Remifentanil - alternative to epidural?

[mouffloncake]

Am interested to hear if anybody had used remifentanil during labour?

I cant have an epidural or spinal block due to spinal surgery & am unable to take morphine or pethadine.
(Will be doing hypnobirthing & try for the pool)

I had a consult with a anetheist who suggested remi but it's unlicensed for use during labour & my hospital only use it once or twice a year.

In Belfast, the epidural rate has dropped by 50% because of women opting for this drug.

Keen to hear from anybpody who has had this, having it, or knows about it.

[StickThemWithThePointyEnd]

sounds interesting, but I've never heard of it...

[straighttalker]

Just one hospital in Belfast uses remifentanil PCAs (patient controlled analgesia) - UHD - but I understand it has dropped their epidural rate quite a bit.

PROS

• Less invasive
  
• Avoids side effects of post epidural headache, nerve damage, etc
  
• When used properly and both patient and midwife are educated about the best use, it's very effective and more reliable than an epidural
  
• Very short acting, so effects and side-effects wear off fast
  

CONS

• New. Not many midwives are comfortable with the pumps and how best to use it in a labouring woman.
  
• Not suitable for labour in a primip (controversial - some do), protracted labours, high risk labours, high BMI
  
• Timing of pushing button important
  
• Midwife needs to stay in room as major SE is depression of breathing
  

Why no morphine or pethidine? Remifentanil is a similar drug to these, though very short acting.

[IngridBergmann]

Watching with interest...epidural made me sick, so would be good to have an alternative.

[mouffloncake]

Thank you straighttalker Thats interesting to read.
I was very ill on morphine & pethidine when I had it for the scoliosis correction so my anethisist said best to avoid.
The breathing thing troubles me somewhat I have to admit so very keen to hear more about it.

[dfoley]

I had remifentanil in my labour with my daughter in July (my hospital are one of the few that use it quite regularly!) & I had an amazing labour. I didn't want an epidural as I felt it was be too invasive. Initially I'd wanted a natural delivery, but after 16 hours of 3 minutes apart contractions, I needed more than g&a when I got to established labour.

I can't rate it highly enough. My established labour was pain free (though they do take it away from you when you're pushing to allow yours & your baby's body to break down the drug inside, it has a very short half life so breaks down quickly & it doesn't leave your baby drowsy like pethidine). I had skin to skin with Bella as soon as she was born & was walking about & had a shower once I had been stitched up.

xx

[MrsO32]

I used Remifentanil for my labour.
I was induced at 13 days, waters broken at 14 and then on hormone drip. when contractions started i was literally floored. i started to hallucinate on gas and air so was taken off it. Remi was on my birth plan

With 30 minutes I was completely out of it. I was a first timer and my contractions lasted 14 hours so was on remi that whole time
Side effects?

Couldn't move off bed
had to have a catheter
Vomitted repeatedly
No memory of labour
Sketchy memeory of the 72 hours following birth

I would not have this again, i wanted short term side effects but i was out of it even beyond my little girl being born.
Theatre after 3hours 20 mins of pushing

Summary: traumatic

[MrsO32]

I used Remifentanil for my labour.
I was induced at 13 days, waters broken at 14 and then on hormone drip. when contractions started i was literally floored. i started to hallucinate on gas and air so was taken off it. Remi was on my birth plan

With 30 minutes I was completely out of it. I was a first timer and my contractions lasted 14 hours so was on remi that whole time
Side effects?

Couldn't move off bed
had to have a catheter
Vomitted repeatedly
No memory of labour
Sketchy memeory of the 72 hours following birth

I would not have this again, i wanted short term side effects but i was out of it even beyond my little girl being born.
Theatre after 3hours 20 mins of pushing

Summary: traumatic

[Twofour6eighttwo]

Hello! First post on mumsnet...why? My baby is nearing 1-year-old and have just been able to bring myself to watch new series of OBEM - it's bringing it all back!

I've been meaning to post for a while as I knew before labour that remefentinal was my best choice of pain relief for labour and found that there is not much information out there so anything I can add will hopefully be of help to someone in the same position.

I have spina bifida occulta and although this has never had the slightest effect on my life (luckily) I ensured that my midwife was aware of my anxiousness over having an epidural in childbirth (due to scarring on lower back). At 34 weeks I had an MRI scan which confirmed I was unable to have an epidural or spinal block due to the risk of damaging my spinal cord. The anaesthetist at the maternity hospital recommended remfentenil as a pain relief option although my birth plan was still to have an active, pain relief free labour. My biggest worry before due date was the knowledge that in an emergency situation I would have to have a Caesarian under general anaesthetic.

I don't think I'm great at dealing with pain. I'll tell you my labour lasted for 3 days whereas my maternity notes say 9 hours! But what I do know is that remefentinal enabled me to feel control over the pain. At one point the midwife asked if I'd been on a hypno birthing course as I was able to breath through each contraction, no screaming. I am however aware that having northing to compare this too, this may or may not be due to the choice of pain relief.

My low point was pushing. 3 hours in total with eventual vontuse. But for 90 minutes of this I decided not to use the PCA as I felt it would help me to push. When the midwife realised, part way through my transition meltdown, she insisted I use it again. It really helped me to cope, nor with pain, which I wasn't feeling so much during this stage, but with stamina. My only warning would be that despite the extremely short half- life, when I stopped using it, I think I felt a 'come- down' which made transition difficult.

Overall, my biggest worry of childbirth was having to have a GA and missing my baby's birth altogether. I feel remefentinal allowed me to participate in childbirth knowing that I couldn't call on an epidural In the darkest of labour hours. I would recommend remefentinal for women in a similar situation.

Will I use it for no 2? I'd like to think that having been through it before I could now more happily face a pain relief free labour, but knowing that there is a non-spinal option available to me makes the whole process a lot more manageable.

[nearlyreadytopop]

I had this during labour. Gas and air just wasnt cutting it. It didnt stop the pain of contractions but it did make them much more bearable. I was induced and was on a drip at one stage. I asked for an epidural but they said that we would review it in an hour. That never happened.
I should add that I was able to go to toilet and walk back and forwards while using it. I was also able to be on all fours on the bed.
The midwife did stay with me at all times but that is standard policy here. I did have to be reminded to breath at one point.
I was not expecting it to be taken away at the pushing stage and it did have to be pulled from my hands by a very stern midwife.
At the pushing stage the babys heartrate was dropping with each contraction so it turned into an emergency forceps delivery. DS had the cord around his neck. I did panic when the room filled with people but I think that would have happened with no pain relief. Ds was rushed off to scbu so I cant comment on how he was after the birth.
Also the dosage is timed, I think its every 2 mins (but might be wrong) so for example when I was put on the drip my contractions were coming very quickly so some I had to have without being able to take a dose. There is a little countdown timer and I remember staring at it thinking those seconds were the longest ever!