Homebirth- who prescribes the pethidine?

[snoggle]

I am 39 weeks so obviously labour could start at any time, hoping for my 2nd homebirth if all goes smoothly.

For my first HB (which was in another part of the country) the protocol was for GP to prescribe a single dose of pethidine for me to keep at home and midwife to administer if I wanted it. For this birth, my new surgery is refusing to prescribe.

They are saying it is the responsibility of the midwife to supply. The midwife says they can do this, but all the pethidine is kept in a safe so can only be accessed during office hours and they have to find a 2nd midwife to pick it up. So would be delayed if available at all.

Have been going round in circles for a week now, and I don't know what to do. My GPs attitude has been pretty rude and unhelpful tbh so I will be making a complaint, but I just need to get sorted now.

Did you have pethidine at your HB, and who prescribed?

AFAIK, not all areas make pethidine routinely available for home births, which might be what you are experiencing.

Did you use it last time?

Oh, I thought it was fairly standard. No I didn't use it last time, it was just more for reassurance knowing it was there really.

I wouldn't be quick to use it this time either, I just wanted to be as prepared as I can.

The midwife asked if I wanted this last time (at my 36 week appt).

I said no because I didn't like the idea of it at home.

Duirng my 30 hour labour, would definitely have taken it if it was there!! I'd have gnawed my own arm off if it would have got the baby out But didn't really remember about it to be honest as it wasn't an option.

(Birth was totally straightforward in the end, just went on a bit!)

So I think the midwives would have brought it, as they offered it.

In my area, the hospital has decided that it is the GPs' responsibility to prescribe pethidine. Midwives CAN prescribe pethidine, but perhaps choose not to to avoid taking the responsibility.

www.nmc-uk.org/documents/circulars/2011circulars/nmccircular07-2011-midwives-exemptions.pdf

However, GPs do not have any obligation to prescribe a drug that will be given to opioid-naive patients (so their bodies aren't used to it) in their own home that could cause respiratory depression in the patient and their baby without full resuscitation facilities.

I'm a doctor, I'm not against home births and have had one myself, but there is no way that I was going to have pethidine at home due to the risks to me or my baby or would ever prescribe it.

Dino - I remember a MW on here saying she was only allowed to prescribe it to a woman in active labour. Is that a general rule, or one that maybe her trust applied?

I don't think that is legally the case that MWs can only prescribe once a woman is in labour. They are allowed in law.

www.wessexlmcs.com/midwiferequestsfordiamorphinejustincase

(Aside from all that, I think pethidine is an AWFUL drug! Causes a lot of vomiting for not much pain relief! The only thing I am pernickety about in my birth plans is that I don't want pethidine and if opioid analgesia is required, I'll have some diamorphine please!)

I'm also a doctor who's had a home birth and I wasn't keen on the idea either for the same reasons as DinoSnores. (but very supportive of home births in general)

All three of my birth 'plans' have said 'I do not want pethidine'. Don't know about my present area, but my last didn't offer diamorphine for labour in hospital.

I would never want it at a homebirth (which is what I've had for no. 2 and no.3). But each to their own.

Thanks for your inputs, and it's really good to hear perspectives from the medical side too. I haven't had pethidine before but have had diamorphibe with no ill-effects; I didn't realise they were much different.

I didn't take it last time and don't really want to this time tbh. So maybe I should just leave it and if I get to a stage where I really can't cope then maybe should be looking to transfer in anyway.

Last time I think I forgot I had it once I was into the swing of things :)

Is it worth buying some codeine tablets to take alongside paracetamol ?

i've had 3 homebirths and pethidine wasn't even mentioned, let alone offered lol.

i'd just go with the flow. if you didn't use it last time then you may well not need/want it this time either. hope it all goes ok :)

They've stopped offering it for HB in our area. As you say, if you get to the point where you really need something more then it's probably time to transfer in. Hopefully you won't need it anyway. 2nd labours are usually easier than firsts in any case.

I was told you can't have pethedine at a home birth. Tbh I'm not bothered at all as had it last time (in hospital) it did little for the pain except send me into a drugged half sleep in between contractions and being violently sick even though they gave me an anti sickness drug with it!! And then DS was super drowsy after birth which could likely have been caused by the pethedine. I really didn't want it but only agreed so that I could stay in hospital as they were about to send me home! Planning a home birth this time to avoid the whole 'when to go in' dilemma and also so I can ensure the availability of a pool!

I did not want it as had had previous bad experience but midwife suggested it should be there - just in case. It was prescribed by the gp, around four years ago.

I did not want it as had had previous bad experience but midwife suggested it should be there - just in case. It was prescribed by the gp, around four years ago.

Dino that is very helpful and informative. I refused it as I was more focused on a good start to breastfeeding...I had no idea about the respiratory risks. X

I was told no due to risk of baby being born a bit sleepy. I thought it had been largely phased out for home births.