Pethedine, when can it be helpful?
Pethedine is the most commonly used opioid in labour, though some hospitals will offer diamorphine instead. Pethedine can be used routinely on a labour ward or birth centre, you CAN sometimes have it at home but the process of getting it is fairly complicated (And involves a prescription from your GP and storage in your fridge) so probably not hugely practical!.
Pethedine is administered via an injection into your upper thigh or bottom. It takes about 20 minutes for the effects of pethedine to kick in, and it works as a sedative and muscle relaxant, essentially taking your mind away from the sensations of labour. The effects of the drug will last for around 2-4 hours.
What are the benefits of Pethedine?
Pethedine offers a similar level of pain relief to that of gas and air.
If you are particularly tired and need some sleep to rebuild you energy, sometimes pethedine is enough to allow you a couple of hours kip!
If you are keen to avoid an epidural, pethedine might be a good middle ground to consider first, as the effects will gradually wear off and it doesn’t come with the increased risk of instrumental birth.
And the risks?
All Opioid drugs cross the placenta, meaning they will reach your baby. For this reason, opioids are not usually something you would be offered if your midwife suspects you may be approaching the later stages of labour. Obviously it’s impossible to completely predict how much ‘more’ of labour you’ve got to go, even WITH a vaginal examination. If your baby is born with pethedine in their system, it may affect their breathing after birth. (For baby’s affected, they may need to be given a drug at birth to counteract the affects of the pethedine). It can take several days for a baby to get pethedine out of their system, meaning they may be particularly sleepy, which may impact breastfeeding.
It’s common for women to experience nausea and vomitting after using opioids, and for this reason they are usually given alongside an anti-emetic (anti sickness drug).
Some women find the ‘spaced out’ feeling that opioids give you disconcerting, and once you have taken pethedine it’s a case of waiting for it to wear off rather than simply stopping using it (like with gas and air)
You would not be able to get into a pool until the effects of the pethedine had fully worn off (usually after 4 hours), due to the possibility of you being too drowsy to float around safely!
That’s a long list of ‘risks’ right?! And pethedine is always the drug that women are most fearful of. However in my experience, when used at the right time and for the right reasons, pethedine can be a really helpful option to consider! If you’ve had a very long early stage of labour and you really need some sleep, if you’re having an induction and keen to avoid an epidural, sometimes pethedine can be a really positive choice! As with all your options, you don’t have to make any hard and fast decisions about it until you’re really there and you can change your mind whenever you like! But discuss it with your midwife and if you have a preference either way, pop it on your birth plan!
References
BNF. 2015.Pethidine hydrochloride. British National Formulary. www.evidence.nhs.uk [Accessed March 2016]
Home Birth Reference Site. 2010.Pain relief and home births. www.homebirth.org.uk [Accessed March 2016]
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NHS. 2013.What is a controlled medicine (drug)?Common health questions. www.nhs.uk [Accessed March 2016]
NHS. 2015.Pain relief in labour.NHS Choices, Health A-Z. www.nhs.uk [Accessed March 2016]
MarchNICE. 2014.Intrapartum care: care of healthy women and their babies during childbirth.National Institute for Health and Care Excellence, Clinical guideline, 190. London: NICE. www.nice.org.uk [Accessed March 2016]
MarchOAA. 2012.Pain relief for labour.Obstetric Anaesthetists Association. www.oaa-anaes.ac.uk [Accessed March 2016]
RCOA. 2008.Anaesthesia explainedRoyal College of Anaesthetists. www.rcoa.ac.uk [Accessed March 2016]
Redshaw M, Henderson J. 2015.Safely delivered: a national survey of women’s experience of maternity care 2014. National Perinatal Epidemiology Unit. Oxford: NPEU. www.npeu.ox.asc.uk [Accessed March 2016]
Ullman R, Smith LA, Burns E, et al. 2010. Parenteral opioids for maternal pain management in labour.Cochrane Database of Systematic Reviews. 9: CD007396. onlinelibrary.wiley.com [Accessed March 2016]