Nubain administration during labor

USA987, MSN, RN, NP · Apr 16, 2005

Unfortunately there is no hard and fast rule of labor progression. I had a primip the other day that went from closed to complete in 3 hrs. and pushed three times. You are right re: administering Nubain in the early phase of labor, unfortunately, it is so difficult sometimes to predict how long the pt will be in early labor. I personally dislike giving Nubain to a multip at any point in the process.

I'm interested in reading what others have to say about this subject...

babyktchr, BSN, RN · Apr 17, 2005

Well...nubain is the drug of choice at my hospital, and although you try to give it in a reasonable amount of time before delivery, it doesn't always happen that way. Every woman is different. I shudder to give nubain when they are 8cms and above, simply cause I find it just doesn't work..and it isn't worth the respiratory depression in the baby.

Respiratory depression I have seen, but can't say that I have witnessed tremors, irritability etc. as you have described. As a matter of fact, I have given nubain to 6cm dilated mom who delivered 15 mins later and the baby comes out SCREAMING with no apparent effect from the drugs.

There is a study out now, and I cannot remember the source, that says after 3 doses of nubain, a baby has an increased likelihood of becoming drug addicted as an adult. I will have to look thru my stuff to find the exact facts. I am almost sure it was after 3 doses. I think the study was foreign, not a US based study. Interesting.

BETSRN · Apr 18, 2005

Hello all,
My name is Amanda and I'm currently a Junior Nursing Student at the University at Buffalo. In spring 2005 I started my clinical rotations in the mother/baby unit at a suburban hospital outside of Buffalo, NY. One of our assignments for the semester is to subscribe to a professional internet listserv to observe discussion and demonstrate the ability to contribute by asking a question pertaining to our clinical rotation.
My question here is: Why is Nubain used so often for an analgesic during labor when there are so many adverse effects that occur in the newborn? During my first day spent in the newborn nursery, there were a total of 3 newborns whose mother's were given Nubain during late active or transition phases of labor. These newborns showed signs of respiratory distress, cyanosis, tremors, and irritability. Without knowing the possible long term effects of nubain administration, isn't this a danger to the baby? The nurses in the unit did explain that if Nubain is given early in the labor, infants distress signs lesson...however with a multiparous labor (which all 3 observed were) second stage can begin quick and within minutes, the baby can be born. The 3 women I observed were 6-8cm dilated when they were given Nubain and their babies were born within 10-45 minutes of administration. I'm not sure I agree with this??? After the birth I was able to observe the babies in the nursery and each one showed similar signs of distress. I also thought it was strange that in one day (7-3 shift) I witnessed 3 Nubain babies. Personally, If I had a friend or family member that was pregnant I think I would advise them NOT to take Nubain if its offered. C'mon, women have been having babies for centuries, sure I believe in epidurals and providing comfort measures during labor, but when this particular drug shows so many side effects, I'm not sure I can agree with administration....
Any feedback would be appreciated.
Thanks in advance.
Amanda :rotfl:

We have never used Nubain but use Stadol instead. Yet other hospitals in our immediate area do use Nubain. It's interesting how facilities can be so different.

You do have to be careful with your timing of narcs. We try NOT to give meds too late on but you never know how someone will react. Just because a woman is a multip does NOT mean that she wil go quickly, nor do all primips take a long time to birth. They can become complete in little time as well.

NewEnglandRN, RN · Apr 18, 2005

In my personal experience delivering my second child:

I was 5 cms & quite uncomfortable. I tried to wait it out, but the pain was bad enough for me to request medication. My Doctor ordered Nubain and within 20 minutes I went from 5 cms to delivered! My son did have some respiratory distress & was evaluated by SCN for an hour. They administered Narcan right after the delivery. He was fine after an hour and had no long-term effects.

jimmyd787 · Oct 20, 2007

There is a study out now, and I cannot remember the source, that says after 3 doses of nubain, a baby has an increased likelihood of becoming drug addicted as an adult. I will have to look thru my stuff to find the exact facts. I am almost sure it was after 3 doses. I think the study was foreign, not a US based study. Interesting.

did you ever find the study??? that makes no sense that getting a drug during childbirth would predispose one to being a drug addict as an adult. did they do a 20 year longitudinal study of these babies who got nubain as a fetus and followed them into adulthood and saw how many became drug addicts later? that just seems silly. if you can find the study or a citation of the study i'd like to read it.

i see in here that nubain and/or stadol AND morphine is being given to women in labor. that makes no sense to me and if i'm misunderstanding someone please explain it to me... but.. nubain and stadol have agonist-antagonist properties and giving one of them precludes the use of morphine and other type analgesics for a while because it blocks their actions. that's why ED physicians hate these drugs so much, in the old days (10-15 years ago)in ambulances we had this drug and we used to give it and then the ED docs had to wait 30 minutes to an hour to give morphine. now we have more choices and things are better: morphine, demerol, diluadid fentanyl

jim

paramedic

RN student

Elvish, BSN, DNP, RN, NP · Oct 22, 2007

Respiratory depression I have seen, but can't say that I have witnessed tremors, irritability etc. as you have described. As a matter of fact, I have given nubain to 6cm dilated mom who delivered 15 mins later and the baby comes out SCREAMING with no apparent effect from the drugs.

As someone who spends a fair amt of time in the nursery with newborns about ~1hour old, I can tell without seeing the delivery summary the ones whose moms have gotten Nubain. Just about all of them have the same scream. It's a side effect, and if we're lucky the scream won't be accompanied on the other end by apnea.

The drug addict study sounds very interesting. I'd be intrigued to see more about it.

babyktchr, BSN, RN · Oct 23, 2007

The reference I cannot find, but I actually heard it for the first time at a Michelle Murray conference. I have looked in the books I could find from the conferences I have gone to and can't find that particular one. She does mention it quite often in her lectures. Sorry I couldn't be of more help.