What type of pain med in labor used? - page 4

After attending an all day pain conference, I learned that what we are using on our unit is "old school" thought. We use Stadol and Fentanyl. I understand from this conference that Stadol is a bad... Read More

  1. by   ashlee853
    We use Stadol 1-2 mg with Phenergan 12.5-25 mg. We are a small hospital so we don't use epidurals, we use intrathecals. We only use the stadol for early labor and the intrathecal when they get to 4-5 cm.
  2. by   obnursesteff
    We generally give Stadol 1-2mg IVP. There is a new doc here who wants us to start using fentanyl. We don't offer epidurals, but we do use intrathecals. We offer the bath for alot of our labor pts. This works supprisingly well.
  3. by   camay1221_RN
    Quote from greenivy
    Thank you!!!!!!!!

    I am concerned that my pro natural birth stance is going to bite me in the a$$ when I start nursing clinicals (in May). I've had two babies naturally and believe in what the female body is capable of. I was soooo adamant about not having drugs (and nurses coming into my room repeatedly pushing meds) that I didn't let anyone know how strong my contractions were until I was dilated to 9 (!). I felt badly that I scared one of the nurses but they were less than enthusiastic about listening to my wishes. I had an easy delivery with no drugs and a fast recovery.
    greenivy,

    I have the utmost respect for you and every woman who have given birth with no medications. However, I was not one of those women!:wink2: As a L&D RN, I like to just let my pts know what is available to them, so if they want to change their minds and have meds, they can make an informed decision. I also have to admit, I like caring for women with no meds, because as you mentioned, a much faster recovery! These women are far and few between where I work, though.
  4. by   FrumDoula
    Quote from camay1221_RN
    greenivy,

    I have the utmost respect for you and every woman who have given birth with no medications. However, I was not one of those women!:wink2: As a L&D RN, I like to just let my pts know what is available to them, so if they want to change their minds and have meds, they can make an informed decision. I also have to admit, I like caring for women with no meds, because as you mentioned, a much faster recovery! These women are far and few between where I work, though.
    I think the time to inform them is once they ASK for the medication, not before. A laboring woman is so highly suggestable that she can possibly misinterpret the nurses education efforts as an assessment that she's not capable of doing the job without the meds. It's upsetting for some ladies to hear, "Well, I know you're wanting unmedicated, but just know that the epidural is an option." Or my personal favorite, "The anesthesiologist is about to go into a c/s. So this is your LAST CHANCE for an epidural." AAARRRGGG. I can understand the nursing rationale, but it's frustrating nonetheless.

    I wouldn't mind if nurses simply educated their patients about their options, but sometimes I hear outright untruths being told. I've heard nurses say that epidurals are perfectly safe, or that the risks are next to nil, etc. I've heard nurses say things like, "I know you're trying to go natural, but you don't have to be a hero .... no one gets an award for going natural." I've also heard of many nurses who, despite seeing a birth plan that states the patients wish to birth unmedicated, will still go in and offer medication instead of offering various coping techniques. It drives me a little nuts.

    I just wish that all OB nurses truly had a grasp on what the literature says about various interventions. It seems clear that some of them pretty much only get their knowledge from anesthesiologists. And let's face it, epidurals are the cash cow of the anesthesiology department, so you're not going to hear those docs dissing them too much, beyond the "well, everything has risks" speech.

    In fact, one of my good friends, a childbirth instructor, got called onto the carpet for teaching her classes that epidurals do in fact have side effects, and some can be serious. She went to the meeting armed with research, and ultimately won out, but the docs were less than pleased.

    In some hospitals, you now have anesthesiologists teaching the epidural classes. Which is ok, except when they're told them have to keep up a certain quota every month, so how well informed do you think some of those women are? It's a conflict of interest.

    Another friend is an L&D nurse, and she hears women being bad mouthed all the time at the nurses station for refusing medication or wanted an unmedicated birth. It's awful .... and it's one of the reasons I'm choosing to have my baby, due in July, at home. Because I know what goes on at so many hospitals, I am nervous to subject myself to that. Sucks, 'cause I LOVE so many OB nurses. I've seen some nurses who have been the only thing that stood between a woman birthing vaginally and some eager beaver doc with a scalpel.

    (When I had my son in the hospital, I had one nurse in particular who was FABULOUS. Loved her. Very matter of fact and kick *ss. A year and a half later, I went in for a miscarriage, and she was my nurse again. Convinced me to not be so quick to rush to a D&C, and I'm glad she did. I'll be forever grateful to her for that.)

    Alison
  5. by   FrumDoula
    Quote from greenivy
    Thank you!!!!!!!!

    I am concerned that my pro natural birth stance is going to bite me in the a$$ when I start nursing clinicals (in May). I've had two babies naturally and believe in what the female body is capable of. I was soooo adamant about not having drugs (and nurses coming into my room repeatedly pushing meds) that I didn't let anyone know how strong my contractions were until I was dilated to 9 (!). I felt badly that I scared one of the nurses but they were less than enthusiastic about listening to my wishes. I had an easy delivery with no drugs and a fast recovery.
    As a doula and student lactation educator (and a student nurse), I would love nothing more than to venture into L&D and postpartum. I think you can make such a difference for so many women. And I also know that what works for some doesn't work for all, and that there are lots of women with complex medical and social issues for whom an unmedicated birth might be more traumatizing than not. But for those who want it, it seems like it's an uphill battle in many hospital settings, and with the induction/epidural/cs bandwagon going full force, nearly impossible at times.

    For those of you who are more into natural/normal/what-have-you childbirth, how have you continued to work in an intervention-heavy setting without losing your mind? I have so much to offer, but am nervous about traumatizing myself or causing harm in a woman whose doc is less than prudent. I mean, the effects are very real to women, and not a few are coming out with PTSD from their birth experiences ....

    I could use some wisdom, sisters!!!

    Alison

    PS. And let's all remember: Pizzas are Delivered, Babies are Born!!!

  6. by   mommatrauma
    Never worked in L and D, however I do have a child...When I delivered 4 years ago, I got Stadol to "make me not care about the pain so much" BAD MOVE...I had a horrible akethesia from it...So now I list it as an allergy...I was so anxious and felt like jumping out the window...I had no control over my eye and facial movements...Then I got my epidural and they gave me fentanyl...once my pressure bottomed out and I vomited, the anesthesiologist became my best friend...I had tons of back labor...I thought the Fentanyl gave great pain control, and when it came time to push they turned down the Fentanyl and I was very effective in my delivery...my son was out in 4 contractions...
  7. by   camay1221_RN
    Quote from FrumDoula
    I think the time to inform them is once they ASK for the medication, not before. A laboring woman is so highly suggestable that she can possibly misinterpret the nurses education efforts as an assessment that she's not capable of doing the job without the meds. It's upsetting for some ladies to hear, "Well, I know you're wanting unmedicated, but just know that the epidural is an option." Or my personal favorite, "The anesthesiologist is about to go into a c/s. So this is your LAST CHANCE for an epidural." AAARRRGGG. I can understand the nursing rationale, but it's frustrating nonetheless.

    I wouldn't mind if nurses simply educated their patients about their options, but sometimes I hear outright untruths being told. I've heard nurses say that epidurals are perfectly safe, or that the risks are next to nil, etc. I've heard nurses say things like, "I know you're trying to go natural, but you don't have to be a hero .... no one gets an award for going natural." I've also heard of many nurses who, despite seeing a birth plan that states the patients wish to birth unmedicated, will still go in and offer medication instead of offering various coping techniques. It drives me a little nuts.

    I just wish that all OB nurses truly had a grasp on what the literature says about various interventions. It seems clear that some of them pretty much only get their knowledge from anesthesiologists. And let's face it, epidurals are the cash cow of the anesthesiology department, so you're not going to hear those docs dissing them too much, beyond the "well, everything has risks" speech.

    In fact, one of my good friends, a childbirth instructor, got called onto the carpet for teaching her classes that epidurals do in fact have side effects, and some can be serious. She went to the meeting armed with research, and ultimately won out, but the docs were less than pleased.

    In some hospitals, you now have anesthesiologists teaching the epidural classes. Which is ok, except when they're told them have to keep up a certain quota every month, so how well informed do you think some of those women are? It's a conflict of interest.

    Another friend is an L&D nurse, and she hears women being bad mouthed all the time at the nurses station for refusing medication or wanted an unmedicated birth. It's awful .... and it's one of the reasons I'm choosing to have my baby, due in July, at home. Because I know what goes on at so many hospitals, I am nervous to subject myself to that. Sucks, 'cause I LOVE so many OB nurses. I've seen some nurses who have been the only thing that stood between a woman birthing vaginally and some eager beaver doc with a scalpel.

    (When I had my son in the hospital, I had one nurse in particular who was FABULOUS. Loved her. Very matter of fact and kick *ss. A year and a half later, I went in for a miscarriage, and she was my nurse again. Convinced me to not be so quick to rush to a D&C, and I'm glad she did. I'll be forever grateful to her for that.)

    Alison

    Alison,

    Thank you for your sharing your thoughts. I agree with you about the L&D RN not pushing pain meds. I have also heard many offer their very non-objective view of all meds available.
    I am a fairly new L&D RN, and I have found that many of the non-medication interventions are hardly ever even offered, and I find that more sad than anything! It is even more frustrating that many of the non-medication interventions are not able to be used because of pitocin inductions, ex. whirlpool and shower.

    I have a wonderful preceptor who is excellent at offering non-medication intervention and I have learned a great deal from her. I hope to give the same care to my pts she gives.
  8. by   obnursesteff
    We have monitors (telemetry and underwater) for those pts on pitocin. They have the flexability to walk, shower or get into the tub. This provides great relief for out pts. without using meds.
    Our anestheisologists have been doing such good intracthecals that everyone is itching and can't pee afterwards.
    Any suggestions for that?
  9. by   mitchsmom
    You L&D nurses probably already know this, but a little on Demerol/Pethidine that I just happened to read today:

    "Meperidine (Pethidine/Demerol) is metabolized to the active metabolite normeperidine which has a long half-life (63 hours in the neonate). Meperidine reaches its highest levels in the fetus 2 to 3 hours after administration, however normeperidine levels continue to rise the longer it is until birth. Normeperidine still has half the pharmacological activity of meperidine.

    Belsey et al (1981) reported that immediately following birth infants of mothers who received meperidine demonstrated

    an increased time before the first cry, and
    more time spent in a drowsy state.
    The higher the cord blood drug concentration the longer the infant was cyanotic.
    These babies also spent less time crying vigorously,
    more time in the cot, and
    less time being held by the mother and interacting with parents.

    Righard & Alade (1990) studied babies of mothers who received pethidine (meperidine) in labor and those who didn't. They found that within the first 2 hours of birth of the infants of mothers who received pethidine 62.5% were too sedated to suck at all, 17.5% had a disorganized suck and only 20% sucked correctly. The statistical significance between the two groups was high and the authors concluded that pethidine in labor is a highly significant deterrent to successful initiation of breastfeeding. "

    Of course no drugs is ideal, but some of the others have a shorter half life at least:
    Morphine has a short half-life (1.5 - 2 hrs) and does not have an active metabolite
    Butorphanol (Stadol) has a half-life of 3 - 4 hours.
    Nalbuphine (Nubain) has a half-life of 5 hours. (Hale, 2002)
    I'm sure there are other factors involved too.
  10. by   SmilingBluEyes
    We do not use Demerol at all on my floor, and have not for years. Besides all of the above, it lowers the seizure threshold in healthy people. Obviously NOT ideal med to use when so many others exist that are better and safer.

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