Experiences of Pethidine

[Sam29]

Hi, am due in 3 and a half weeks and have my fingers crossed for a water birth using gas and air to see me through.
However, need to have a Plan B just in case something hiccups and I can't have a water birth. Do not want to be bed bound so epidural not an option so am thinking of pethidine if I end up having to be on dry land! I know it can make the baby sleepy which concerns me as I want to get baby to breast asap but has anyone had any good / bad experiences of pethidine or tips on having it and having a relatively awake baby!

If you're gonna have pethidine have it early rather than late in the labour, and don't expect it to help, anyway.

I have a friend whose baby almost wouldn't breathe at birth because she had pethidine too close to the birth (at midwife's encouragement). Worst part is, the whole experience was nearly repeated with her 2nd baby (midwife saying, "You'll be ages to deliver, have some pain relief", and then 20 minutes later baby arrives, but thankfully friend had declined pethidine). And it nearly happend to another friend ("Yes, we agree you aren't coping with the pain well and you're hours from delivery; oops, is that the baby's head we see crowning?".)

Anyway, I had pethidine when I thought (had been told) I was hours from fully dilated, and no way I could envision another 4-7 hours without some strong pain relief. Then sure enough I was fully dilated 45 minutes later and pushing. I guess I can be very glad it did take hours to push him out...

Plus the pethidine meant constant internal monitoring so I couldn't move around or adopt any sort of birthing position where gravity would help. There were other interventions that only happened to me as a knock-on effect of having the pethidine, too.

And on top of all that, I can honestly say I don't think the pethidine helped relieve my pain relief.

So I guess you can tell I'm not a fan! Too dangerous, and doesn't work, anyway... In My Experience.

I thought pethidine was a sedative rather than an analgesic, ie it'll probably make you less aware of the pain/coherent but not actually tackle the pain itself. it's the only drug midwives can give you - apart from entonox - and I suspect that's why some midwives are so ready to offer it. I wouldn't touch it with a barge pole, but it's up to the individual.

Pethedine is an opioid analgesic, it is licenced for the treatment of moderate to severe pain, obstetric analgesia and peri-operative analgesia (according to my rather dated BNF). It also makes you feel 'out of it', which might explain the sedative effects that ou describe so well. But it is an analgesic, and has a similar profile (but not identical) to morphine and heroin.

Hmmmm. Here's an interesting article on some of the studies involving pethidine/opiates

Interesting article. I didn't have pethedine in labour, but I did have diamorphine. I found it good, and contoled my pain better than the entenox I had to that point. It does sedate, as does the entenox, but I found it better as the pain increased. Dd was more than 8 hours outside the dose IYSWIM, as I later needed an epidural which was topped up for the section.

hmb, I only had an epidural as I'd had vomiting from the start of my labour & heard that entonox can make you feel nauseous which I was anyway! I ended up with an emergency c-section so had a top up for that and was very impressed by the effectiveness, if a little worried at one point at just how low my blood pressure got!

I had pethidine with my first (due to long labour bla, bla, bla) and I loved it. My husband, however, thought I'd gone mental for a couple of hours - talking absolute gibberish mainly, but no change there. My baby was very sleepy though, and not just immediately after, for about 3 or 4 days. I even called my mum over to try and wake her up for a feed after about 10 hours of sleep. Didn't have anything with the second and have to say I felt a hell of alot better after the birth and he sat there wide awake waiting for his first feed. To be honest, if, at the time, you need it, then go for it, but if you think you can manage without it then do't bother. Good luck.

PS gas and air is fantastic. If you could buy it a the supermarket, I'd be there every Friday night!

I find it interesting that Bundle refers to her epidural as "I only had an epidural" and wouldn't touch pethidine with a barge pole. For me that would definitely be the other way round!

How interesting that Pethidine doesn't seem to prevent pain,but does prevent you remembering it! Seems a bit of a con to me.
BTW I am amazed that more hospitals don't offer mobile epidurals. It seems to me these should be standard issue for all you stoical folks not going for a c-section ( ) - particularly as the studies I've seen show that they don't increase the 'risk' of intervention.

I agree CAM. There was no way I was letting anyone interfere with my back during labour (I doubt if I could have lain/sat still long enough to get an epidural into me to be honest. It was the ONE thing I really didn't want. I had a lumbar puncture a few years back and ended up with chronic headaches for months, and have had 2 or 3 friends for whom epidurals (and one was a mobile) have gone really badly wrong - one friend ended up flat on her back in hospital for over 2 weeks while they tried to figure out why she'd not got any feeling in her legs!
And I am oddly smug that I didn't have one. I used the gas and air and had diamorph in my first labour and felt in control the whole time.

i really get cross with people who are smug about not having had an epidural.

me too !!

I tell you, the 'interfering' in your back is a lot less noticeable and no more painful (though possibly less pleasurable) than the interfering in your front that got you pregnant in the first place

Fantastic if you can do without an epidural... but so blooming what if you can't? We all have different pain thresholds and, more importantly, we all have different labours. I had an epidural after 24 hours - most of which was spent stuck at 4cm. Yes the pain was bloody awful but, more importantly, I was shattered and been told that I had at least another 12 hours ahead of me (which proved an underestimate). If I'd been told that I was a few hours away I might not have bothered, but I equally wouldn't be kicking myself now if I had.

But I don't think I "failed" in any way - or that I'm weaker than those who managed to go without. Comparisons are only valid when they are on a like for like basis - use them when trying to select a package holiday, a new car or a mobile phone tarrif. Don't waste your time trying to apply them to something so fundamentally unique as giving birth.

Am getting the feeling that may be better off trying to stay off the pethidine as some of you have found it pretty ineffectual AND with icky side effects.
On the issue of "mobile" epidurals, we have been told in no uncertain terms that it is possible to give a more steady and lower dose of the drug which has come to be known as a "mobile epidural" but this does not mean getting off the bed and walking as in all likelihood our legs would go from underneath us! What it does mean is some sensation in the legs which means we can help manoevre around the bed and not just be a dead weight. not sure that sounds any better really....

Agreeing to Pethidine was the biggest mistake of my labour. It wasn?t on my game plan as I was uncomfortable about it crossing the placenta etc. etc. I was coping really well on gas and air but the labour was very long and I was knackered but ok! My midwife broke my waters (despite previous midwife who finished her shift advising her that I was coping fine and should be left alone). She seemed rather impatient and wanted to get on with it regardless of my feelings...Be warned, be prepared if they break your waters as it can immediately lift the pain into very new realms of agony. I was so unprepared for it that I pannicked and agreed to any drugs she could offer. I couldn?t sit still because it hurt so much and the idea of an epidural seemed ridiculous - there was no way I could hold any position for more than 2 seconds. I was so angry that she hadn?t warned me of how much it could spped things along and offer pain relief beforehand. Against my better judgement, I agreed to pethidine. It had no effect on the pain, just made me feel sick and slightlydrunk - I was was unable to speak and yet my brain was still functioning. I remember the midwife leaning over me and telling my husband in a loud voice not to worry as I was out of it and likely to talk nonsense. I was so furious - I was not out of it, in a lot of pain and unable to communicate my distress. I am sure the pethidine was also responsible for my daughter to become distressed and sleepy - her heart rate became very erratic 20 mins after taking it and it has been text book perfect up to that point. This created panic amongst the midwives, suddenly the room was full of people discussing options loudly, ignoring me and my husband and frighteming us both to death.....turned out ok (avoided c section by 2 mins, ventouse and inevitable stitches..) and she is truly wonderful, but the whole situation was awful. I really regret not standing firm and allowing my body and gut instinct to stand up to the midwife and not have my waters broken - at least ask her what to expect and get prepared for it. Taking pain relief is a great option for many but please be aware that it can take away your clarity and therfore your feeling of control and communication - this can be a very scary experience. I don?t want to frighten you, but I feel really strongly about this and feel cheated that my special event was so badly managed and so frightening. I guess what I am trying to say is stay in control of your labour - for some that might mean pain relief to help cope, for others this could well mean as natural as possible and allow your body to guide you. Just make sure that you get to choose what speed it goes at, not your midwife.

Sam29,

I think I had a `mobile' epidural. I was never given to understand that I would be able to walk, just be able to move a bit on the bed, which I could (certainly couldn't have walked). But by that time I didn't care as I just needed some effective pain relief so I could sleep (I had a very long labour, and pethidine was no good for me - see my earlier posting). I think it is impossible to predict what will work for you until you are actually in labour. I started off with TENS (which I think worked), then gas and air (very effective for me, but some people hate it), then birthing pool with gas and air (great). But eventually I gave up as I was so exhausted that I was falling asleep between contractions (dropping the gas and air tube in the water) and then waking up mid-contraction, at which point gas and air no longer works (you have to start inhaling it as you feel the contraction starting). So I opted for the epidural which gave me total pain relief (and a chance to sleep) but I think it slowed things up even more.

I think you are wise to find out as much as you can about the different pain relief options available to you but be prepared to be surprised by your labour, one way or another!

Incidentally, my labour was probably so long (about 48 hours - sorry, I don't mean to scare you) because ds' head was not in the optimal position. You may improve your chances of a straightforward labour by going around on all fours before the birth.

Good luck!

I'm not saying I am pleased about feeling smug about not needing an epidural. What I meant was that an epidural was the one thing that I was sure I didn't want (given the problems a lumbar puncture had given me) and even with the other complications I had I know an epidural would have been wrong for me. I am pleased that I managed to stick to something I had planned when so many other things went differently to that which I had hoped.
There are things about most our birth experiences which we are pleased with ourselves about, no matter what kind of experience we had. I was pleased with myself second time round as I didn't have an assisted delivery. I think we should be allowed to be smug about the things we managed the way we wanted.

Aloha - the problem with mobile epidurals is that they require 2 people attending the mother (that includes usually the partnert+ MW)... because she still needs to be supported (at least to avoid any risk of her falling!) That is why some hospitals aren't keen.... At least that's how I understood it... Mears?

gingernut, that sounds so much like me, espec. falling asleep between contractions, only to be jerked awake by the pain of the next one.

ok, susanmt, have it your way. be as smug as you want.

Jaytree, an epidural or spinal block are painkillers that don't make you feel out of it at all. Completely yourself and lucid, in fact.

I think there is a bit of confusion here about 'mobile ' epidurals. There epidurals are at such a precise low dose that you can indeed walk around, supported ofcourse. However, when they need topped up it must be done immediately or any pain relieving effects are lost. Not all midwives are trained in top-ups and the anaesthetist may be unavailable in theatre. At our unit we do not provide mobile epidurals for those reasons.

Sam29 - the type of epidural given in our unit sounds like the ones you describe. Mobility is still retained so that you can move about fairly well in bed, but you would not be able to weight bear. After the epidural is inserted and a dose of local anaesthetic is given to ensure it is effective, a continous infusion of low dose local anaesthetic is started which keeps the epidural effective. Sometimes additional top-ups are needed which are given by the anaesthetist. Mixed with the local anaesthetic in the infusion is a drug called fentanyl which is a painkiller. Not all units do the same thing because they all have various degrees of success with different methods. I think though that the aim is to ensure pain relief with as much retained ability to move as possible around the bed. I remember the epidurals from 20 years ago and women were 'dead' from the waist down. That is only the case now with epidurals and spinals prior to C/S. HTH.

I have to suggest, for those who believe the rise in CS rates to be a problem, that they might consider that one of the reasons why a so far small but rising number of women choose a cs is that they don't trust hospitals/midwives to offer sufficient pain relief. I know that I couldn't allow myself to be put at risk of experiencing the kind of agonizing pain so many people describe on this site, but as even Mears admits, if epidurals wear off, they often aren't topped up. I have read the chilling comments on the AIMS site where midwives boast that they'd rather do anything than organise an epidural and that they are very proud of women who refuse them (very strong implication that they rather despise the ones who don't). They also talk a lot about persuading women not to have one, which I suggest accounts for a lot of women told, 'no you are too far along' only to find they have hours and hours of pain ahead of them, or being told 'oh you don't want you, you're doing so well.' I would find this totally unacceptable, myself - in fact, it makes me feel very angry at this patronising high-handedness. I personally know friends who have gone straight for cs because they don't beleive they will get adequate pain relief otherwise. I thinks AIMS positively fetishises pain.

Aloha - any woman in my care who requests an epidural will get one if it is possible/advisable. Sometimes it is not possible because the anaesthetist is in theatre with someone else having an emergency C/S or other operative procedure. During the day there are 2 anaesthetists, but at night there is only one who stays in the building 'on call'.
Sometimes women come in in advanced labour with the head visible. There is absolutely no point putting in an epidural at that stage because the baby will be out before the epidural is effective. If the head is not visible and an epidural is put in during second stage, it is highly likely that this will result in a forceps delivery because the pushing sensation is lost.
Sometimes women who come in asking for an epidural change their minds when they find that they are more advanced in labour than they thought they would be, and that the experience in not as bad as they imagined.
Often women asking for an epidural do not have a clue what the procedure involves and think that it just means they will have their baby with no pain involved. When they realise they will be stuck on a BP machine, drip, monitor and that labour can be slowed down by an epidural, increasing theis chance of a forceps/ventouse delivery, they are not so keen. Many chose to see how they will get on without it first.
For women who are truly terrified of labour, an epidural is given very early on at the outset if they present in time. It is not actually that often that women come in too late. I have also had women who have had epidurals first time round and did not want to have one again because of the lack of being able to walk around during and immediately post delivery.
I am not a fan of epidurals for uncomplicated labour, as you are aware from my previous posts, because it is an intervention that is not without side effects. However, they are invaluable for women running into problems and I have been there advising women to have one. There are far more women out there delighted that labour went well enough for them that they did not 'need' an epidural. In my experience they outweigh the women who feel they were denied adquate pain relief for labour. It is the same argument about adequate pain relief after C/S. Many women are very sore afterwards and feel they had inadequate pain relief. The thought of a C/S terrifies them. However, your experience was that it was not that bad. You probably have a high pain threshhold and wouldn't find labour pain that bad either. It is all relative and I would hope that in the main, midwives try to meet the needs of all individual women as best they can.