Diamorphine vs Pethidine

[spannermary]

We had our Antenatal day at the Hospital yesterday, and discussed various pain management techniques, and painkillers.

Diamorphine and Pethidine were mentioned after G&A, as the first painkiller that would cross the placenta, but they weren't really differentiated. We could have either apparently.

Anyone know the difference, different side effects, uses, effectiveness etc? Or does it really not matter...?

Afaik diamorphine is able to deal with specific pain better than pethadine, which is a more generic analgesia. I think it is less likely to make you throw up. I was told that where possible diamorphine is the preferred option for patients but more expensive than pethadine, so that is often hospitals preferred choice.

diamorphine is heroin, and depending on dosage, can be very powerful.

If you are not on it for long, I doubt you will get dependent or suffer withdrawal, but I have no idea what effects it may have during childbirth. Presumably it will have been screened or they wouldn't offer it. I didn't think Pethidine was as strong, but it must depend on the dosage.

I am not a pro.

It was 12 years ago now but I had Meptid. Is that still available?

The medical professionals do not like to use diamorphine if they think birth is likely within 4 hours of having it as it makes baby groggy and can affect breathing. Same I think for pethadine but poss able to have it closer to birth. Pethadine and diamorphine are both opiate based and therefore are both potentially addictive, however, unless you have had an opiate addiction you are highly unlikely to become addicted to it with one or two shots during a long labour, because you ar not taking it recreationally, you are taking it to alleviate pain.

Am a m/w and we used to use pethidine but have now switched to diamorphine. Just from what I've seen I would say that diamorph works a lot better. Its a better painkiller where pethidine does kill pain it also works by making you more remote from the pain so you don't care about it as much. Though yes, diamorph also does this to a certain extent but I do think the pain relief side of it is better.

A friend of mine is an obs Dr at a different hospital and was horrified that we use it. Asked about increased incidence of babies being born with breathing problems, etc. I haven't noticed any increase and its been a couple of years since we switched. I think if it was causing problems the paeds would have had a fit by now and demanded we switch back.

I used to work in a hospital where first time Mums got diamorphine and second and more got Pethidine. Diamorphine has a longer lasting effect (especially for the baby) and first time labours tended to be longer. There was a revolt amongst the local women who realised they were being short changed with pain relief and they changed the system so that a half dose of diamorphine was offered to great effect. Pethidine isn't a great pain killer for labour pain although fantastic for kidney stones apparently!
I also worked in a place where the head of Anaesthetics wanted to ban Pethidine in labour and insist women had gas and air or epidural as their only choices. It didn't happen thankfully.

I can only give you personal experience, as I had Pethidine with DS1 and Diamorphine (on request, instead of Pethidine) with DS2.

Pethidine sent me loopy and made me throw up - I lost big chunks of time between contractions. Not fun.

Diamorphine was a much 'cleaner' pain relief IYKWIM - didn't feel as spannered, but I needed another dose fairly soon after the first (and then had an epidural anyway - v painful induction).

I have had diamorphine with all 3 of my labours all inductions and unable to have an epidural.at my hospital they give it with an anti sickness injection at the same time.

I like it it makes it feel like you're separated from your pain but not out of control. Time seems to go quicker as well. All 3 babies have been fine no breathing difficulties and the last 2 not too sleepy and fed immediately. With my first we were both learning to breastfeed so I think the feeding problems were due to that but she wasn't sleepy.
Am pregnant again and will use it again when gas and air isn't cutting it! I manage for as long as I can on gas and air as diamorphine is my last form of pain relief available!