Stadol Screamers

subee, MSN, CRNA · Oct 12, 2006

at our hospital (i work level i, ii, & catch babies) we have noticed a trend with stadol and its affects on newborns.
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[color=#483d8b]we get a lot of drop-ins who typically get iv stadol instead of an epidural. the trend seems to be:
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[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.
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[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.)
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[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.
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[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.
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[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.

33-weeker · Oct 12, 2006

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.

NYnurse97 · Oct 12, 2006

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

33-weeker · Oct 12, 2006

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!

JaneyW · Oct 13, 2006

I have also seen this with Stadol. Not so much with Nubain.

htrn · Oct 13, 2006

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.

33-weeker · Oct 13, 2006

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.

flytern · Oct 13, 2006

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.

:balloons:

33-weeker · Oct 13, 2006

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.

LKB82 · Oct 14, 2006

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.

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.

33-weeker · Oct 14, 2006

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.