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PETHIDINE Pethidine is a pain relieving drug usually given by an injection into the muscle of your leg or buttock.

It takes about 20 minutes to work and is effective for around 3 hours. Pethidine helps you to relax and may lessen the pain of your contractions. It can also speed up your labour but it does not work for everyone and it often causes side effects. !omiting is common after having pethidine so an anti sickness drug is usually given with it. "ther side effects include# feeling shaky light headed and disorientated. $he more of the drug you have the more likely you are to suffer these effects. $he usual dose of pethidine is %00mg but you may choose to have less. Pethidine very &uickly crosses the placenta and reaches the baby. If you have an injection of pethidine 2 to ' hours before you deliver your baby(s breathing will be affected and occasionally an antidote needs to be given. )ost babies are fine but they do tend to be a little more sleepy in the first few days and take longer to establish feeding. )idwives are able to give pethidine without a doctor(s prescription and it is the drug most commonly used but there are alternatives. )eptid or )epta*inol

)eptid is similar to pethidine but causes fewer side effects in mother and baby. +ausea and vomiting are the only unwanted effects that still tend to be a problem. ,ecause it does not make you feel sleepy meptid is often used for women having water-births. .iamorphine .iamorphine is very effective at relieving pain in labour. It tends to give you a feeling of well being and causes less nausea and vomiting that pethidine. $here is some evidence that babies exposed to diamorphine in the womb are more likely to become addicted to the drug in later life. /or this reason most )aternity 0nits do not use it. $he action of any pain relieving drug is unpredictable and the associated side effects can be a problem. 1aving said this many women benefit greatly from having a pain relieving injection during labour. If you are able to choose which injection to have meptid is probably the best option.

Pethidine is a widely used drug for pain relief in labour. Pethidine is a similar drug to morphine and heroin. $hese three drugs are from a family of drugs known as opioids. "pioids basically are morphine-like drugs. )orphine is a natural drug that can be extracted from the opium poppy where as pethidine is synthetically made. Pethidine was first used in 2ermany in %3'0 to reduce pain in labour and its use has continued to the present day. Initially when pethidine was created it was thought to be non addictive but we now know that this is not true. Pethidine works my mimicking the effects of endorphins - the body4s own morphine-like substances. "ne of the functions of endorphins is to act as the body4s natural pain killer. Pethidine 5like endorphins6 attaches to special sites on the outside of nerve cells. $hese sites are known as opioids receptors. "nce pethidine attaches to these receptors a chain of events occurs that results in the depression of normal activity for a little while. Pethidine4s effects are far more dramatic than endorphins. $he effects pethidine has on a woman4s body can readily observed after it has been administered. 7 woman may become di**y drowsy her eyes may change in appearance and she may experience an altered level of perception of events around her. Pethidine acts on the central nervous system by inhibiting the pain signals that are sent to the brain. $he subse&uent result can reduce the pain experienced by the woman in labour. Pethidine can also increase the amount of pain a woman can tolerate. 1ow is pethidine given to a woman when she is in labour8 $he most common way that pethidine is give to a woman in labour is by an injection into the muscle 5usually into the thigh or buttock6. "ccasional pethidine is given into a vein via a drip. Pethidine usually has to be ordered by a doctor but is then given by a midwife. $he dosage a woman receives in labour varies usually ranging from 90mg to %00mg. $he total volume injected into the muscle is one to two millilitres. 1ow long does pethidine work for8 If pethidine is given via an injection into the muscle it usually takes around ten to twenty minutes to begin working. Pethidine4s effects when given by this method last two to three hours. If pethidine is given directly into a vein via a drip the effects are a lot more rapid. Pethidine begins working within two to three minutes. :hen pethidine is given via a vein it enters the blood stream directly and only takes a couple minutes to circulate around the entire body therefore pethidine reaches the brain and the nerve sites rapidly. $he problem with giving pethidine directly into a vein is even though the effects are rapid they only last for a short time. $he effects of pethidine injected into a muscle last a lot longer. :ill pethidine provide me with ade&uate pain relief while I am in labour8 $his is not an easy &uestion to answer as women report varying responses to pethidine. ;ome women say that it provides ade&uate relief while other women say they achieved no pain relief whatsoever 5'<= of women in one survey said this6. :omen report pethidine provides greater relief in early labour rather than in later labour 5when the

contractions are a lot stronger6. $he bigger the dose of pethidine the more effective the pain relief. ,ut the bigger the dose the more side effects a woman and her baby may experience. "ne piece of research said that pethidine does not provide ade&uate pain relief during labour but ends up heavily sedating the woman. "verall pethidine may reduce pain experienced during labour in some women. If a woman is tired pethidine can provide sedation 5and sometimes much needed sleep6. Pethidine can act as a muscle relaxant which can in some cases result in faster dilation 5opening6 of the cervix. :hat are the disadvantages of using pethidine for pain relief in labour8 Pethidine may not provide ade&uate pain relief for some women. +ausea and vomiting are common a medication may be mixed with the pethidine to help reduce these effects. ;ome women report feeling drowsy and confused. $he effects pethidine has on perception may make the contractions difficult to deal with. "ther potential side effects for the woman in labour include difficulty passing urine dry mouth hallucinations respiratory depression low blood pressure and allergic reaction . $here are no advantages to the baby if the mother has pethidine. Pethidine is known to cross the placenta and is present in breastmilk. $he major problem for the baby is that pethidine can cause breathing difficulties after birth due to its depressive effect on the baby4s respiratory centre. $hese effects are at the worse if the baby is born one to three hours after an injection of pethidine has been given. $his is the reason that pethidine is ideally avoided when the birth is perceived to be close. 7n antidote can be given to the baby to reverse the effects of pethidine however the effects of the antidote only last a short time and when they wear off the baby may re-experience breathing problems. ,aby4s are more likely to have jaundice if their mothers have pethidine. Pethidine effects the baby4s sucking reflex and can cause breastfeeding difficulties for the first few days. ,aby4s may re&uire special care or neonatal intensive care from the effects of pethidine resulting in separation of mother and baby.

>abour begins when your uterus 5womb6 begins to contract. In the days before labour starts you may experience tightening of the uterus which causes discomfort rather than pain. >abour is said to start when you get regular contractions. ?ontractions increase in fre&uency and intensity throughout labour and can become painful in a similar way as you may experience pain in other muscles in your body when you do vigorous exercise. 7t the same time the opening into the uterus 5the cervix6 is stretching to eventually allow your baby to pass through into your birth canal. :hen the opening to the cervix is fully open 5dilated6 you begin what is known as the second stage of labour when your baby is born. $he baby passes through your birth canal and is born by a combination of the continuing contractions of your uterus and your

conscious effort to push your baby out by using the muscles of your lower abdomen. .uring your pregnancy changes happen in your body to prepare for these events. $he ligaments of your pelvis loosen to permit your pelvis to relax and allow your baby to come out. "ther changes occur to adapt your body to accommodate childbirth. 0nfortunately despite these changes it is likely you will feel pain. /irst labours are probably more painful than subse&uent ones. ;ometimes when it is necessary to start off labour or stimulate it if progress is slow your labour may be more painful. @very person(s appreciation of pain is different and what one person can accept another may find extremely painful. Coping in Labour Aou can do a lot to help. Preparing for childbirth during your pregnancy can improve these natural changes. 7t parentcraft classes you will be advised on exercises to make you fitter. Belaxation and breathing exercises to help you manage your labour pains. ;ometimes this is all that you may need. ?are with your diet and stopping smoking are other ways you can help yourself by improving your fitness and training your body for the task that lies ahead. 2entle exercise breathing posture and relaxation techni&ues help in early labour. 7 warm bath may also help. $ranscutaneous @lectrical +erve ;timulation 5$@+;6 may be of help in early labour. 7 midwife will spend most time with you in labour. In their training midwives receive instruction in the methods of pain relief available. $hey are licensed to administer some forms of pain relief and are able to advise and seek assistance to administer other methods. )idwives are involved in giving advice at ante-natal classes. Physiotherapists may also be involved and give advice on $@+;.

"bstetricians are doctors specialising in the medicine of childbirth. 7s part of this they may have knowledge and administer some forms of pain relief including some local anaesthetic techni&ues involved in childbirth. 7naesthetists are specialist doctors having knowledge and experience in providing all types of pain relief and can apply more sophisticated forms of pain relief to you in labour as well as giving anaesthetics should they be necessary. TENS

$@+; has been used for pain relief in labour and is said to be effective particularly in early labour. $reatment with $@+; consists of attaching pads to your back. 7 low voltage electric current is passed across these pads and this stimulates your body to produce it(s own natural pain relieving substances. It takes about 30 minutes before an effect is felt. $he pain relief achieved is usually assessed as moderate and is sometimes inconsistent. $here are no known ill effects from $@+;. /or some women it is of considerable value. 7s labour progresses the intensity of the electrical stimulation can be increased to cope with the increased pain of contractions but fre&uently stronger pain relief may be re&uired. $@+; machines may be hired either from the hospital or from groups such as +ational ?hildbirth $rust. GAS (ENTONOX) Pain relieving gas is often used to relieve labour pain. @ntonox is a mixture of oxygen and nitrous oxide 5laughing gas6. It is designed to provide as good a pain relief as possible without causing undue sleepiness. $he gas works &uickly but takes about 30 to '9 seconds to have an effect. $o gain maximum benefit you need to start breathing it as soon as you feel a contraction start. $his means the maximum action is being achieved at the height of the contraction. @ntonox can be used throughout both early labour and the delivery of your baby. @ntonox crosses the placenta but is not known to have any effect on your baby. $he higher concentration of oxygen may help your baby. ;ome mothers feel light-headed during use. "ccasionally nausea can be experienced as can tiredness. ;ome mothers complain of a dry mouth so you may wish to have a glass of water to sip or small ice cubes to suck. Aou may experience a tingling in your fingers. $his is due to overbreathing. Aour midwife will know when you are doing this and remind you of your breathing exercises 5sigh out slowly6 and this will automatically lead to rhythmic breathing. @ntonox only works when you breath it in so it(s effects wear off very &uickly once you stop breathing it normally within a minute. 2as mixtures will give help to relieve pain but will not remove it completely. $he best use is to cope with a short periods of pain such as the time immediately before giving birth. Pain Killing Injec ion!

$he three painkilling drugs available at the Cessop 1ospital are .iamorphine Pethidine and )epta*inol. $hey are used on your re&uest to relieve pain during labour. $hey are administered with an injection into the muscle of the thigh or buttock. $he drugs can sometimes be given into the bloodstream directly for a faster effect. $here are some devices which can be programmed to allow you to administer the drug yourself 5Patient ?ontrolled 7nalgesia-P?76. $hese are commonly used for postoperative pain but are occasionally suitable for pain relief in labour. Pressing a button releases a controlled amount of drug into the blood. .oses can be added until you are comfortable. $hese drugs are available to all expectant mothers on re&uest but individual circumstances are taken into account. $he dose given broadly depends upon body weight. Aou may have more than one dose during labour. )onitoring of the baby(s heart rate is done at the midwives discretion 5if there are no other reasons to monitor it6. ;ide effects of these drugs are drowsiness nausea and vomiting. $hey can slow your breathing down if you have too much. If given close to the birth of your baby they can slow down the baby(s breathing and make him or her sleepy. $hese drugs can be of great benefit to you when used within the safe guidelines. In terms of timingD Dia"orp#ineD in early labour because it has a longer length of action. Pe #i$ineD in both early labour and a little later on as it(s action is shorter and less likely to affect the baby. %ep a&inolD up to late in the first stage of labour because of it(s minimal effects on the baby. Powerful painkilling drugs give good relief of pain. $he effect of each injection is around two to three hours. If given often in big doses or too close to the delivery of the baby they can make you and your baby sleepy and may delay successful breastfeeding. Epi$ural Analge!ia

$he nerves from the uterus 5womb6 and birth canal go to the brain through part of your lower back 5see the diagram6. It is possible to bathe these nerves with local anaesthetic using an injection. 7 fine tube is placed in the region of the nerves so that painkiller can be injected. $his can be repeated or (topped up( when needed during your

labour. Positioning of this tube is done by an anaesthetist. "nce the tube is in position you will be almost unaware of it(s presence. /or the second stage of labour the (top up( is usually injected with you sitting up. $his stops the pain from the lower nerves. $his top up will also allow a doctor or midwife to deliver your baby painlessly if assistance is re&uired. 7ny stitching can be done while the epidural is still working. 7n epidural will leave you pain free but you may still have some sensation of pressure particularly as your baby is born. A S an$ar$ Epi$ural $his techni&ue uses a strong local anaesthetic solution. Aou may find your legs may feel &uite heavy with this techni&ue. A %obile Epi$ural 7 fine needle is placed in the region of the nerves and a single injection of painkiller is made. $he fine tube is then placed in the same region so that (top ups( can be injected. $he (top ups( are a combination of two types of painkiller. $he local anaesthetic is weaker than a standard epidural and it is less likely that your legs will feel heavy. 2ood pain relief is achieved by the use of a second pain killer in the mixture used for (top-ups(. '#en( $his type of analgesia can be started at any time during labour. /or the greatest benefit it needs to be done early enough to be useful. $he normal dosage of the painkillers used will not make the baby sleepy or slow to breathe at birth as some of the other strong pain relief injections used in labour may do. '#ic#( ?ertain factors play a part in the anaesthetist(s decision process. $he pain relief used before asking for an epidural is important. )obile epidurals cannot be given within 3 hours of .iamorphine or Pethidine injections. If you have a preference please feel free to discuss it with the anaesthetist or midwife. A$)an age! * Di!a$)an age! o+ Epi$ural!

7n epidural gives much more complete relief from discomfort in labour than any current alternative.

+ormally epidural analgesia is straightforward and very effective with little risk of harmful effects. @pidurals may cause low blood pressure and a drip is routinely set up before they are commenced. $hese methods may not always work in a satisfactory way. In this case it may be possible to switch from the mobile epidural dose to a standard epidural but it may be necessary to reposition the epidural.

,ecen re!earc# #a! $e"on! ra e$ #a -ou are no "ore li.el- o ge bac.ac#e a+ er #a)ing an epi$ural +or labour #an i+ -ou #a)e -our bab- /i #ou an epi$ural0 !ery rarely a slow leak of spinal fluid can occur afterwards and may cause a headache meaning you have to lie flat for a day or so until the leak seals itself. !ery occasionally a second injection has to be used to seal the leak. .espite the few disadvantages most women find that an epidural makes their labour much more enjoyable. E"ergenc- Cae!arean Sec ion It may sometimes be possible 5depending upon assessment at the time6 for a working epidural to be used for emergency ?aesarean section. 1owever a general anaesthetic may be necessary. A!!i! e$ Deli)er- 1 2orcep! or 3en ou!e 7 functioning epidural can be used to make an assisted delivery a pain free experience should it be necessary. Ob aining #e Pain ,elie+ 4ou 'an 7dvice on the various techni&ues with their pros and cons can be obtained from your midwife. If you have a preference you can ask for whichever of the methods of pain relief you think will suit you best. If you have any health problems please mention this to your midwife or doctor early in your pregnancy. "ccasionally there may be medical reasons why one of the methods is not suitable for you. If this is the case the reason and the alternatives that are available will be explained to you. If you suffer from any medical condition please mention it to antenatal

clinic staff. $hey can then decide whether it is necessary for you to be seen by an anaesthetist before you are in labour.