Pain relief in labour - Pethidine or Diamorphine?

(74 Posts)
mears Wed 09-Oct-02 11:00:17

There is much debate about which injection is better in combatting pain in labour. They are both opioids but a lot of units have changed from Pethidine to Diamorphine. Herein lies a problem.
Midwives can legally administer pethidine in her own right, without a prescription from a doctor.
Some units only use Diamorphine which legally needs prescribed unless it is written up in advance ( technically not legal).
If practicing legally this could mean a delay for the woman in receiving pain relief when it has been asked for.
The question is - who has experience - good or bad - of either drug. Has anyone had pethidine with one labour and diamorphine with another?
I know it is preferable to have neither but for many women that is not an option ( and that is a different debate).
As a midwife I think women should be able to have a choice. If they are requesting pain relief they should be able to have Pethidine from me immediately or they can be prescribed Diamorphine by the doctor. That might mean a wait if he/she is not available just like the situation with epidurals.
The best solution would be that, if diamorphine is a better form of pain relief, the law be changed to allow midwives to give it in the same way that they can give pethidine.
What do experienced mumsnetters think?

mears Wed 09-Oct-02 12:42:19

Where is everyone this morning?

SoupDragon Wed 09-Oct-02 12:45:24

Well, I'm here but I had neither pethidine nor diamorphine so I can't help!

What's the advantage of Diamorphine over Pethidine? Is it a matter of cost or is one genuinely better for mother & baby than the other?

mears Wed 09-Oct-02 12:50:11

I think it can safely be said neither is good! However some people think diamorphine is a better pain killer. Personally I think women are more sedated and just can't tell you that it's still sore.

mears Wed 09-Oct-02 12:51:48

Thanks anyway soupdragon

Demented Wed 09-Oct-02 12:55:44

OK, I wasn't going to answer as I have only had Diamorphine and thought that someone else could help better if they had experience of the two, but seen as it's you Mears!

During my first labour I was given Diamorphine, I felt more or less pushed into having it by the Midwife, all I can remember her repeating was 'we can give you little injection that will help'. I held off for a while saying that I wanted to wait until my DH arrived first. Through the blur I do remember that it was a Doctor who administered it, I had a half dose initially and it did feel good, I was giggling etc, only looking back when a Doctor came in to explain that I carried Strep B and would need an injection of Penicillin, all I could do was laugh at her and tell her that Penicillin gave me thrush on my tongue so I didn't want it (had the Penicillin in the end mind you).

Not long after I felt awful, sleepy and not in charge anymore, they gave me the second injection of it and I just felt worse, more sleepy, less in control. I wish I hadn't had it as it didn't take the pain away, just distanced myself from the pain, which was fine, but I also felt distanced from the birth experience as well.

Anyway although Diamorphine was not for me I think a Midwife should be able to administer it, afterall that surely would free the Doctor up to see to more urgent matters and although I got my injection right away I'm sure in many circumstances a woman would have to wait if there was no Doctor available.

Hope that helps and makes some sense, I haven't been getting my words out properly today.

Tissy Wed 09-Oct-02 13:24:48

Again, have never had both pethidine and diamorph, but I was given the latter after my section when the spinal started to wear off. Diamorphine made me fell very peculiar! It *did* take the pain away, but I felt out of control and didn't want to hold dd in case I dropped her! I vote for voltarol suppositories- absolutely marvellous!(Though probably no good for labour!)

Bumblelion Wed 09-Oct-02 14:38:31

I had pethidine for my first labour (only gas and air for subsequent two) on the advice of the midwife who was delivering me. She felt I was losing control and thought it would help me. It is not supposed to be administered within 4 hours of giving birth and my midwife thought I would not be giving birth until the following morning (this was about 11:20 pm). As it turned out, I gave birth at 11:35 pm and the paediatrician had to be called when they realised I was about to give birth and my daughter had to be given the anti-dote to the pethidine as it can make babies drowsy and late to respond.

Demented Wed 09-Oct-02 15:38:16

Tissy you've just reminded me, after giving birth to DS1, having had diamorphine during labour I was sitting in the wheelchair going up to the ward and they put DS1 in my arms and I kept thinking 'I could just let go of him and he would roll off my knee and onto the floor', in my mind at the time this didn't feel like the wrong thing to do, just an option. IMO I don't think it helped with the bonding process being so spaced out. The midwives then left me lying in bed with DS1 latched on and I fell into the deepest sleep ever, surely this was not safe as I was still v much under the influence of the diamorphine.

bundle Wed 09-Oct-02 16:31:03

mears, I'd heard that pethidine acted more as a sedative than a painkiller..and it's only effective in about 30% of women. haven't had it though...ended up with an epidural which was just as well as I needed an emergency c-section. I think the prescribing issue is very interesting..the midwife on my ante natal ward kept asking me/dh whether I wanted gas and air/pethidine even though it was in my birthplan - and we reminded her - that I wanted neither. she was very pushy and that was the last thing I needed when I was throwing up and having contractions.

Catt Wed 09-Oct-02 16:40:12

Diamorphine is actually the medical name for heroin. It must therefore be mainly a sedative rather than a painkiller and I suppose pethidine is in the same class? I had neither of these (had an epidural that contained a mixture of lignocaine & fentanyl). I know fentanyl is a strong painkiller so I reckon it's a better bet if you're after pain relief rather than feeling woozy.

Mears - I can't see why midwives can't be allowed to administer diamorphine just as they administer pethidine. I mean, it's not as if you're going to turn people into junkies is it? Isn't pethidine a controlled drug, just like diamorphine?

bundle Wed 09-Oct-02 16:45:50

I had diamorphine post-caesarean and it's certainly a very effective pain reliever - you can really feel it when it's wearing off!

SueW Wed 09-Oct-02 20:20:27

I had pethidine.

I do remember it made me quite paranoid, or maybe it was the situation. I had been having contractions for about 6 hours (was induced) and after I'd had the jab, I lay on my left side, laughing and joking with mum and DH.

A midwife came in carrying a kidney dish with a syringe and needle in it. For some reason (cos I was spaced out I suppose!) I was convinced she was going to give me another injection. I said I wanted to see E, the midwife who had been looking after me. She said E was on a break and she was looking after me now.

I just about lost it - I looked at DH and my mum wildly, trying to work out if this was a conspiracy and they were in on it - another injection. In the end, I blurted out 'I don't want another injection' and then the midwife explained it wasn't for me, she'd just popped in on her way to someone else cos she thought I should be more relaxed. She tried to calm me down by rocking me back and forth and making soothing noises but I wasn't really up for relaxation! I calmed down when she'd left.

I haven't experienced diamorphine personally but saw MIL take morphine in a syrup when she had cancer (self-administered orally by syringe). She was told to take one, wait a couple of mins to see if the pain went, then take another if necessary. It seemed a very effective form of pain relief.

DD had diamorphine following her op. It was via one of those syringe machines. It made her nose itch and she was out of it for the first 16 hours post-op but since it was night-time that didn't really matter. The biggest problem was it made her nose itch which meant she kept knocking her oxygen mask off. I also saw it's painkilling effects on the girl in the bed opposite who had suspected appendicitis and to whom it was administered during the night. 20 mins of agony then a shot from the doc helped no end.

I think if midwives are able to dispense one drug they should be able to dispense both but my concern would be that the possible side effects of both weren't explained to women and they weren't offered a proper choice. In the heat of the moment, it's very easy to say 'Whatever you think best' - I know, I've done it!

mears Wed 09-Oct-02 21:07:40

Thanks for your responses. Catt - they are both controlled drugs. The act that allowed midwives to administer pethidine was passed in 1971. Things have obviously changed over the years. Diamorphine has become the drug of choice in a lot of units. It certainly is the medical name for heroin. Lots of midwives and doctors feel it is more effective. Only a couple of small studies have been done providing evidence that women feel the same. How do you do a valid trial - no 2 women's labours are the same. Second labours tend to be less painful than 1st ones so so couldn't compare 2 different drugs on the same woman. Very difficult issue isn't it?

pupuce Wed 09-Oct-02 21:42:41

Mears - This was in the Independent today... there is more on pain relief as well (including pethidine)
It is a review of Nikki Bradford's latest book :

"So, were she to compile a list of the top five painkillers, which would occupy the number-one spot? Uncontroversially, Bradford opts for spinal injections such as epidurals. "They're the Rolls-Royce of pain relief," she says. "They knock about a third to two thirds off the pain, although one in 20 don't work properly and they can lead to backache." Her choice for second place, though, is more surprising: "That would be a trained birthing partner, or doula," she says. "Someone to stay with you and say, 'I'll rub your back, talk to the doctors – I'll do whatever you want'. Studies have shown that a doula's presence makes labour on average a third faster and reduces the need for pain-relieving drugs by five sixths."

The whole article is here :

http://www.independent.co.uk/story.jsp?story=340802

sb34 Wed 09-Oct-02 22:11:13

Message withdrawn

SofiaAmes Wed 09-Oct-02 22:45:54

Mears, I had a 40 hour labor followed by a c-section first time around. I was given a shot of pethidine somewhere around 20 hours. I didn't find that it offered much in the way of pain relief though it did take the edge off the contractions. I am surprised about what you are saying about a mid-wife being able to administer it without a doctor's permission as this was not my experience. I had to wait several hours for a doctor to give a midwife the ok to give me the injection. I did all my dialating in the 12 hours after being given the injection (don't know if this was coincidental or not). I was then told I needed to be induced, so I asked for an epidural, but during the 5 hours it took them to come up with the epidural, I used gas and air which I found barely helpful. The epidural took away all pain, but I could still move my legs. I was given what I think was Diamorphine after the c-section and that seriously dulled the pain, but didn't make me out of control as others have described. I would say it was far more effective than the pethidine. However, it was a pretty big shock (I got the shakes really badly) when the effects wore off.
Why is gas and air considered a "natural" pain killer? For example it was the only "drug" pain killer offered on the natural "birth centre" floor where I had my second baby.

pupuce Wed 09-Oct-02 22:48:50

Gas and Air is not a pain killer free labour... it is laughing gas and interestingly enough only the UK and Australia use it... To my knwoledge it isn't used anywhere else !
It can make women quite "funny", laugh or cry and they can loose the plot if they seriously inhale too much !

mears Thu 10-Oct-02 09:16:11

Gas and air- which is actually a 50% mix of nitrous oxide (laughing gas) and oxygen has a very short half life. That means that there are virtuallty no side effects except in very prolonged use. When it is breathed in it must be started at the beginning of the contraction so that it is working before the height of the contraction. Once the contraction is gone the effects of the gas quickly leave the system. The baby has no lasting effects after birth, unlike diamorphine/pethidine which cause the baby to be sleepy and possible feeding problems in the first few days.
Although the mum feels 'drunk' breathing the gas, the effects go when she stops breathing it. That means she is in control of when to start and stop. Once an injection is in the effects are there for hours, sometimes lasting post birth which can cloud the experience.

Bron Thu 10-Oct-02 09:53:24

I had pethadine - I wanted an epidural but a selfish woman had just walked off the street 8 cms dilated with twins without phoning in so the anaethsetist (sp?)was unavailable. I remember hearing DS and midwife discussing something but not cariing what it was about. It was an amazing feeling - I'd been in labour for 12 hours by that stage and was on the syntometrin drip so it was a releif. It wore off suddenly tho. I then had my epidural as I was in labour for another 5 hours. I was completely against having it but as teh epidural was not an option and I was sooo tired by that stage, I agreed and it definitely helped even if it just lulled me into a trance for an hour and I feel it was far enough away from the actual birth to not be worried. I don't think I would have it again tho.

Eulalia Thu 10-Oct-02 11:41:13

Wasn't offered Pethidine at our hospital. Had Diamorphine both labours. Gas and air doesn't do anything for me, just makes me feel nauseous.
The midwife didn't need permission to give me the injection. In fact the first time I only saw one person throughout the whole labour except to give me the morphine and that was only because I was being given an injection so another midwife came in. Certainly no doctors were present. I didn't know that about not giving it 4 hours before the birth as with my 2nd labour I had the baby about 45 mins after the injection.

The morphine did make me very woozy first time but also extremely relaxed. It certainly calmed me down and helped me get through the next few hours. I felt able to 'wake' myself up OK to push and the birth was no problem. I did feel a bit spaced out afterwards but I don't think it interfered with bonding. Ideally I'd not like to have had it as I am sure it didn't help with feeding problems but the problems were going to be there anyway. Also I did feel jumpy afterwards for a few days.

2nd time I don't think the morphine had time to take effect as the birth was so fast. If I'd known then I probably wouldn't have bothered having pain relief. I think the adrenalin of giving birth wiped out most of the effects and I had no after effects this time. Perhaps also because I'd had it before. I only had one shot each time and I this was enough.

For me it worked postively - I think it affects people differently (makes some sick) and also depends on your mental status, ie how tired you are already and if the labour is going well and how in control of the situation you are.

ionesmum Thu 10-Oct-02 11:48:38

I had pethidine and diamorphine. And gas and air. And an epidural. And a general anaesthetic.

hmb Thu 10-Oct-02 11:51:01

ionesmum,

And me, except the GA! And I had a Tens machine. And they were all wonderful, a various times. The diamorphine was better for me because it didn't make me feel sick, the petadine did.

mears Thu 10-Oct-02 12:36:18

The reason I posted this question was because there has been a recent change in the law (2001) about patient group directions. Up until then the hospital had a standing order which named the drugs midwives could give without getting the doctor to physically prescibe. Since this change midwives cannot give pethidine/diamorphine without physically getting the doctor first. This means a delay for women when the unit is busy. There issue of pethidine could be argued because, in law, midwives did not need a prescirtion technically. However, most hospitals have now changed to diamorphine as it is thought to be more effective for labour pain, with less vomiting associated with it. I have been getting information from all quarters and it would seem that it is not worth preserving the right of midwives to give pethidine as diamorphine is better. The law needs to be ammended to allow midwives to administer it legally when the woman wants it. How long do you think that will take?

Catt Thu 10-Oct-02 15:30:35

Mears - it's interesting that, as a midwife, you turn to those who have been in labour for their views. In my experience, that's what midwives do. They work with us to achieve the best possible labour experience we can have. But as for the hospital or health service as a whole, let's face it they will amend the law late in the day, long after midwives have been pushing for a change (excuse the pun!)and definitely without bothering to find out what actual women in labour think.

Call me cynical, but I wouldn't hold your breath for a quick change in the law to bring practice up to date.

Willow2 Thu 10-Oct-02 16:20:44

I didn't have pethidine or diamorphine during labour - but have had the former numerous times after operations, and I would just like to say that I love it and would strongly recommend it to anyone recovering from an operation! It makes you go all woozy and lovely and warm - frankly, if they could bottle it and sell it in Oddbins they would be on to a winner. Having said that it also makes you talk absolute xxxxxxxx - I once asked the nurse to stop my dog from knocking over the flowers - so it might not be a good thing during labour if you are keen to make informed choices!

dinosaur Fri 05-Sep-03 15:15:26

I thought I would revive this thread in order to ask a question about adverse reactions to pethidine.

My DS1 nearly died at birth - he collapsed and turned blue and was out for about ten minutes whilst they struggled to revive him - eventually they had to give him intracardiac adrenalin.

When I was pregnant with DS2 I discussed this with the then newly appointed consultant midwife at Homerton Hospital - marvellous woman - and she said she thought it was most likely an extreme and unusual (but not totally unheard of) reaction to pethidine. This was her view even though I had the pethidine over eight hours before he was actually born.

Did anyone else's baby have similar reaction? Needless to say, nothing would have persuaded me to have pethidine second time around, nor any other form of artificial pain relief.

zebra Fri 05-Sep-03 15:35:42

I know someone who's baby also nearly died at birth due to pethidine; the MWs told the mother she was ages from delivery; she had the pethidine jab & 20 minutes later baby was born, not breathing.

Her 2nd labour went similar, and she was sorely tempted towards the pethidine, but resisted because of the first experience. Sure enough, less than 1/2 hour after she nearly opted for pethidine her 2nd child was born.

dinosaur Fri 05-Sep-03 15:41:32

That's interesting.

I find it quite surprising that you don't tend to see or hear much information about the risks associated with it.

The midwife who delivered DS1 was taken completely by surprise; in fact I think she was almost in a worse state about the whole thing than I was. However I know that by the time I had DS2, someone else's baby at that hospital had had a similar experience.

Of course we will never know to what extent DS1's autism was caused/affected that all that. Did your friend's child suffer any lasting effects?

Hughsie Mon 08-Sep-03 10:21:29

I had pethidine with ds1 but it was probably about 8 hours before birth but he was fine and had an apgar of 10 straigh away. I didn;t like it though - lost control a bit and felt realy weird so didn't have anything for ds2

Jenie Mon 08-Sep-03 10:46:49

Haven't read the whole thread (just the recent bits) but I just thought I'd ask if having pethedine could increase the risk of baby being in distress during labour?

dinosaur Mon 08-Sep-03 10:54:56

I don't know the answer to this one. Certainly DS1 did not exhibit any signs of stress before he was born(heartbeat okay, no meconium) which is why the midwife was in such a state of shock when heh collapsed and nearly died.

Jenie Mon 08-Sep-03 12:11:48

Both of my children had meconium in the water but only dd was in distress to the point that her heart beat was dangerously low and things got a bit frantic. No one ever said that it was due to the pethedine, I didn't get any explanation just accepted that that was the way it goes some times.

M2T Mon 08-Sep-03 13:00:00

Mears - I had diamorphine with my ds. I was extremely thankful at the time, but in hindsight it still hurt like hell and my gas and air was a distraction for me.

The diamorphine made me drowsy, unaware fully of what was going on and I kept drifting off inbetween contractions which meant I would wake up midcontraction..... too late to take a nice big inhale of gas & air.

I also didn't like the fact that I felt totally spaced out and when ds was born I still felt drunk. I have had to rely on my dp to tell me all the details of the labour. Plus my ds was a bit groggy too and wouldn't latch on to the breast for a good 24 hours.

I really would rather do it without diamorphine next time so I can remember clearly what it was like to see their wee face for the first time.

spikeycat Mon 08-Sep-03 13:10:24

I had two lots of pethadine (a 36+ hour labour) with my ds, then a epidural. When ds was born he wasn't reactive and to my view was dead (although this was never confirmed). He was eventually bought round in SCBU (so I don't know how they did it) and went on to suffer serveral convulsions.
The morning following his birth I was asked whether I had taken any drugs during my preganancy (like heroin or cocain), which I certainly hadn't - I really think it was due to the amount of drugs they had given me during a very painful labour (they had also given me 20mg antidepresant that can help you sleep, can't remember what its called). They only discovered he was back to back with me after about 15 hours of labour, so the care we got there was crap. Bummer is I am having 2nd baby next march and thats the hospital I have to go to

dinosaur Mon 08-Sep-03 16:47:33

Spikeycat,

I can really understand your worry.

However (and you are probably fed up hearing this!) you may well have a much better experience second time around. My DS1 was also back to back with me, whereas DS2 was not, and the labour second time around was so much quicker (DS1 - about 20 hours from start to finish - DS2 about 3 hours from start to finish). In fact, second time around, I didn't have any pain relief at all, not even gas and air, which certainly wasn't my originalintention - things just moved so fast there wasn't really time to bother with it!

However, it now seems to be accepted within the medical community that pethidine can cause extreme reactions in some babies, so given your experience with your first child, you would probably be wise to avoid it second time around. I've not heard of this kind of problem being associated with epidurals, so that's what I was going to do if I couldn't stand the pain.

I got hold of mine and DS1's hospital notes from first time around and insisted on having an appointment with a consultant - took him through the notes (he hadn't bothered to read them in advance) and made sure he'd looked at all the relevant bits. Because of what had happened to DS1, I was actually offered an elective caesarean, although I turned it down. What we agreed in the end was that they would put a big flag in my notes, so that when I came into hospital to have DS2, all the midwives would be aware of what had happened before, and they would also put a paediatrician on standby in case DS2 had to be whisked away to SCBU. This meant that I had two midwives in attendance at all times, as well as the paediatrician on standby. Of course, I reckon that if I'd had two midwives to help me with DS1, I'd never have needed the pethidine and so the whole thing likely wouldn't ahve arise at all, but there you go.

Have you had the opportunity to discuss your fears etc with the hospital? I must say, it helped me enormously and made me feel much happier about everything.

dinosaur Mon 08-Sep-03 17:12:17

Mears - I hadn't registered the fact that you are a midwife.

Have you had any experience of pethidine causing extreme reactions in babies?

mears Wed 10-Sep-03 09:40:11

dinosaur - I have never come across your experience being attributed to Pethidine - what an awful experience for you. It is extremely unusual for a baby to need that level of resuscitation so I am not sure that there will be evidence around to support the belief that it would be due to the pethidine. However, since there was no other sign of distress prior to delivery I can see why the connection has been made.
Pethidine/Diamorphine in labour can have an effect on the baby. Babies most affected are usually born around 2-3 hours after the injection. It used to be that paediatricians were called to the delivery if it occurred within 2 hours of the admimistration of pain relief, but the effects of the drug are not usually at it's height then. It can affect the establishment of breathing in the baby and floppiness. An antedote called Narcan can be given in extreme cases.
Epidurals can also affect babies because the drugs used in them can also cross over to the baby. One of the drugs used often is Fentanyl (Sublimaze) and it can also cause the same effects in the baby.
Alternative forms of pain relief such as TENS, Massage and water (pool) can be really effective without the side effects of drugs. The support of midwives is also crucial.
Dinosaur - second labours are often much more straight forward and there is less need for drugs. The chances of the same thing happening to you are remote I would think. Best wishes for a good experience next time

tamum Wed 10-Sep-03 09:44:45

Hello Mears, I realise this is an old thread, but are you still interested? I have had both pethidine and diamorphine and am happy to write about it if it would be useful, but one was in a "normal" delivery and the other a C section, so it's not a very scientific comparison.

mears Wed 10-Sep-03 09:48:27

I am always interested in womens' experiences

tamum Wed 10-Sep-03 09:56:17

Ahh, that's nice! Well, it's all highly unscientific, but my first labour was all fairly hideous, culminating in a ventouse and baby with very badly damaged scalp. I was given pethidine, I would guess about 3 or 4 hours before he was born, and I absolutely hated it. It made me sleepy and spaced out, so I was completely unprepared for the contractions when they came, I was just woken up to a wall of pain, it felt like. I really find it hard to believe that it dulled the pain; I can't be sure, obviously, but it just felt as though it was just as intense but I was less able to deal with it.

The second time my dd was breech, and it turned out I have a very narrow pelvis, so I had a C section. I had diamorphine on a pump I controlled, and it felt so much better than the pethidine -I'd been dreading it as I assumed it would be the same, but although it made me a bit drowsy I didn't feel out of control, and it helped the pain enormously. Obviously I was post-operative and not in labour, so you see what I mean about it not being a very valid comparison!

Thanks for listening

dinosaur Wed 10-Sep-03 10:22:05

Mears,

My second delivery was fine - I just wrote about it to try and reassure Spikeycat that she might not have such a bad experience next time.

I'm interested that you haven't come across such adverse reactions to pethidine. I shall never know for sure why DS1 had such a bad reaction, or even whether it definitely was pethidine. Certainly was a terrifying experience.

dinosaur Wed 10-Sep-03 10:24:25

Mears,

My second delivery was fine - I just wrote about it to try and reassure Spikeycat that she might not have such a bad experience next time.

I'm interested that you haven't come across such adverse reactions to pethidine. I shall never know for sure why DS1 had such a bad reaction, or even whether it definitely was pethidine. Certainly was a terrifying experience.

Jenie Wed 10-Sep-03 11:10:50

Mears I too had not realised you were a midwife. Oh can I ask you some questions about my labour with ds then please? I know that you must get this all the time but there are a couple of things that are still bothering me 17 months on and getting in touch with someone at the hospital to talk to is like.... well the words needle and haystack spring to mind.

mears Wed 10-Sep-03 12:54:36

If I can help Jenie, I am happy to.

Jenie Wed 10-Sep-03 13:09:08

I was sent to hospital to be induced as I was 10 days over due and fed up, dp was going away with work the following week and I was desperate for him to see ds prior to leaving.

Well after labour was started using that cream thing, I was in full throws give or take 1hr and in the delivery suite in heaps on pain. Well my waters didn't break for a long time (about 20 mins prior to his delivery). When they did there was meconium (sp) in the water the midwife said something about it being there for over 24 hrs (how did she know this) and got the pead down for clearing airways etc.

Well when he was deliverd he had the cord wrapped around his neck and it had a knot in it (how does it get knotted?).

Something was then mentioned about if I hadn't been induced that night that he may well have died due to this...... would that be right? I had to beg and plead and plain old refuse to leave until I'd been induced due to staff shortages.

I'd been in and out just befor due date as I kept having contractions that were painful but nothing was happening other than that, everytime I was given an internal ds head would "bob away". Should this have indicated that there was alot of water surrounding him and that maybe they should have been scanned for this.

Any way if you could answere these questions I'd appreciate.

mears Wed 10-Sep-03 14:16:27

Hi Jenie,

I'll answer your questions in a different order if you don't mind so that you can see a chain of events if you like.

When you mentioned that the head would "bob away", that is a sign that the baby's head has not engaged as yet. It is quite common for women to come to hospital thinking they are in labour because of painful contraction but often these contractions are 'pre labour' ones which, although they are painful, are the body's way of preparing for labour. I would say that your previous admissions were prelabour pains and that the head was not engaged. There is no need for a scan at this stage unless the baby was facing the wrong way or the head was no where near the pelvis.

The prostin gel you were given obviously put you into good going labour so you were probably close to going into labour on your own anyway.

It is not uncommon for baby's bowels to move in the womb (meconium stained liquor) when you go past your dates. Sometimes it can be a sign of distress if the heartbeat shows decelerations on the monitor tracing. Often there is meconium but no distress of the baby at all. If there is a lot of meconium seen in the waters prior to delivery, a paediatricain is called so that the baby's airways can be cleared at birth before the baby has a chance to 'breathe in ' the meconium (meconium aspiration). However, babies actually sort of breathe in the womb anyway and the meconium can already be in the lungs prior to birth. Usually the paediatrician looks down the baby's throat with a light to see the vocal cords. If no meconium is seen then it hasn't gone into the lungs. If a baby comes out screaming there really is no need to look down because they would not be able to cry like that if there was a problem with the meconium. You can tell by the shade of the meconium whether it is fresh or old. I presume yours looked like old meconium hence the midwife saying it looked like over 24 hours old.

It is better for the baby actually the longer the waters go without being broken (intact membranes), even if there is meconium. Intact membranes cushion the baby during contractions and it is les painful for the mother.

I think it is ridiculous that someone said the baby might have died had you not been delivered that night. It is not uncommon for a baby to have the cord wrapped round the neck (all 4 of mine did). Some babies have really long cords and they are wrapped round the body and limbs as well.
I have seen true knots a few times. The knot occurs because of movements of the baby in earlier weeks. The baby may have moved to breech and back again and the knot has been made as the baby has swum through a loop. The cord has blood vessels with thick jelly round them to protect them. Knots can be present that cause no problem for the baby. Sometimes though, the knot can be tight and the baby's heart rate slows down a lot during contractions. If the tracing of the heartbeat shows a significant problem then the baby might need to be delivered by caesarean.

Being induced is actually very stressful for a baby. You laboured very well but had they tried to induce you say a week earlier, the gel might not have worked and you might have needed to have your waters broken as well and be put on a drip. When the waters are broken the baby is not so well cushioned and because of the cord round the neck and the knot in the cord, your baby would have been much more stressed. It is a good thing that your waters were not broken which some hospitals automatically do when you are getting induced. How was your baby at delivery? Any problems?

Hope I have answered your questions. Let me know if you think of anything else

Jenie Wed 10-Sep-03 14:37:07

Thank you so much it does help to know, I wasn't in there for long afterwards, had a bath and toast then left with ds.

My labour only lasted 3hrs from having the cream to delivery so there wasn't time for too much monitering but he had a good heartbeat up to the point of my waters breaking and by then I'd done the rest so it would have surely been quicker for me to carry on. Glad I did tbh.

Ds was fine after delivery, he had a floppy larinx that I don't think is connected and so had very noisy breathing for about 8 months (still does to some degree now) but they removed the cord and cut it befor he was fully delivered. Lots of facial bruising (normal as it was the same with dd).

That's about it.

Ever thought of answering mothers labour questions for a living? Everyone I know has atleast one question. You could charge £10 per question - blimey I'd owe you atleast £30......

pupuce Wed 10-Sep-03 15:07:28

Blimey Mears.... if only more MW felt the way you do!

It is very rare that you hear this :
"Epidurals can also affect babies because the drugs used in them can also cross over to the baby."
Or
"It is better for the baby actually the longer the waters go without being broken (intact membranes), even if there is meconium. Intact membranes cushion the baby during contractions and it is les painful for the mother." - way too many women get their waters broken !

or

" It is not uncommon for a baby to have the cord wrapped round the neck" - so many people are told that they are lucky their baby is alive.... they are led to believe that the Dr saved their baby (and this justifies the intervention)...grrrr.....

Sorry had to rant!

jasper Wed 10-Sep-03 16:08:50

for all the help mears has been to me I will need to get a bank loan....

mears Wed 10-Sep-03 21:31:25

Thanks you lot I adore being a midwife and am happy to help when I can. Any sign of anymore babies Jasper - only time I get hands on to myself is when friends have babies

jasper Thu 11-Sep-03 00:12:24

Believe it or not I do still have a hankering for a fourth, . Most of the time it seems like a bad idea but you only need to think it's a good idea for five minutes (or less) for it to become a reality

Harrysmum Thu 11-Sep-03 09:50:08

Mears - the thing about the intact membranes is really interesting. I had my waters broken with ds1 at 4cm because I had been 4cm for dear knows how long (I went in with some bleeding; no contractions; they said I was too dilated to go home; slept all night and so they decided to get things going in the morning). With ds2 I was at 10cm before my waters broke spontaneously and I didn't understand until after why they hadn't broken them for me - having them intact does explain why it wasn't as horrifically painful as the first time (it took 2 hours from waters being broken to ds1 being born). They were trying to explain that I could in fact deliver ds2 with my waters intact which was too bizarre a concept to get my labouring head around! It was also not so bad because I had morphine. Having checked with dr dh it was morphine and it was given with no reference to a doctor - the midwife prescribed it (I think). It was fantastic - didn't stop the pain but made it bearable and allowed me to really rest between contractions. Mw warned that it may slow things down but given that the whole labour was 4 hours with the second stage officially recorded as 2 mins that kind of slow I can deal with!

StripyMouse Thu 11-Sep-03 10:22:49

Mears - like Harrysmum I was really interested to read about the waters being intact. I have always felt this to make sense and yet have never read any proffessional actually saying so. Reading you words has meant a great deal to me.

Against my wishes (and the previous mw caring for me’s advice to the next one at the cross over), a change of shift resulting in a different mw examining me and breaking my waters with a throw away comment like "there you go, we will get a faster move on now" I was horrified as suddenly my whole birth experience changed from being calm and in control to being unable to cope with massive increase of pain (not prepared so was also very frightened) and agreeing to pain relief that in other circumstances I would never have taken (pethidine). The pethidine made me feel even less in control (couldn’t speak but could hear all going on around me) and to cut a long story shorter, baby became distressed, hb dropped, ventouse done - again with no discussion - (pethidine wasn’t working in terms of good pain relief and so ventouse proved very painful - was badly bruised). She arrived "safely" but was very sluggish, slow to latch on etc. etc. All in all, left feeling as if I had been violated (examined frequently with no prior warning or sensitivity to my contractions), my labour hijacked by an impatient mw and possibly my babies health put at a slight risk. Judging by the huge number of staff who ended up in my room at the end, they were clearly worried that something was going wrong - never offered much of an explanation or decent "debriefing" - depsite several requests at the time. I was so shell shocked that we just wanted to get out of there and go home to recover.

So, personally, I would never take pethidine again. I never like feeling drunk and hated feeling unable to coordinate my words and express my feelings despite being able to see and hear everything. The pain relief seemed minimal and didn’t notice any real reduction. The medical staff seemed to take my "enforced compliance" to mean that they could just get on with it and tell me what they were doing rather than ask - eg. "I am examining you now" - despite being mid contraction and me desperately wanting to ask them to wait or ask if it were necessary - seemed to have one every ten minutes, I believe a student midwife was "practising" at the time.... I even remember one member of staff leaning right over me and telling my husband "don’t worry about her now, she is totally out of it". Those words still haunt me - it was so frustrating not to be able to shout back at her "no I am not, I am in pain, and very frightened. Stop ignoring me and start treating me like a real person again." Interestingly, a close friedn’s sister who was a mw for several years (now on maternity leave herself) said that pethidine was often given to women by some mws she worked with just to "shut them up a bit and let the staff get on with their job"...not sure how much truth is in this but she is a lovely girl and seemed genuine when saying this.

Sorry to go and on - this post has uncovered a lot of deep seated feelings that I thought I had worked out of my system but obviously not! I am going for a home birth this time and hope to avoid all medical intervention as much as is possible.

Cam Thu 11-Sep-03 10:28:16

yes very interesting about the waters, in both my (normal) deliveries the waters did not break by themselves, but were broken for me and I delivered less than 20 mins later. I had always thought that it was necessary for the waters to break and that somehow my body "failed" me by it not happening naturally. Now I realise that my body was doing the best thing. Thanks Mears.

SueW Thu 11-Sep-03 10:58:38

I think the waters thing is interesting too.

My waters broke naturally whilst i was in an upright position (semi squatting, I think, definitely leaning against a sink). My daughter was posterior (I had an anterior placenta i.e. on the front of the uterus which prob didn't help) and she ended up in an unusual position with her head presenting sideways, chin and ear first.

In some ways I wish my waters had waited a little longer before going or I had been in a position where there was less room in my pelvis (not at all squatting) as my DD's head might have got into a better position and not got stuck! Perhaps if I had been in a position to do handstands, that might have helped.

Can't help but smile at the thought of 42 week pregnant woman weighing 92kgs doing a handstand in a delivery room! Maybe tying me by my ankles and dangling me from the ceiling may have helped!

pupuce Thu 11-Sep-03 16:12:13

Both my labours waterrs went of their own accord at the end of the first stage.
I have been a doula to a mum who delivered baby in water with its sac intact! Very interesting... it burst when she came out !

buzzybee Fri 12-Sep-03 09:36:01

A small vote for pethidine here (sorry haven't had diamorphine Mears). I had a home birth and after 8 hours through the night of contractions 3-4 mins apart (dd was very low apparently) and still at only 3cm dilated I was deperate for some rest. Pethidine enabled me to doze between contractions for the next 5 hours through to 10cm and 2nd stage was only 15 mins. No problems for baby or me. My waters were broken at 10cm - I must admit I too assumed they had to be broken some time!

HAPPYFACE Fri 12-Sep-03 21:31:21

JUST READ SOME OF THIS THREAD AND MEARS DIDN'T REALISE YOU WERE MW EITHER!
MY WATERS BROKE OVER 3 DAYS BEFORE I HAD MY DD AND AFTER BEING SENT HOME IN AGONY LOADS OF TIMES BEING TOLD I WASN'T IN ACTIVE LABOUR THEY FINALLY LET ME STAY AND GAVE ME PETH WHICH I DIDN'T WANT BUT WAS SO TIRED HAD AND SLEPT FOR NEXT 6 HOURS! WOKE WITH BAD CONTRACTIONS AGAIN ONLY 7CM SO HAD EPIDURAL AND THEN WENT ANOTHER 12 HOURS BEFORE ACTUALLY GETTING DD OUT!
NO-ONE EVER TOLD ME WATERS BREAKING MADE IT MORE PAINFUL! KNOWING THIS MAKES ME FEEL A BIT MORE HAPPY FOR WHEN I TRY FOR ANOTHER, HOPE FOR SHORTER LABOUR AND CAN HANG ON TO MY WATERS!
IS IT ANY MORE LIKELY THAT THEY WILL BREAK EARLY AGAIN?

dinosaur Mon 15-Sep-03 11:47:03

My waters breaking was the first thing that happened both times, if you see what I mean.

They broke about 7 a.m. on the day before DS1 was born. No contractions beforehand - contractions started spontaneously about midday.

Second time around, again my waters broke before I went into labour, but everything happened much faster - waters broke about 4 p.m., DS2 born at 8.15 p.m.

I didn't realise that waters breaking early made it more painful. However, Happyface, if it is any consolation, labour with DS2 was not too bad despite my waters having broken, I managed with no artificial pain relief.

SueW Mon 26-Jan-04 14:58:57

Mears, is this still the case - that midwives can administer pethidine but not diamorphine?

Apparently a local hospital is beginning to use diamorphine although has previously used pethidine (and perhaps meptid, not sure).

mears Mon 26-Jan-04 15:07:51

Hi SueW - midwives can no longer administer Pethidine. Hospital midwives actually should not have been doing it in the first place but fairly new legislation regarding the administration of drugs makes it unlawul. Opiates should only be prescribed by doctors and pethidine is included in that. There are drugs that midwives and nurses are authorised to administer without a prescription and these come under Patient Group Directions. Community midwives may be able to give pethidine. There needs to be an ammendment to the legal situation but in the mean time, Diamorphine is prescribed in our unit for all women since the doctor needs to write it up anyway (midwives used to write up the pethidine).
The law needs to be ammended for community midwifery units where a doctor isn't present. It annoys us that we have to get the doctor to write the prescription for our midwifery cases. You know how long the legal wheels to turn.

WeeObsAnaesthetist Thu 18-Oct-12 18:29:39

We have just conducted a large two centre randomised blinded controlled trial of 484 women comparing 7.5mg diamorphine with 150mg pethidine for labour pain. Diamorphine gave better pain relief for the first 1.5 to 3hrs compared to pethidine but at the expense of longer labours by about 1.5hrs. We looked at all the confounding factors that may prolong labour and eliminated them and we still found that mothers who had diamorphine delivered about 50mins to 1.5hrs longer. This is not widely known by women who choose diamorphine. There were no significant differences in the outcomes of the babies from mothers who had either diamorphine or pethidine and we looked at a number of outcomes during labour and up to 2hrs post-delivery including sedation and breastfeeding. We hope to publish our findings soon in a high impact medical journal. So the simple message is - if you want diamorphine, be prepared for a longer labour but you will get better pain relief for about 3hrs after the drug. More women seemed to be more satisfied with diamorphine compared to pethidine but 85% of women in our trial in BOTH the diamorphine and pethidine said they would choose the same analgesia again for their next pregnancy.

elizaregina Thu 18-Oct-12 19:19:06

I was told diamorphine was a " cleaner"drug and didnt pass placenta as much as pethadine? and was also more effective?

I had pethadine, there wasnt much else to choose from, the g&A wasnt cutting it - although still had it - and i wasnt allowed an epidural with the old - too far gone, not far gone enough routine....

with nothing else to try - i had pethaine and it certianly relaxed me whilst still feeling the pain.

it was definalty a postive - but its not like there were many other options....

YES mw should be able to adminsiter it - why add another thing for busy over stretched docs to try and do !!!

AlisonDB Sat 20-Oct-12 22:01:22

For what it's worth I had a great experience with pethadine!!
I think I had what is referred to as failure to progress.

My contractions started on the Thursday night 22.00 ,
Coming every 4 minutes but lasting a max of 25 seconds....
The where strong enough and regular enough that I couldn't sleep.
This continued right the way through till Friday tea time 6.30 when my contractions (which I hadn't had a break from) began to last 1 minute. They where still coming regularly every 4 minutes...

The midwife (who i had been in contact with all day) came to my house at around 7.30 where she checked and said I'd dilated 1cm....

She left and came back at 11.30 and I was still only 1.5cm...
So she referred me to the hospital (I had been due for a home birth)

Once at the hospital the midwife there gave me pethadine to help me sleep. :-)
2 hours later I woke "needing a pooh" as I thought she checked me and I was fully dilated,
Contractions still only every 3 minutes lasting slightly longer than 1 minute.
I had no further pain relief, didn't feel I needed any.
60 minutes later baby was born, only complication was he had done a pooh in the amniotic fluid, so was monitored straight afterwards,
But he was fine.

I have already told my MW that if the same happens I want pethadine.

BoysBoysBoysAndMe Sat 20-Oct-12 22:59:35

Pethidine with ds1. Felt really drugged up and although I could still feel the numbed contractions iyswim, I couldn't talk or move much.

But it did dull the pain.

Ds2 I had diamorphine and I loved it!! Only the first shot though.... Was exhausted an needed a rest.

Had 2 further shots which I feel prolonged labour but again was exhausted and had not wry supportive mw's sad

In hospital for over 24 hours before ds2 was born via emergency spinal block and ventrouse. Was going to have a caesarean if ventrouse didn't work.

Ds3 due in 12 days and I'm shitting myself grin

Don't want pethidine or diamorphine but worried how I'll cope with the pain if its another long labour and I'm exhausted.

Handonheart Thu 27-Dec-12 11:14:41

Hello Mears - I know I'm very late in joining this convo but wanted to add my 2p worth! I only had Diamorphine (I asked for it plus had it on my birth plan) - don't remember Pethidine being talked about much but for me Diamorphine was a big mistake as it didn't relieve my pain and just sent me off the rails - didn't listen to any midwife instructions from then (apparently!) and tore badly which I believe was from not listening and going a bit la-la. My DS was so knocked out when he was born he wouldn't feed properly for 2 days and I have always wondered if it had a long term affect on his brain - do you know if there is any evidence to show this could be possible? You may have long gone from these conversations but have always wondered..... Happy 2013!!

Handonheart Thu 27-Dec-12 11:18:08

WeeObsAnaesthetist - has a report been published? Would be interested to learn more of findings from Diamorphine as my son wouldn't feed properly for 2 days after birth as he was so knocked out and I wonder if there are any findings of long term affects on the baby? (Son is age 9 now!). thank you.

Ushy Fri 28-Dec-12 11:07:54

Weeobs interested in this "More women seemed to be more satisfied with diamorphine compared to pethidine but 85% of women in our trial in BOTH the diamorphine and pethidine said they would choose the same analgesia again for their next pregnancy."

What were they comparing with - especially if it was a first child?

Having had both pethidine and an epidural, I had wooziness, slight nausea, hardly any pain relief and difficulty in communicating with the former. I refused pethidine for a subsequent birth so that I could argue forcibly for an epidural which I got (after a battle) and which gave 100% pain relief with no side effects whatsoever.

I had Diamorphine. I was begging the midwives for it, for about 2 hours before they let me have it. I was in a huge amount of pain.

When they injected me, I screamed 'it's just water!!'. But it worked. BUT...it did result in a very very very sleepy baby who didn't feed for ages, total actual birth amnesia for me, which I think led to my PND and psychosis (was convinced baby belonged to someone else, as I couldn't remember giving birth, just being in labour). I pretty much gave birth, threw up, had a shower, and fell asleep (only had short labour, so wasn't like I'd been awake for hours like some women). Didn't want to hold the baby until we got home, which was 4 hours after birth. And even then I didn't really pick up except to feed/when the midwife came. Felt totally disconnected from him.

Also, I got the injection about 20 minutes before I gave birth, had been using the pool and G&A up till that point. I was in so much pain I would have shot myself (or anyone else including my partner!) if it would've stopped the pain.

Shagmundfreud Sat 29-Dec-12 12:46:07

My really big issue with pethidine is that many women are not making an informed choice in opting for it, because many midwives don't set out the facts on how ineffectual it can be as an analgesic in advance.

Women need to be told that perhaps half of those who take it will still be in severe pain an hour later.

My understanding is that midwives routinely rate pethidine as more effective as pain relief than mothers themselves do. Perhaps because it makes women nice and quiet and easy to look after. wink

sittinginthesun Sat 29-Dec-12 12:48:47

Haven't read the whole thread, but my experience of diamorphine was awful. I was still in agony, but couldn't express it. I was hallucinating, and it took about three days to feel normal. Just awful. sad

NinthWavingAtTheSnowman Sat 29-Dec-12 12:56:23

This thread is older than my children! grin

I had pethidine for first birth, diamorphine for second. The latter was better, a 'cleaner' pain reliever. It worked well for a few hours until I had to have a synto drip.

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