Stadol Screamers

  1. at our hospital (i work level i, ii, & catch babies) we have noticed a trend with stadol and its affects on newborns.
    [color=#483d8b]
    [color=#483d8b]we get a lot of drop-ins who typically get iv stadol instead of an epidural. the trend seems to be:
    [color=#483d8b]
    [color=#483d8b]- the more they got
    [color=#483d8b]- the closer they got it to delivery (not uncommon to see it
    [color=#483d8b] given as little as 11/2 hours or less before delivery :angryfire )
    [color=#483d8b]- and if it was combined with phenergan
    [color=#483d8b]the more likely the baby is to have trouble.
    [color=#483d8b]
    [color=#483d8b]the problem is, these babies don't have trouble until later in transition. therefore, giving narcan in the delivery room never happens, because they don't fit the drug-depressed baby scenario. (i have given it later on a few occasions and it did help.)
    [color=#483d8b]
    [color=#483d8b]these babies scream a lot. they are very irritable. this seems to affect them at delivery in a positive way in that they pink up and often have a second apgar of 10. but later, when they start to tire out, they exhibit periodic breathing and often apnea between periods of screaming. there is little or no 'quiet alert state'. state regulation in these babies is poor. many go on to get dusky and desat. thus, frequently, they at least end up on extended obs. or are (unnecessarily? ... :wakeneo: again) admitted to level ii for dusky spells, then turn out to be fine and go home relatively quickly.
    [color=#483d8b]
    [color=#483d8b]i feel so sorry for these babies. they must feel like crawling out of their skin or something. they are so irritable they usually won't nurse in the delivery room either.
    [color=#483d8b]
    [color=#483d8b]has anyone else noticed this, too?
  2. Visit 33-weeker profile page

    About 33-weeker

    Joined: Oct '06; Posts: 441; Likes: 97
    Nursery I & II
    Specialty: 20+ year(s) of experience

    18 Comments

  3. by   subee
    [quote=33-weeker]at our hospital (i work level i, ii, & catch babies) we have noticed a trend with stadol and its affects on newborns.
    [color=#483d8b]
    [color=#483d8b]we get a lot of drop-ins who typically get iv stadol instead of an epidural. the trend seems to be:
    [color=#483d8b]
    [color=#483d8b]- the more they got
    [color=#483d8b]- the closer they got it to delivery (not uncommon to see it
    [color=#483d8b] given as little as 11/2 hours or less before delivery :angryfire )
    [color=#483d8b]- and if it was combined with phenergan
    [color=#483d8b]the more likely the baby is to have trouble.
    [color=#483d8b]
    [color=#483d8b]the problem is, these babies don't have trouble until later in transition. therefore, giving narcan in the delivery room never happens, because they don't fit the drug-depressed baby scenario. (i have given it later on a few occasions and it did help.)
    [color=#483d8b]
    [color=#483d8b]these babies scream a lot. they are very irritable. this seems to affect them at delivery in a positive way in that they pink up and often have a second apgar of 10. but later, when they start to tire out, they exhibit periodic breathing and often apnea between periods of screaming. there is little or no 'quiet alert state'. state regulation in these babies is poor. many go on to get dusky and desat. thus, frequently, they at least end up on extended obs. or are (unnecessarily? ... :wakeneo: again) admitted to level ii for dusky spells, then turn out to be fine and go home relatively quickly.
    [color=#483d8b]
    [color=#483d8b]i feel so sorry for these babies. they must feel like crawling out of their skin or something. they are so irritable they usually won't nurse in the delivery room either.
    [color=#483d8b]
    [color=#483d8b]has anyone else noticed this, too?[/quote


    what do we know about these mothers? are they using narcotics. giving an agonist-antagonist could be the problem if babies are going through withdrawal syndrome.
  4. by   33-weeker
    No. I know NEVER to give narcan to a baby of an addict. These are regular moms and vag. deliveries. We test all drop-ins for drugs. This is just the effect of the Stadol it seems. Not every baby acts this way, but enough of them that I see a definite trend.
  5. by   NYnurse97
    I am a new L and D nurse and what you are decribing happened to my son after delivery and I was given Stadol. It was the WORST thing that I had in my life. I felt so out of it and it did not help with the pain. my son was screaming when he was born and then after about 10 minutes had to go to nicu for apeanic spells and stayed there for 8 days for them to find out nothing. it didn't help that he has a thalessmia trait so it took even longer for the medication to get out of his system. next baby NO STADol


    Kim
  6. by   33-weeker
    Bless Your heart! and His!!!

    I am so glad I had my babies at home with no drugs. (I would do it again if my tubes weren't tied. LOL) Too many health problems - doc says no more for me. BOO HOO. Birth is so wonderful!
  7. by   JaneyW
    I have also seen this with Stadol. Not so much with Nubain.
  8. by   htrn
    I had stadol with my first labor 16 years ago - that stuff should be BANNED!!!

    It was absolutely awful, did not help with the pain and I think it made the whole experience worse than it had to be.

    I ended up having to have a crash section and honestly don't know exactly how his transition went - my husband is a very poor historian. I do know that nursing did not go well after I finally came around.
  9. by   33-weeker
    i worked in a place that used nubain. the babies were often sleepy and wouldn't nurse well for a good while.

    to the lady who had nubain & crash section -- i am assuming you had a general with that. if so, the drugs from that would make your baby sleepy, too.

    for what it's worth - with stadol, in the mothers who've had it earlier in labor and then get an epidural or for some reason don't get any more stadol for several hours, the effects are not nearly as bad on the baby.

  10. by   flytern
    Why are they getting Stadol that close to delivery? We don't give after about 5-6cm, figuring it's going to be at least another 4-5hours before delivery. Should be out of mom/babies system by then. Figure it works on baby about 2-4hours after being given. We give it between 2-3 cms, when it's still too early for epidural. Affects baby the same as mom, lethargic strips. I always tell moms it's like drinking to margarita back to back! Just about every MD at my hospital uses it.
  11. by   33-weeker
    much to my dismay, at our hospital they don't encourage the mothers to walk - docs want them on the monitors. the l&d staff (save a few) don't bother to teach non-pharm. pain relief measures.

    we get a lot of drop-ins, many with no pnc. the docs won't come in a night for epidurals (some not even for their patients!) and currently, anesthesia won't do them without a doc in house.

    the nurses just push stadol to keep them quiet. i hate it. i wouldn't consider transferring to l&d at this place for that reason. i do occasionall take it upon myself to teach back pressure to the family when i go set up the baby warmer.
  12. by   LKB82
    the docs won't come in a night for epidurals (some not even for their patients!) and currently, anesthesia won't do them without a doc in house.

    [font="comic sans ms"]just curious, but what is the rationale for the ob having to be in house for an epidural? we do epidurals all the time without the patient's obstetrician being in house. on the other hand, we always have a level iii ob in house just for emergencies, so maybe that covers us.
  13. by   33-weeker
    because of the risks of an epidural dropping mom's blood pressure to the point of fetal distress when it is first started, and thus the potential need for a stat section, they want the docs in house. (it's gonna drop her pressure, it's just a matter of how much - which you don't know ahead of time)

    we are small enough of a hospital that we don't usually have an ob or a neo in house routinely at night.
  14. by   mitchsmom
    Quote from 33-weeker
    much to my dismay, at our hospital they don't encourage the mothers to walk - docs want them on the monitors. the l&d staff (save a few) don't bother to teach non-pharm. pain relief measures.
    basically no one on our unit walks unless they are an outpatient labor check that's just going to walk around the hospital an hour or two and then let us look again to see if she's making change. they pretty much all come in and get immediately and permanantly strapped to the monitor, and most don't know any better

    we don't give stadol late in labor for the aforementioned reasons, so no one still has it floating around in their system when they are complete unless their cervix just melted away faster than we anticipated

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