Diamorphine or pethidine?!? Advice/experiences needed

[RPC3110]

So I'm 31weeks and decided to really start thinking about what I want during labour however I'm not entirely sure. So I need some advice/experiences, which is better diamorphine or pethidine?

I have a terrible pain threshold so guaranteed I won't take pain well, I want to start with gas and air but then I don't know where to go from there. I did want an epidural but I'm thinking against it for various reasons, it would now have to be my last option I go to.

A part of me feels like having diamorphine in one dose in early labour is like saying I'm done/ I quit before I've even begun but people say it's suppose to be the best form of pain relief and I haven't a clue what pethidine is like but I know you can have it in active labour in 1-3 doses before 8/9cm so to me seems more reasonable. I'm just scared I'll be so out of it I won't remember and the baby will come out floppy and unresponsive as both can cross from me to baby. Someone please tell me if they are the same or one worse/better than the other? It would help me make up my mind a lot more, I know everyone doesn't always have the same reaction but I'd rather hear it from people who have had these than just from the information given in my antenatal classes.

I had pethidine in fairly early labour and it just made me fall asleep for a few hours which was what the midwife suggested ( I had already been awake 24 hours +). It literally just enabled me to sleep through the pain for a few hours, had no side effects, I'm glad I did it. Then went on into 'proper' labour and used the pool which in my own experience was almost as good!!

My birth plan with my first simply said - I'd rather not have pethidine.
However I went in for induction and they examined me (before doing anything) and basically the examination acres as a sweep and sent me into labour.
I apparently have precipitous labour (really fast!). My contractions hit 2 minutes apart straight away, my body couldn't cope and it went into shock. So my DH took the option of giving me pethidine. To give my body a break. It was like being in a fog, but a pleasant fussy, not painful fog!
I don't really remember getting from pethidine to 10cm, but it was only 2 1/4 hours, once the pushing bit started I 'woke up'. I clearly remember pushing and the birth. I suffered no residual fog or issues from that point on I was entirely myself again.
So never say never. I wouldn't have coped without it.

My second labour birth plan said, I'll try anything! I got 10 minutes of gas and air as my labour was 55minutes total!

Go in feeling flexible about things. Most people I know who have felt disappointed with their births went in with fixed ideas. "I want to use water and gas and air," - they end up with a 36 hour back to back baby and feel a failure for having an epidural, they are mad! No amount of water will sustain you for 36 hours! They should be proud and happy, but instead beat themselves up.

Sorry got a little soapbox at the end there!

Both your main concerns - hazy memory and risk of a slightly doped baby if the timing is misjudged- would be completely eliminated by choosing an epidural instead. I know you say you had moved away from this preference but it really would address your problems and provide vastly more reliable pain relief than either drug.

A lot of private Obstetricians dont use pethidine at all now and go straight from G&A to Epidural if the patient wants something a bit stronger. Before everyone jumps on me to say she may not get an epidural in the NHS, I know that, but my point is that if in a non-resource constrained environment, Obstetricians are not using pethidine, then that probably says something.

I had every pain relief going! But nothing touched the pain better than the pool.

I started off with the tens machine, paracetamol, codine, pethidine and gas and air.

The pool was amazing and really helped, I cried like a baby when I had to get out of the pool(Due to DD not budging).

I then ended up with a caesarian, so had the job lot!

I believe pethidine is rarely used other than obstetrics simply because it's not a very effective pain reliever. To me, that says something pretty misogynistic.

Just an aside but I have an APPALLING pain threshold but due to having a home birth in the US as I couldn't afford anything else I had no pain relief at all. Not even paracetamol. And it was fine.

I used to be a proper party girl and would neck painkillers as soon as I thought I may possibly have a headache.

It's not a given you'll need anything.

No flaming needed, just another, positive, point of view.

With my first dc, over the period of a 12hr labour, I was 'strongly advised' to have diamorphine - twice. As according to the midwife, I just wasn't coping. I was so off my face that every time I tried to go to the toilet (vomiting and the shits - nice!), I staggered and fell on the floor. I couldn't speak coherently, could only whine and slur. I was in so much pain still but couldn't vocalise it. DH was terrified by the state of me. In saying that, my whole labour and delivery was a catalogue of mistreatments, and it resulted in being close to losing DS. I still have PTSD.

Anyway, to get back on topic, the feeling I got from diamorphine was one of the worst things I've ever felt, and DS slept for about 48 hours - had to be forced awake to feed for a few seconds before zonking again.

I've since had three drug free labours which were the best experiences of my life.

I've had on all birth plans - NO EPIDURAL! Because I'm terrified of someone putting a needle in my back. I once had a lumbar puncture and it was horrid, and I'm frightened of catheterisation. So my only option left was drug free.

wherethefuckis My mum had the same experience back in the seventies- she was hallucinating and thought the cubicle walls were coming in on her and was vomiting uncontrollably. Crazy that they're still using it because it is highly unpredictable and if people havent experienced it before, labour probbaly isnt the best time to be experimenting.

At our hospital they offer a mobile epidural. You wouldn't be able to run around but you can move position etc. Would that be an option?

Talk to your midwife rather than the NCT person.

Yes epidurals lower BP......which is why a drip is started straight away to combat this.

Diamorphine is a better pain relief. Pethidine just makes you too sleepy to tell anyone you're in pain. Where I work we will give more than one dose of diamorphine so not come across the problem of it wearing off and no more allowed before.

Keyser they even also gave me two antiemetic injections and I was still vomiting every five to ten minutes (I do vomit during labour but only usually close to/during transition).

I think it's really an awful drug, because of, as you say, the unpredictability. If someone has had it before with no adverse reactions then all good, but to try it out for the first time during an already frightening event is madness!

"Talk to your midwife rather than the NCT person"

I'm an 'NCT person'.

here

This is one of the few good quality RCT (random controlled trials) comparing outcomes of pethidine and diamorphine.

If you look at the results you'll see that pain relief scores an hour after administration were "modestly better" for diamorphine compared to pethidine, and women were more likely to be satisfied with their analgesia (45% versus 34%) after administration, but if asked within 24 hours of birth similar numbers (85%) would have the same analgesia again.

What this study does throw up is that the women in the study who were randomised to the diamorphine group had 'significantly longer labours' from the time the dose was administered to the birth of the baby, when compared to women having pethidine. 82 minutes longer on average, so that overall the women who had diamorphine experienced more pain in the labour than those who had pethidine, despite the fact that their analgesia was marginally more effective.

Neonatal outcomes (I'll just quote the study) :

"There were no significant differences in the neonatal primary
outcomes of the need for resuscitation or Apgar
scores