c. Category C
- Animal studies have shown the drug to be
embryocidal or teratogenic
d. Category D
- Definitive evidence of risk to the human
fetus exits, but the benefit in certain
situations may justify the use of the drug
despite the risks.
e. Category X
- Studies in animals or humans have
demonstrated fetal abnormalities, or there
is evidence of fetal risk based on human
experience, or both, and the risk clearly
outweighs the possible benefits.
II. Common Drugs in the Labor Room and Delivery
Room
A. Analgesics – the term analgesia indicates a
reduction of pain without loss of consciousness.
Until recently, analgesia during labor had
resulted in many side effects for the mother and
infant because significantly high doses were
given IM or IV. Reduced fetal movements and
poor beat-to-beat variability as seen on the
fetal monitor is the effect of large doses.
i. Opioid Analgesics – all opioids cause the
same analgesic effect in equigesic doses.
 Butorphanol titrate (stadol) – this
mixed agonist-antagonist analgesic
with a duration of effect of 1 to 3 hours
crosses the placental infant because
metabolites are inactive. Some centers
do not use butorphanol because there
may be transient sinusoidal fetal heart
rhythms. Respiratory depression
should be observed.
Nursing Considerations:
 Assess for allergies and opiate
dependence.
 Observe vital signs and respiratory
function in woman (12 per minute
or more) and newborn (30 per
minute or more)
 Have naloxone and resuscitation
equipment available for
respiratory depression in woman
and neonate.
 Report nausea or vomiting to the
birth attendant for a possible
order for antiemetic.
or other CNS depressants may
enhance the respiratory
depressant effects of butorphanol.
 Nalbuphine (Nubain) – has been used
the same way as butorphanol. In a
single 10-mg dose IV, nalbuphine in the
first stage of labor gives better
maternal analgesia than butorphanol.
Respiratory depression should also be
observed.
Nursing Considerations:
 Check I&O, vital signs, and fetal
responses.
 Side rails should be used.
ii. Antianxiety Agents – may be used during
labor to calm the mother and to increase
the strength of analgesic effects. Several
of these medications have an antiemetic
effect, as well. If given too close to the
time of birth, the infant may have
reduced muscle tone and a slightly lower
temperature and respiratory rate.
 Diazepam (Valium) – is given to
enhance pain relief of opioid and cause
sedation. Diazepam is only used during
the actual birth because of its effects on
the fetus.
Nursing Considerations:
 Not recommended if mother is
breast-feeding in early recovery
period.
iii. Opiate Antagonists
 Naloxone (Narcan) – the current drug
of choice of an antagonist to the
depressing effects of narcotic
analgesics. Nowadays, it is used in a
woman who has recently given birth to
combat adverse effects of intrathecal
or epidural analgesics. It acts to combat
central nervous system and respiratory
depression and reduces pruritis related
to the narcotic dose.
Nursing Considerations:
 Be sure client is not using other
drugs of abuse.
B. Anesthetics – may provide local or regional
numbness, with loss of sensation of pain, or the
result may be general muscle relaxation and
loss of sensation and consciousness because of
varying degrees of central nervous system.
i. Local Infiltration – provides a pain-free
area for episiotomy or repair of
lacerations. A few minutes for absorption
must be allowed before the procedures
begins. The woman will sense the tugging
 and pulling of surrounding tissues and will
expect to feel plain.
 Xylocaine
Nursing Considerations:
 Assess for drug allergies, especially
to dental anesthetics because they
are related to those used in
maternity care.
 Apply ice to perineum to reduce
edema and hematoma formation
and to increase comfort.
C. Uterine Stimulant (uterotonics) – are
medications that cause, or increase the
frequency and intensity of, uterine
contractions. These drugs are used to induce or
augment labor, facilitate uterine contractions
following a miscarriage, induce abortion, or
reduce hemorrhage following childbirth or
abortion.
 Misoprostol (Cytotec) – an effective
agent for both cervical ripening and
labor induction.
D. Uterine Relaxant – used for women at risk of
Nursing Considerations:
 Be sure client has never had a
history of uterine surgery, a
previous Cesarean delivery, or
several previous births because
these can cause severe bleeding,
having the uterus removed, and/or
death of the mother or baby.
 Oxytocin – This is done prior to the
onset of labor to evaluate the fetus’
ability to handle uterine contractions.
To avoid the possibility of exogenous
(introduced) oxytocin putting the
woman into labor, she may instead be
asked to stimulate her nipples to cause
the release of natural oxytocin.
Oxytocin’s major functions are in labor
and lactation.
Nursing Considerations:
 Uterine contractions, fetal and
maternal heart rate, maternal
blood pressure, and, if possible,
intrauterine pressure should be
continuously monitored to avoid
complications.
 Continuance of labor with oxytocin
should be avoided when evidence
of fetal distress, fetal prematurity,
abnormal fetal position, previous
E. Ophthalmic Instillation
surgery of the uterus or cervix
(including 2 or more cesarean
deliveries), or in any condition
presenting as an obstetric
emergency requiring surgical
intervention.
 Methylergometrine – used for the
prevention and control of excessive
bleeding following vaginal childbirth.
Nursing Considerations:
 Monitor BP, heart rate, and
uterine response frequently during
medication administration.
 Notify health care professional
promptly if uterine relaxation
becomes prolonged or if character
of vaginal bleeding changes.
 Assess for signs of ergotism (cold,
numb fingers and toes, chest pain,
nausea, vomiting, headache,
muscle pain, weakness).
 Remind client to not breastfeed
within 12 hours after taking
methylergometrine. This may pass
into breastmilk in small amounts
and could affect a nursing baby.
miscarriage in the belief they relax uterine
muscle, and hence reduce the risk of
miscarriage.
 Terbutaline (Brethine, Bricanyl) –
prevents premature labor, especially in
individuals who are more than 20
weeks into gestation and have no
indication of rupture fetal membranes
or in whom labor is not far advanced.
Nursing Considerations:
 Assess vital signs: baseline pulse
and BP before each dose.
Cardiovascular adverse effects are
more apt to occur when drug is
given by SC route or it is used by a
patient with cardiac arrhythmia.
 Be aware that muscle tremor is a
fairly common adverse effect that
appears to subside with continued
use.
 Monitor for symptoms of
hypoglycemia in neonates born of
a mother who used terbutaline
during pregnancy.
 Monitor patient being treated for
premature labor for CV S7S for 12h
after drug is discontinued. Report
tachycardia promptly.
 Erythromycin
 Nursing Considerations:
 Report onset of GI symptoms after
PO administration to physician.
 Monitor for adverse GI effects.
 Remind client to not breastfeed
while taking the drug without
consulting the physician.
 Vitamin K – It is essential to prevent
serious bleeding. Babies do not get
enough vitamin K from their mothers
during pregnancy, or when they are
breast feeding. Without vitamin K, they
are at risk of getting a rare disorder
called ‘vitamin K deficiency bleeding’
(VKDB). VKDB can cause bleeding into
the brain, and may result in brain
damage or even death.
Nursing Considerations:
 Be sure client understands that the
choice to decline an evidence-
based standard of care intended
for their baby’s protection may be
a choice that increases risk of
harm.
 Hep. B Vaccine – Pregnant women who
are at high risk for this disease and have
tested negative for the virus can receive
this vaccine. It is used to protect the
mother and baby against infection both
before and after delivery.
Nursing Considerations:
 Make sure the newborn receives
the vaccine within 12 hours after
birth if the mother of a newborn
carries the hepatitis B virus in her
blood to immediately provide
protection against the virus.
III. Common Side Effects of the Drugs
a. Side effects on the mother
i. Hypotension
ii. Dizziness
iii. Confusion
iv. Headache
v. Euphoria
vi. Nausea and vomiting
vii. Blurred vision
viii. Constipation
ix. Muscle weakness
x. Irritable or sore throat
b. Side effects on the newborn
i. Respiratory depression
IV. Nursing Responsibilities
i. The nurse should include education about
medications in antepartum and postpartum
classes for every lactating woman;
ii. Explain the benefits and risks of medications,
especially those that are questionable;
a. Benefits
 Pain experienced by the mother can be
lessen.
 Drugs have minimal effects on the
baby, meaning the baby is alert and
ready to breathe normally once
delivered.
 Leaves the mother alert and able to
move and sense the amount of pushing
the mother needs to do at the
appropriate time.
 Educate all mothers about the
nonpharmacologic methods for minor
discomforts during pregnancy, labor,
and recovery;
b. Risk
 Many of the drugs routinely
administered to the mother can have
profound effects on the newborn that
the pediatrician in the delivery room
and nursery must manage.
iii. Educate all mothers about the
nonpharmacologic methods for minor
discomforts during pregnancy, labor, and
recovery;
 Give continuous labor support. This
involves offering a sustained presence
to the laboring woman by providing
emotional support, comfort measures,
advocacy, information and advice, and
support for the partner.
 Immerse the woman in warm water for
relaxation and relief of discomfort. This
nonpharmacologic measure is called
hydrotherapy.
 Changing positions frequently (every 30
minutes helps lessen the pain.
 Therapeutic touch and massage use the
sense of touch to promote relaxation
and pain relief. Massage works as a
form of pain relief by increasing the
production of endorphins in the body.
iv. Encourage women to take childbirth classes and
support the educated mother in her attempts to
cope with labor and delivery;
v. Include a record of any incidental prescriptions
or nonprescription medications taken before
labor during the interview and assessment of the
mother.