Narcan at Delivery

SmilingBluEyes · Dec 15, 2004

We rarely use narcotics in labor, therefore, the need for Narcan is almost nil.

JaneyW · Dec 15, 2004

We rarely use narcotics in labor, therefore, the need for Narcan is almost nil.

Do most of your patients have epidurals? Do they go without pain relief? Where do you practice?

Where I am, we have a heavily Hispanic--Mexican--population. They are very wary of epidurals but all too eager to get IV pain meds. So, it can be a problem for us at times. Especially with multiparas who go from 4cm to complete after getting Nubain and relaxing.

SmilingBluEyes · Dec 15, 2004

Most use do one of two routes:

Epidural/intrathecal

Natural

Narcs just don't do the job. I never encourage their use at all----but do not stand in the way of those requesting them. I do educate them as to the different coping methods, and let them choose. Most choose epidural as this is less likely to affect their babies. Narcotics are on the standing orders for those who request them, but most people opt out.

USA987, MSN, RN, NP · Dec 15, 2004

Most use do one of two routes:
Epidural/intrathecal
Natural
Narcs just don't do the job. I never encourage their use at all----but do not stand in the way of those requesting them. I do educate them as to the different coping methods, and let them choose. Most choose epidural as this is less likely to affect their babies. Narcotics are on the standing orders for those who request them, but most people opt out.

I agree completely. I am very hesitant to even give the Nubain....especially with multips...

SmilingBluEyes · Dec 16, 2004

We have a choice of Stadol, Nubain and Fentanyl...I hate to use any of them.

allnurses Guide · Dec 16, 2004

We have a choice of Stadol, Nubain and Fentanyl...I hate to use any of them.

Fentanyl . . usually to help while we wait for the CRNA. :)

But we rarely use narcotics either. I don't like using them at all.

steph

unikuelady, RN · Dec 16, 2004

We have been having a sudden increase in needing narcan for infants of our Stadol receiving moms. We also have a high risk population for illicit drug use. I asked in L&D why so many more moms were receiving Stadol, they told me that more of the moms were not wanting epidurals and they don't want the moms screaming in pain at the end of labor. I'm not sure if these nurses are educating the moms about the possible consequences of stadol close to delivery or not, but we have admitted at least 10 infants over the past month to the NICU for respiratory depression-even with the narcan whereas it used to be 1-2 a year! (we have also had new OB docs working for us and several registry RNs which may or may not have anything to do with this new trend). It's very frustrating because we have to watch these infants like a hawk in an already crowded nursery and they are being kept away from their moms for longer than optimal time. We keep them in the nursery on pulse oximeter for at least 3 hours observation-not all respiratory depression shows up right away. If they are apnic/require narcan, then they are kept another 3 hours or so. This interfers with the bonding/breastfeeding process. I guess you get the frustration I feel on this issue. :uhoh21:

JaneyW · Dec 16, 2004

We have been having a sudden increase in needing narcan for infants of our Stadol receiving moms. We also have a high risk population for illicit drug use. I asked in L&D why so many more moms were receiving Stadol, they told me that more of the moms were not wanting epidurals and they don't want the moms screaming in pain at the end of labor. I'm not sure if these nurses are educating the moms about the possible consequences of stadol close to delivery or not, but we have admitted at least 10 infants over the past month to the NICU for respiratory depression-even with the narcan whereas it used to be 1-2 a year! (we have also had new OB docs working for us and several registry RNs which may or may not have anything to do with this new trend). It's very frustrating because we have to watch these infants like a hawk in an already crowded nursery and they are being kept away from their moms for longer than optimal time. We keep them in the nursery on pulse oximeter for at least 3 hours observation-not all respiratory depression shows up right away. If they are apnic/require narcan, then they are kept another 3 hours or so. This interfers with the bonding/breastfeeding process. I guess you get the frustration I feel on this issue. :uhoh21:

This is exactly what I was talking about!!! I am also in SoCal. In regards to "not all repiratory depression shows up right away", this is what I was getting at in the original post. If I have a mom who receives Nubain or Stadol less than 1-2 hours before delivery I know that baby will most likely have a problem with respiratory depression but maybe not right at birth. Soooo, should these infants be given Narcan at delivery to keep this from occurring?? Would that even help? Do you give the Narcan 2 hours later when the symptoms show up? (I am not a nursery nurse!)

In regards to the woman getting good education during labor, I can tell you from experience that when a laboring woman is screaming and out of control and fighting everyone you cannot really have a decent educating experience with them. They want drugs and want them NOW!! In California, we are responsible by law to tend to their pain relief and document as such. It is difficult to try to talk someone out of pain meds when they are screaming for them and they have been ordered.

idreamofjeannie · Dec 16, 2004

The recent post about delaying Narcan 2 hours post delivery got me thinking about my own hospital. We have recently trasitioned from having nursery do the newborns about 2 hours post delivery to having either the L&D nurse or a nursery admit nurse do the newborn care in the LDR room during the first 2 hours while the parents can watch. I like the new system. I am comfotable with doing newborn care, but I am not as familiar with our nursery protocols and ped orders as I would like to be.
Our OBs give either Stadol or Nubain for pain intrapartum. If either is given too close to delivery the baby sometimes has some minor respiratory sx soon after delivery--but not always right at delivery. A dose of Narcan seems to help a lot. Sometimes we will give the Narcan right after delivery if we are worried because of pain meds within 30 minutes to an hour of delivery. I believe we are kind of doing this under NRP guidelines and not specific orders from the ped because it is 2am and not really a good time to call. Do you get what I'm saying?? However, we aren't really responding to resp distress but preventing it.
Do any of you have protocols at your facilities for this kind of thing? Anyone else see apnea about 1-3 hours postpartum after Stadol? High pitched crying after Nubain? I would love to hear how this is addressed as I feel our unit needs to revamp their thinking on this.
Thanks

JaneyW are you the originator of this thread? (not very computer literate).I just thought in reading through all the responses, i wasn't sure what you wanted to know. i work in a small setting too where no epidurals are available. use coaching and stadol mostly, some nubain, some demerol, some morphine. since the establishment of the 2000 NRP guidlelines, our use of narcan took a nose dive and the newborns are much better for it. don't use it at delivery and never use it later either. going exactly by the guidelines, the use of narcan should not be very frequent. NRP, as you read the book, is mostly a respiratory course. I have found this to be true.

as far as stadol and nubain effects on infants, i believe most my coworkers and i find, if used in large amounts, the babies are not as good at feeding etc, haven't noted any cry differences or anything.

in reading responses, one comment was they were not very effective, i don't think they are meant to be. nothing will completely resolve the pain but delivery, the meds are adjuncts to good coaching, relaxation and breathing techniques. youve probably heard it all by now anyway, just thought i'd add my 2 cents. have a great day

unikuelady, RN · Dec 16, 2004

Also a very difficult decision to make is: Is the baby apnic/de-satting due to moms narcotic administration or is the infant having respiratory distress due to sepsis or other problems. This is also the reason to watch them like-a-hawk in the nursery. I have given narcan up to 3 hours post delivery-but usually within the first hour of birth.

Some of our doctors just put the infants on O2 via nasal canula until the drug wears off. of course this entails admit to the NICU due to O2 being a drug and need for cardiorespritory monitoring.