Nubain before pushing?

[jjoy]

I'm having trouble finding reliable information on this topic. I recently had a primip that progressed very quickly (from 3 to complete in a little over an hour) and thus she didn't have a chance to get the epidural she wanted. Just prior to pushing, the doc ordered 10 mg of nubain. Delivery was about 20 minutes later. He said it takes 2 hours for nubain to reach the baby and the nursing staff is divided on how quickly it happens. I was taught in school that giving nubain late in labor can cause lower APGARs. What's your opinion/experience/literature?

[ashleyisawesome, BSN, RN]

We only have one doctor that orders Nubain in labor, most others do Stadol. But regardless we don't give either if we think they are going to give birth imminently or within the next hour or two. Our general cutoff is 8cm, but it can vary by how their labor is going. We definitely wouldn't give it when they are complete and pushing. How would it take 2 hours to reach the baby? You are putting it right into mom's blood stream, it's going to get to the baby fairly quickly. You can tell because when you give it in labor you will notice 9/10 times your variability will become minimal with little to no accels for a while, usually within 15 mins of giving the med. This can be a problem if the baby is born with the narcotic in their system, as they may have respiratory depression/decreased tone.