Effect of Mom's Pain Meds?

[JaneyW]

I am an L&D nurse in a high risk unit. I am new to the high risk arena and am learning. I am a bit concerned about the use of Demerol as a pain med for laboring women. I would like to change what my unit does and am starting to research what the best practice would be.

So, I have a question for you NICU people. When you get babies from moms who have had IV pain meds in labor, what do you see with the different meds?? What do you prefer? What makes you crazy? I'm not really talking about timing because that can be a tricky thing--especially for preterm moms. They can go from stable to baby pretty quickly. I am talking about type of drug and the effect on the neonate good/bad/whatever.

I'm not asking you to do my research for me--I just want your experiences. Thanks so much for your time!

[Jolie, BSN]

When a sick infant (term or preemie) is admitted to the NICU, it can be difficult to determine whether the s/s of illness are due to prematurity, sepsis, glucose instability, RDS or mom's pain meds.

The nurses in the best position to answer this question are probably those who do well newborn care, who are more likely to see respiratory depression and other complication of mom's analgesia separate from other disorders.

About 15 years ago, I worked in a hospital with an old-fashioned L&D, nursery and post-partum set-up. Not many patients requested epidurals, so a lot of IV pain medication was used. I don't recall all the drugs that were used, but Nubain and Demerol were common. Newborns exposed Newbain seemed to be far more irritable than others, almost to the point of being inconsolable. They would come into the nursery (usually before 1 hour of age), and lie in the warmers and cry constantly. They didn't have any other problems that I recall (no increase in respiratory depression or blood sugar problems beyond what was seen in other infants).

Looking back, I wonder if we'd had a mother-baby system, and these kiddos had the opportunity to bond and nurse if we would have seen such irritability.

[JaneyW]

I think you are definitely right with the mother-baby care model decreasing crying/irritability. I try to recover my babies skin to skin with their moms. They can nurse when they want and are kept warm and secure. It can make you nervous at first to have them so quiet, but you get used to it.

[Littlewonder]

Hey, I do LDRP and have used Nubain frequently in one hospital for about three years. We did not have the irritable babies described, but we did use a mother/baby skin to skin type care model. I really dislike using Demerol - keep that Narcan handy!!! Fentanyl is good - does not seem to bother the babies. Stadol is usually fine but sure makes for loopy moms! (You can't really tell if baby is loopy, they can not talk about elephants!) I have never had any problems with our epidural babies. Great question! I know we are careful with what we use because we deal with all the babies and with only two on duty for moms and babies you don't want to court disaster.

[palesarah]

. Stadol is usually fine but sure makes for loopy moms! (You can't really tell if baby is loopy, they can not talk about elephants!)

Why is it always elephants with stadol? Pink elephants, white elephants, polka-dot elephants... :roll