Meds during labor

For labor and delivery meds we don't have the epidurals and use Nubain 10-20mg every 1 hour IM and people say that they like the way that it works. Speaking from personal experience I liked the Nubain and didn't like the spinal that I had previously with my first child. That just made me take the brush to my face with the itching. We also use Vistaril IM if they don't really want the "drug effect." beak73

IF they choose narcotic pain relief we are allowed to administer the following:

Nubain 5-10 mg q 2 h

or

Fentanyl 50-100 mcg q 2 h

or

Stadol 1-2 mg q1h

all the above are given IV.

we generally withhold narcs after 8-9 cm in primip's and at 6-7 for multips. rare is the woman who chooses narcs for pain relief and I don't encourage it. I find epidural anesthesia MUCH more effective and safer for mom and baby in the long run. Yes, there are risks, but it's rare we see complications from epidural anethesia versus narcs which lose their effectiveness quickly and CAN cause respiratory depression in some moms and also in newborns immediately after birth.

We have standing orders for Nubain 5-10mg q2 hrs. Also generally will not give it after 7-8cm. Nubain is usually first dose best dose and if a pt. is progression quickly, I find that it doesn't work that great.

We give 5-10 mg Nubain q 2 hrs x 2 doses. And can augment that with Phen 12.5-25 mg q 4 hrs.

The first dose seems to be the best. After that, it doesn't seem to help as much. I think we're pretty evenly split between epidurals, narcs, and natural childbirth.

Originally posted by beak73

Nubain 10-20mg every 1 hour IM

This seems high to me.... anyone else giving these dosages

I have ordered Nubain in this high of a dose, but only in acute cases involving an injury. I've never seen it given that high on OB. While I beleive it could be done, I don't see the risks of using that much (20mg) out weighing the benefits. In the case of needing that much pain control, I would suggest an epidural, or use Fentanyl.

Our L&D department has standard orders for 50-100mcg of Fentanyl Q2hrs, with the option to repeat Q1hr. Our nurses are really great when it comes to controlling a patients labor pain.

We also just contracted with a anest. group who will offer 3 CRNA's for our OB floor and I expect our narcotic use to go down as epidurals will be availble much quicker than before. The way I understand it is that we will have a CRNA in house to handle L&D as well as a few other things.

That 5 minute drive through town isn't too nice for a woman in labor :)

Dave

We use Nubain as well, 10-20mg q2hours, and yes q1hour does sound like a lot of drugs, talk about a gorked baby--yuck!! I worry with the doses we give and have my narcan ready, but with that much what does the strip look like??

I do see quite a few still go for the epidural even after nubain--it just doesn't cut it for them.

We used to give Stadol before I was there I hear, but stopped because too many people were having bad reactions--psychotic type reactions.

We do get the occasional "bradley" pt--any one else get these people?? ---and they go all natural--the tub, the ball, music, massage, dark room, etc. .....all in the "plan" of course. I'm okay with a birth plan as long as the couple isn't "married to it" and totally unflexible.

>

That was how I had my last baby (Aug 2003). I absolutely LOVE my patients that want to birth this way, provided that they are flexible in their birth plan, since most births do not go 100% according to *plan*.

PS - I referred to my plan as *birth preferences*

Originally posted by susancox

We do get the occasional "bradley" pt--any one else get these people?? ---and they go all natural--the tub, the ball, music, massage, dark room, etc. .....all in the "plan" of course. I'm okay with a birth plan as long as the couple isn't "married to it" and totally unflexible.

Get them quite a bit as we have a good sized midwife practice. I love them! It is a much more empowering experience for everyone involved, IMO.

When I first stared as an L&D nurse 6 yrs ago, all we used was Demerol and Phenergan. Some docs liked to use Stadol 1-2 mg. I liked the Stadol although some patients experienced really strange hallucinations on it.

Last year we stared using Fentanyl 100mcg with 50 of Benadryl... "Fenadryl" as we called it. I thought it worked really well.

At my new place they use Nubain or MS and I don't think either of them work as well as the Fenadryl--we don't have the option for epidurals here (only intrathecals) and surprisingly, not many of our patients get ANY pain meds. Very fast laboring population of women!!

Erin