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Pregnancy

Talk about every stage of pregnancy, from early symptoms to preparing for birth.

Pain relief experience with Remifentanil

8 replies

Nic0lajane · 30/04/2021 11:00

Hello
I just wanted to write a brief post about my positive experience with Remifentanil during my labour. It is a drug that doesn't appear to be widely used yet with labour but some hospitals use it more frequently than others during childbirth. My hospital was not one of these but I had been informed about it by a midwife from another hospital who uses it regularly.
The drug itself is a very potent pain relief. Somewhere between Pethidine (which was a poor choice for me in a previous labour) and an epidural.
It is an infusion which goes directly in to you vein via a drip and cannula. It is very quick and easy to set up with minimal discomfort and then u press a button when u need a dose.
The drug itself is fast acting and quickly out of your system. Meaning that u press when a contraction begins and it lasts long enough to provide pain relief during the contraction but then subsides quickly, so you can remain mobile and non drowsy between contractions.
You can't Iver dose on it because the dose is set and the button locks out for a period of time after being pressed. Between 2 and 3 minutes. This is set and can be altered by the anaesthatist.

An anaesthatist sets the Remifentanil up and tells you pros and cons and how to use it. Only you are allowed to press the button, not midwife or partner.

The huge positives for me where:

  1. You can control it yourself, which means you can use it when your ready and if you don't like it or don't need it, then you simply don't press the button.
  2. It is out of your body system very quickly. Both me and baby were alert once she was born (Pethadine made us both very drowsy with my first child and didn't give good pain relief at all, it was more a relaxant).
  3. It was a very effective pain relief!! I managed my pain very well until the last 2 hours of labour when things get more intense.

I know it's hard to believe but I actually enjoyed my labour this time. I could reflect on it in a really positive way because I felt much more in control, being able to control my pain relief. After my first labour I didn't think it was possible to enjoy a birth or look back on it positively but now I know it is possible.

Obviously any drug affects people differently but I would definitely recommend remifentanil before an epidural. Or if u feel u want more than pethidine.

The first couple of times i pressed it, it made me feel a bit light headed and hot but it was over quickly and from then on it didn't have that affect.

If you want to consider using it then request to speak to an anaesthatist prior to your labour. There are some side effects to be aware of. It can slow yours and baby's heart rate but it did not do this for me. When I asked about this, the anaesthatist explained that because it is out of your system quickly, it is not of great concern because the drop in heart rate is breif. He also said there was no lasting issues from using the drug.

I just wanted to put a post on here because when I was trying to find more info from peoples actual experiences with Remifentanil, there wasn't many and I didn't know anyone in person that has used it.

Xx

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SillyBry · 30/04/2021 11:04

Thanks for sharing! I used pethidine in my first labour and hated it!
It gave me an hour's sleep, which was great... but I felt totally off my face and out of control of how to deal with the pain, if that makes sense?
Then we were both drowsy and my daughter ended up on the sun bed for jaundice, which looking back, I know now is because she was too sleepy to feed!
Definitely something to ask the midwife about nearer the time!

Roadhouse111 · 30/04/2021 11:17

I loved it, although it did make me feel nauseous at times. The only downside for me was not getting to use it during the pushing stage, because that was the part I was most worried about. ds was born within 5 mins of pushing so not a huge issue in the end

countbackfromten · 30/04/2021 12:16

Just to add that remifentanil isn’t available in all labour wards - has only been in one or two that I have worked in - so always a good idea to check what options there are in the particular hospital you are going to!

Nic0lajane · 30/04/2021 19:37

SillyBry I totally understand what you mean about Pethadine. I feel it had barely any advantage for me personally. It definitely did not do much for the pain. My mum is a retired midwife and she said that she didn't rate it because it tends to make woman drowsy between contractions and then all they are aware of during labour is the pain. She told me this after my 1st birth and I could see what she meant.

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SillyBry · 30/04/2021 20:10

@Nic0lajane That's just it - on the plus side, I had a nap. But the second she injected it my thigh, my brain went to jelly! The midwife asked me from 1-10 how the pain was and my response was "I know what the numbers are, but I couldn't tell you what they mean anymore..." I mean, proper drunk!!
And when I woke up, I was sick... and then could feel the pain, but couldn't really engage my brain to deal with it.
It did the job I guess, but this time I hope to cope on gas and air and my trusty TENS machine. And pray the second birth is quicker than the first of course! ;-)

Greybeardy · 30/04/2021 20:14

@countbackfromten

Just to add that remifentanil isn’t available in all labour wards - has only been in one or two that I have worked in - so always a good idea to check what options there are in the particular hospital you are going to!
Remi definitely has its uses in labour, but does have significant risks and that’s probably why isn’t universally available.

The most significant issue with it is it can make you stop breathing so there has to be a midwife in the room the whole time and this has significant staffing implications. Also although it’s a drug we use a lot in anaesthetics the non-anaesthetist staff on the labour ward also need to be pretty familiar with it to use it safely and that means it needs to be used pretty regularly. In smaller places that may not be so easy if it’s only used once in a blue moon.

Nic0lajane · 30/04/2021 20:49

@SillyBry good for you! I also used a tens machine this time round and found it excellent!

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Nic0lajane · 30/04/2021 21:00

@Greybeardy I agree with your points. I do think the most likely reason it is not used routinely in most labour wards is more down to staffing and as you said, needing to have a midwife present at all times. There are risks of course but there are risks with any drug, particularly epidurals and after speaking to 3 anaesthatists and a midwife (I was a bit anxious as I hadn't heard of it before so wanted to make sure I was super informed), they all spoke of the side effects you just mentioned but reassured me that because the drug was quickly out of your system, the risk was quite low and that it didn't have lasting effect. It was enough to reassure me, knowing that there was a midwife there at all times. Although I did apologise to her that she was no longer able to leave the room. Luckily she was very supportive and found my apology amusing Grin

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