a little concerned I keep having to explain myself when I say I don't want opiates...

[ardenbird]

So I'm starting to get a bit concerned that I seem to have to explain over and over again when discussing my birth plan or even just talking about my wishes (HV, MW, GP) why I don't want the opiate shot. It makes me worried that even though it's in my birthplan, I'll have to have this argument at the time too, and it would be a very bad idea for me to have the shot.

I've already discussed the issue with my consultant, and given my past reaction to opiates he agrees that I should avoid the shot and go straight to an epidural if I can't cope with gas and air. I don't have an actual allergy, so it doesn't trigger any of those flags. But I have very extreme forms of the typical side effects (e.g., uncontrollable, constant vomiting lasting for a few hours followed by several days of severe nausea and vomiting -- really not the best situation for childbirth or caring for a newborn).

It's just about the most important thing to me in my birthplan, aside from taking care regarding my SPD, and I thought that a simple "NO OPIATES" was the best way to go. But just saying that seems to produce cajoling about how painful labour can be and I should consider opiates, and then I have to explain, no, opiates don't mix well with me. Then they tell me about the antinausea shots they can give at the same time. But since I've already discussed this with the consultant and HE didn't suggest this, plus knowing the severity of my reaction, I'm not hugely convinced they would be particularly useful and really not interested in giving it a try during the birth of my first child when epidurals are also an option. (Maybe during another colonoscopy...)

Will the MWs on the labour ward be better? I'm going into the MLU because I want to use a pool, which has been okayed by my consultant, and they'll transfer me to the CLU if I need an epidural (or the weird condition I have him for causes problems).

How can I best present this in my birth plan to avoid arguments? The back-talk I'm getting about this is starting to worry me, and I'd like to make sure I don't have to do this while in pain.

Tell them it is an allergy, rather than a bad reaction. They will take that more seriously!

Make sure your birth partner knows all this so he can act as ayour advocate.mif you don't want them when you are actually in labour just say no, they cannot force you... Would it just be the pethidine shot though? An epidural will contain opioids too...

Sorry, trying to type on ipad...

What Viking Lady said. Make you sure you write it in big letters across the top of your birth plan. Who is going to be your birthing partner? You need to train him/her to mention it loudly and clearly every time someone new comes in - "ardenbird is allergic to opiates. She must not be given opiates". It shouldn't be something you have to worry about at that stage. Your birth partner could also thrust a copy of your birth plan in every new MW's hands.

Looking on the bright side, it's by no means certain you will need any pain relief at all, if things go smoothly. I had 2 DC with no pain relief, with the help of a pool and huge amounts of walking around between contractions. It helped that the births were straightforward and I didn't have particularly big babies. But do bear in mind that transition (just before you start pushing) is often the point when it feels most unbearable, but it's too late for an epidural by that point (I believe), and that's the time where you need most encouragement from MW and birth partners.

Could you have opiates and an anti emetic? It's a shame to miss put on them. They absolutely rock and despite my needle phobia, was sticking my bare arse out of the bed an anticipation every four hours after my cs. Opiates deliver.

*of course they're highly addictive and lead to a life of misery/crime/prostitution, which is admittedly a down side.

It's pretty crap that you have to justify and explain your choice at all. I also have no intention of taking Pethidine or any other opioid drugs, and this is my first baby, so I have no idea how I would react to them anyway. However, after researching them and speaking to other women who have had experience of them in birth, I have decided against them and have noted this on my birth plan.

Now, before anyone accuses me of being unrealistic and inflexible, I understand that complications can arise during labour and I may be crying out for any drugs available when the time comes. However, in my view, my choice at present should be completely respected and I shouldn't have to jump through hoops to explain myself. If I change my mind during labour, then so be it.

I have no allergies whatsoever and I still put No Pethidine in my birthplan and expected that to be respected- as indeed it was.

I'd call it an allergy. You have already had adverse reactions to the drug suggesting you're sensitive to it. What would anyone say if you'd had this reaction to peanuts? "oh try it again, i'm sure the benefits will outweigh the risk of anaphylactic shock" . Hardly.

When asked about allergies I always state human insulin. I've had bad reactions to it in the past and this saves an argument when I'm feeling vulnerable about trying something new which may end with me in a coma. It won't cause immediate death though. I've not encountered a problem with doing this.

:) bran

I'm uncomfortable saying it's an allergy when it isn't if for some life-threatening reason they needed to knock me out with them or something they could do so, I just wouldn't be very happy afterwards. DH knows I don't want them, so hopefully that will do let him do the explaining and keep pointing at it on the birth plan. Also, I've already looked into epidurals without opiates and my consultant has talked to the anaesthestist (we might need her for my heart), so I feel comfortable there.

I also know they don't work so well for me: I lost about three hours during my colonoscopy but according to DH I continued to scream in pain even after the shot. I don't like the idea of being in pain and just not being able to remember it, especially if those moments include the first meeting with DD!

Some midwives just bloody love pethidine.

According to research they consistently rate it as more effective as an analgesic than mothers themselves do, especially when those mothers are asked actually DURING labour, instead of hours/days/weeks afterwards, when you've actually forgotten exactly how little pethidine probably did in reducing labour pain (doesn't help that pethidine can have a powerful amnesiac effect)

The suggestion is that midwives often confuse sedation with pain reduction. So if a woman goes really quiet and dreamy after being given pethidine, they assume she's experiencing a lot less pain. When in fact she might be experiencing a lot of pain still, but isn't reacting to it in the same way.

I suppose in a very busy NHS, there's always going to be strong support from some staff for sedating women (and their babies).

(would like to add - I'm not denying that some women find it helpful).

Tell 'em you've done your reading and you think it's a shit drug.
'nuf said!

I said no pethidine because I simply don't like the dissociated feeling I get from opiates. No one offered them to me. However, IIRC there are/can be opiates with an epidural. I know that I got some of some kind (DH saw them signing them out of a lockbox) when I went for EMCS, so it may be worth bringing this up beforehand and checking with the anaesthetist. My anaesthetist was very interested in whether I was feeling sick too, I'm pretty sure they don't want that.

I had an injection in my first labour, hated it, didn't help, just felt sick, put of control and unable to speak.

Second time, I put it on my notes, and just said to the midwife - I'm going to manage as far as I can, and then ask for an epidural. No gas and air, no injection etc.

I was also supported by my consultant, who made a note on my notes to say that they basically had to listen to me!

Worked like a dream.

What drug is given in the epidural - is that not an opiate?

I guess a lot depends on where you give birth. I went in to hospital with DC2 and for the first two hours, all they would give me was co-codamol - i could have stayed at home for that. This was despite contractions every two minutes, lasting 90 seconds. I find midwives ignore birth plans and go with their own idea- no medical intervention.

If you are allergic, say so.

I was advised not to have pethidine and indeed i didnt. I had a trained and student midwife at my birth and gas and air were enough for me , and i actually in between contractions felt sleepy! I ahdnt slept for three night before though so that might have been it.

BTW, in my birth plan it said NO STUDENTS in capitals but she was so good, and tbh, i didnt really care that much. But they didnt even offer me anyuthing stronger than gas and air. Maybe cos i only had an hour on gas and air. And i seemed to be coping well, i was coping well. I remember just before i gave birth to the head, oh dont forget your driving lesson, at 9.30......have to admit the puzzled looks i got will stay with me forever!!!!

I think you maybe have been particularly unlucky. I had 'no pethidine' in my first birth plan. The plan didn't even make it out of the bag, but no one pressed it on me.

Second was a home birth, so I'd have had to have actively planned to use it in advance.

shagmundfreud I think you may have a point there. I had some morphine after my section, and I told the midwife that I'd heard that it doesn't take the pain away but it makes me not care that it hurts (the sedative part). The midwife muttered something about "takes the edge off" and stabbed away.

Not so much an issue with me because I wasn't in labour at the time. I was exhausted and wanted the sedative effect.

No pethidine was on my plan. I didn't ever get asked about my plan before I was in hospital (and only discussed it when we gave it to the MW, she didn't ask for it). I certainly didn't have discussions with my MW, HV or GP about it. When in labour no one ever suggested it. I went from G&A to epidural.

I didn't want it as I had heard of the unpleasant side effects and that if they occur you more or less have to sit it out and wait for it to wear off. So my reasons not to have it were not as strong as yours as I didn't even have past experience to go on.

I think you probably won't have a problem with it, but if you do then the main thing is to have a well briefed birth partner who can take the MW aside and say "ardenbird is very clear about this, she has had previous problems with opiates and does not wish to discuss them".

I'm not wanting to start banging on like one of your midwives but I just wanted to add something.
I had opiates years ago after an operation. I had a huge reaction to them like you. I was sicker than I'd ever been in my life and nauseous and weak for several days.
Fast forward a couple of years to me in labour with dd. I was terrified of opiates and was determined to do without them.
I laboured fast and didn't have time for an epidural and the me suggested an injection. I really didn't want it we had discussed it but I at the time felt I needed something more than g&a.
In the end I agreed only because the antiemetic was going to be administered in the same syringe.
I never had a bad reaction that time and am actually glad now I took it.

How bizarre- I thought that pethidine was generally considered A Bad Thing nowadays. I don't know anyone who had it, and I wasn't even offered it. Do you have a particular medical condition that suggests it or something?

I'm really surprised that you're experiencing resistance to this. I've concluded from pre-natal classes and talking to mothers who were totally knocked out by diamorphine that, because of the nausea, irreversible sleepiness / detachment and it affecting the baby, I don't want pethidine / diamorphine and would rather go from G+A to epidural, if necessary (might change my mind at the time of course). My MW was fine with that, also those at PN classes and everyone has emphasised we have choice.

I would not pretend to have an allergy, medical staff need accurate information not well-meaning obfuscation. I would check what is in epidurals.