Pethidine

[lolalalabing]

I'm 35+4 and am hoping to give birth at my local midwife led unit where the strongest pain relief they offer is pethidine. At our NCT classes pethidine didn't score very highly when we were assessing the risks and benefits to both mother and baby but the midwives at the unit have said that it can be really good at relaxing you and helping you dilate when administered at the right time and that there's very little to no risk for either mother or baby.

Does anyone have any experience of taking pethidine, especially at a midwife-led unit?

Thanks

[butternut22]

I had diamorphine, which is similar. It really helped. No bad side effects for me and baby. I could still feel the pain but I felt more detached from it and it was less intense.

[TheWanderingUterus]

I had it about an hour before DD was born. It made me feel trapped and woozey and out of it. It added to my panic and took away none of the pain, but I couldn't communicate this through the fog.

I have very little memory of DDs first hours other than struggling whilst she alternately zonked out and screamed hysterically. I believe it was a contributing factor to my PTSD and PND. The first thing I put down on my birth plan with DS was 'NO pethidine'.

[minifingers]

"Wished to God I'd gone for Pethidine..."

Pethidine isn't more effective than Meptid. Some people just get crap analgesia that family of drugs (opioids) for labours

[MrsPatMustard]

I had Meptid, which is meant to be easier on the baby, didn't work AT ALL. Wished to God I'd gone for Pethidine...

[VisualiseAHorse]

I did not know it was a sedative.

[VisualiseAHorse]

Made me throw up several times, and almost on the baby! He was drowsy for hours and hours, maybe a a whole day. Which made BF hard, and he lost a little weight.

I didn't feel I could pick him up for about five hours as I was so shaky. I would not like to have it again.

[minifingers]

"On the plus side, it stopped me vomiting every 15 minutes with DS1"

Whereas in my case it MADE me vomit every 15 minutes for 4 hours, despite the anti emetic I was given.....

this is an interesting article about pethidine use in labour

[minifingers]

I think how you respond to pethidine is down to the way individuals metabolise certain drugs. I believe there are some people - a fairly sizable proportion - who will have a really unpleasant experience with pethidine.

This is the RCM's latest statement on perhidine:

"Pethidine is the most commonly used opiate in labour. Its popularity is ascribed to its being until recently the only drug for pain relief included in labour ward patient group directives
for midwives, and the fact that it is low cost. However, there are considerable doubts about its effectiveness and concerns about its potential maternal, fetal and neonatal side-effects (Ullman et al. 2010; NICE 2007). The small randomised controlled trial undertaken by Tsui et al. (2004), found that the pethidine was more effective than placebo, but the effect was modest."

I could show you dozens of other trials that back up my view that pethidine has crap analgesic qualities and a good number of unpleasant side effects.

I wouldn't try to make a case that it has NO place in the management of labour pain, but I think midwives need to be completely clear with mothers about the clinical evidence on its effectiveness so that women can make an informed choice as to whether they want it.

[cece]

I took it with my 2nd and 3rd baby.

I absolutely loved it. I felt really spaced out and woozy - a feeling that I loved. But I do know some people don't like it! I only had gas and air with my first and it was horrendous.

[HelloLA]

One of the fathers in my NCT class was an anaesthetist, and he gave a very detailed and convincing explanation of why pethidine was generally a poor choice. (I won't even try to repeat it here; other posts have summed it up.)

I put 'no pethidine' on my birth plan. This didn't stop a really unpleasant midwife from trying to bully me into taking it during the MLU night shift, where there were only two patients on the ward: 'come on, for goodness' sake: you don't know what you're talking about. The other woman's taking it and she's having a lovely relaxing time'.

I didn't take it, and ended up in the medical ward and had an epidural, which was fine. I do think the midwife community needs to address how some practitioners deal with pethidine. From anecdotal evidence, which seems to be backed up by the research Minifingers mentions, it seems like women are often underinformed about how it functions and unhappy with the results.

[OneHandFlapping]

On the plus side, it stopped me vomiting every 15 minutes with DS1.

On the minus side, it doesn't actually stop the pain - it just makes you care less about it.

[flipflopsandcottonsocks]

I had meptid (after swearing pre-labour that I wouldn't touch it!), and I really liked it. I had done 15 hours of labour by the point they gave it to me, and an epidural wasn't available at that point. I had two doses of it, and coupled with entonox it definitely helped me to gain control again (as after 15 hours I was beginning to lose it), and I managed to do another 7 hours before it wore off and I completely lost the plot and demanded an epidural! I ended up with an EMCS 9 hours after that anyway, but that's irrelevant to the meptid. It did make me sick twice, but labour sometimes does that anyway, so I guess it may not have been related. I would definitely absolutely 100% have it again. It had no effect on my DS either...he definitely didn't sleep for long after he was born, quite the opposite!

[IHeartKingThistle]

I'd never have it again. Made me out of it and still in pain, and made me unable to communicate with DH. Freaked him out for quite a while after tbh. 2nd time didn't have it, was able to hold a conversation between contractions and we both had a much more positive experience!

[Rosie55]

I had it with DC1 after having being put off by the exercise in NCT classes mentioned above which made it look as though it had no benefits. The midwife didn't claim it would relieve the pain, but she said it would help me sleep a bit - I was exhausted having been in early labour and unable to sleep for 3 days, and I think I must have been very tense. She convinced me by saying she would also give an anti-emetic, that the baby wasn't likely to be born soon enough to be affected after birth, and that she had had it in her own five labours.

In my case she was right. I slept for about 4 hours, woke up feeling much better, and had progressed from being stuck at 4-5 centimetres to 7 cm dilated. The baby wasn't born until 9 hours later, had no breathing difficulties, and latched on like a pro. I didn't need to have an epidural afterwards - just went back on gas and air. It must depend on the circumstances and on it being given at the right time.

[Lovethebubbles]

I had a very long labour and was denied an epidural because they were too busy. I ended up having pethidine and agree with others that it did nothing for the pain. When I asked my midwife why it wasn't doing anything for the pain she said "it doesn't take the pain away, it just makes you not care about the pain as much". I was slurring and managed an hours sleep after having it. It didn't seem to affect my DD... Managed to breastfeed fine. DD didn't seem particularly sleepy.
As a pain relief I didn't rate it... If you need some rest after a long labour you may want to opt for it. Good luck!

[minifingers]

Do you really believe that most mothers get good pain relief from pethidine?

That view is absolutely not supported by the evidence.

[LavenderFox]

Not sure where such a personal attack is coming from Mini, I am simply trying to help a prospective mum by relaying both my experience and professional knowledge. Our information leaflets state specifically that pethidine is a sedative, relaxing opiate with a potential impact on initiation of breastfeeding and much more rarely, on the onset of spontaneous respirations in the newborn so there aren't really mums who end up having it without knowing exactly what it is. Usually they say they know someone who had it who said it was brilliant etc. In the rare case where pethidine really hasn't worked I haven't fobbed anyone off from having an epidural straight after, because pethidine does stop your natural endorphins so from there unfortunately the only option is to go higher, if it doesn't work.

[minifingers]

BTW - are you aware that the patient information leaflet on pethidine available through the Obstetric Anaesthetists Association rates it as less effective an analgesic than entonox?

I do appreciate however that if you are caring for a woman in strong labour who is struggling to cope then heavily sedating her may make the situation more manageable, in some cases for the mother as well as for the midwives, so I do understand the liberal use of it by overpressed staff in UK maternity units.
I just think it would be more honest to inform women that you are offering them a very strong sedative which may help some of them cope with the pain, rather than telling them it's pain relief and constantly implying that it's a better analgesic than entonox - because the evidence doesn't support that assertion.

[minifingers]

Lavender - I'm not an NCT teacher, though I work with some.

I base my views of pethidine on the clinical evidence from Cochrane reviews, as I assume you do.

I'm not persuaded by anecdotal evidence from your practice - sorry.

[LavenderFox]

Mini, I tend to go with what the ladies say, not what they look like, and many have genuinely loved the experience. I have taken pethidine twice myself. Second time I felt like I had superpowers - I was in incredible pain but it just didn't matter - and I remember walking around and doing squats while giggling to myself.

I think the midwives at the birth centre have a lot more experience about how pethidine actually works, rather than NCT teachers. Some NCT teachers bash on about potential problems so much it stops being 'informed choice' and turns into a self-fulfilling prophecy. All birth centres are closely audited for complications and transfers so they most certainly wouldn't want to give you any treatment where risks would outweigh the benefits. In the birth centre in my unit up to 40% of women use no medical pain relief which should be a reassuring statistic. Only about 10% end up needing pethidine, and transfers for epidural only are the second least common reason for transfer (way below slow progress, suspected distress, high blood pressure or bleeding). Compared to the consultant-led unit these numbers are dramatically smaller.

[HumblePieMonster]

I had it. A long time ago. It was foul. It did not ease the pain (no pain could have been greater, that's how I know) but it did make my body 'relaxed' ie useless to push etc.

My GP was horrified - he came to the birth and played merry hell with the midwives because 'this woman doesn't even take disprin!'

I had hallucinations for weeks. They were worst on the first day, when I saw trains coming at me out of walls, and my husband's head, about six foot across, appearing out of the wall by my bed. Horrible.

The baby was completely out of it, zonked and floppy, for over twelve hours.

[minifingers]

Lavender, the research tends to find that midwives consistently rate the analgesic qualities of pethidine higher than mothers themselves.

I'll give you that women do APPEAR to be in less pain after pethidine but then they're heavily sedated so tho doesn't surprise me.

[LavenderFox]

You can't use the birthing pool with pethidine which means you have to be very careful about taking pethidine in a MLU. Midwives don't really like offering it either because it can make it more likely you transfer to labour ward for epidural (because you can't use the pool for pain releif and options may quickly run out if pethidine doesn't work). I have used pethidine for multiple labourers as a midwife and find it is generally much better than its reputation - none of my mums have vomited on it and never had a baby with breathing problems either. A fair number of mums have used pethidine and gas&air together and acted like jolly drunks which is not generally a bad way to go.... I propose you don't worry about it so much in advance, just prepare as well as you can for doing your breathing and relaxation. Anyone who is booked for MLU also has the right to go to labour ward if they change their mind, so if you think about it, you always have back-up options.

[VisualiseAHorse]

Oh, and I had it at a MLU, so nothing stronger available. I could have done it without it I think.

[VisualiseAHorse]

I would try and avoid next time. For me, it left us with a very drowsy baby, a violently sick me, and didn't make me feel calm at all. I also blame it for the loss of memory following birth, I still have very little recollection of the last hour or so, and 48 hours after the birth.