IV meds for Labor, what do you use?

Specialties Ob/Gyn

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Just curious to see what everyone else uses. We used to have demerol but we can't get it anymore, now we have stadol and nubaine(nalbuphine) I've heard of some places using fentanyl, and I have used that a few times.........WHat's your opinion and what do you like best?

We use Stadol a lot, but I find that for most people it doesn't really help with the pain at all, but it takes the edge off and helps them relax so they can stay in control of and on top of the pain of the contractions. One patient described it perfectly, "It didn't help with the pain at all, but it made it so I didn't give a shit that I was having it!" Some of the docs will even let pts have Stadol when they're complete and have a little pushing to do. The babies haven't been affected, but it worried us.

In CA, we gave Fentanyl, seemed to work way better, but no docs to it here in WA. We still give Demerol or Morphine (w/visteril or phenergen) if they are in early labor, gets them rest and relaxation through the night and they wake up more dilated.

I was impressed with someone's 35% epidural rate. Ours is much higher. Pts come in with their minds made up that is what they want, and the first contraction that is painful they start asking for it. Its pretty hard to do anything else without them having an open mind.

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Demerol/Phenergan, Fentanyl 100mcg q hr, very rarely Stadol. I guess our epidural rate is probably 75% ---love that!!!

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ewwwww--- i'd hate to have epidural rate of 75%

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Specializes in OB.

I agree mark - I'm really getting burned out with women who have been brainwashed into believing they can't give birth without an epidural. Their first question on admission is "How soon can I get my epidural? Seems to me medicine is once again disempowering women, made worse by the anesthesiologists I've seen coming around trolling for pts. "Hello, I'll be here when you're ready for your epidural. You don't plan on one? I'll be available if (expression implying WHEN) you change your mind)"

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I agree it really is frustrating when women have this belief that childbirth can and should be painless............We have some docs who really push for epidurals, and others won't let multips have one when they're 5cm! I think epidurals are great when used appropriately and at the right time.........we too have a high epidural rate..........

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I have to relate an experience of last night. This is a LONG story,but please bear with me . All the talk of epidural rates and meds got me spinning here....

OK here goes, last night, labor pt w/pit on, 4 cm about 50% effaced in no pain. NO PAIN! Baby SKI HI. Dr. comes in says "lets get this over with"---- and ruptures her. Then he says, "get an epidural NOW"! "I want you to delivery by 7:30 (3 hours later)....The patient asks me: I am in no pain, why should I have an epidural?" I said it was up to HER! If she did not want it, should not have it til she FEELS READY. Anyhow Anesthesia saunters in no more than 10 minutes later.......(no I did not call them, but of course "someone" did.....

I said "she is not sure she wants an epidural right now. We are only on 2 mu pitocin and she is early in this. She wants to wait." He says "thats up to her, but if she decides she wants one later, good luck. I may have a case"....WELL THAT IS WHAT THE HELL BACKUP IS FOR!!!!!! I was incensed. I said, to the patient. "this is YOUR Decision....you can and will have an epidural when you decide".....well by then she was cowed to do whatever "told" to. She opted for the epidural w/o further question.

Then the dr comes in at 1900 (@ 2 hours later) checks her, she is 7-8 but "stretchy". ( I never checked her, being ruptured and having NO indication to)...He proceeds to have her PUSH and literally pulls her cervix apart while her doing this. I tried not to cringe. Fortunately, it goes ok, cervix is friable enough to pull back and the baby comes after about 6 or 8 contractions. And yes, he got a retractor and looked at her cervix, no apparant tears, no thanks to HIM!

I go to the charge nurse and report all this (yes I was UPSET) and she says "this is how dr ****** works, we are all used to it".....How bout that? FOLKS: The WORST pp hemorrage I saw was NOT a boggy ute, but from a torn cervix done this same way 5 years ago. I will never forget that case; pt was in the ICU as a result of the blood loss. I am disgusted and horrified at the assault on our patients. I don't know if I can stand party to this much more... I am just glad none of the other dr's I work with behave in this way......It is unreal. Anyhow, I had to vent. I felt powerless and angry the rest of the night !!!! I just finished my paperwork and stormed out of there..........My poor husband, I could not talk I was so pizzed....

OH and another thing: this SAME DR yelled at me for putting the "pit too high" (24 mu) and risking hyperstim??? Jeeze, we had an IUPC in and I was doing MV units.....I WAS THE ONE PUTTING HER AT RISK???? WTF?????? Oh-- I am mad. ON the schedule again tonite. I am so angry I don't know if I can go there calm, and this same patient will be there today. Oh well......I need to find a midwives group to work with...I can't stand much more of this.:o

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we use stadol mostly.Our docs have started using epidural duramorph for their c-sections.Do any others use this and what are your thoughts on it? I like the outcome so far.The mothers are up and around so much quicker.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

we use duramorph for spinals/epidurals all the time. usually awesome pain relief for about 24 hours, til they are ready for PO meds.....coupled w/IV/IM toradol, it is how we do it most the time.

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We also use spinal duramorphs. I think they are the greatest things. I also try to encourage some PO pain meds the moment they start to get pain when it close to it wearing off then they are able to get up when the foley comes out with minimal discomfort.

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I encourage an alternating dose of tylenol and motrin when they start to feel pain also.The docs usually have the foleys out in less then 12 hours with these ladies.I am so impressed with the duramorph and here I thought PCA's were it.We have even sent some ladies home at 16 hours post-op.they recovered so well

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Our high epidural rate isn't from the OB's or the Anesthesiologists pushing them, it seems to come from the community word of mouth. Like I said, they come in thinking "when can I get my epidural" when some of them aren't even in labor yet, and they haven't had a chance to talk to the docs yet. They tell about their friends getting them and how great it was, and they seem to think that is the only way. Talking can't convince them otherwise. I like natural births and I like epidurals, but sometimes it's frustrating when they want one and they're 1 cm, and not yet breathing through the cont, or hysterical and climbing the walls already!

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Originally posted by cindyln

I encourage an alternating dose of tylenol and motrin when they start to feel pain also.The docs usually have the foleys out in less then 12 hours with these ladies.I am so impressed with the duramorph and here I thought PCA's were it.We have even sent some ladies home at 16 hours post-op.they recovered so well

:eek: PLEASE tell be you do NOT give Motrin during labor, but this post is only about postpartum patients!

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