King's : is Diamorphine available during labour?

[Indiana]

Wondered if anyone knew whether Kings use Diamorphine during labour?

[Saila]

yes - this is readily given out on request as it's administered by midwives.

From my knowledge of pethidine - the pain relief it gives is pretty useless and only works in half of women, gas and air is much better.

epidural will give you proper pain relief if you need it but you'll be lucky if you get an epidural at Kings

If you want one, i'd ask for it at the very beginning but that probably wont work either (didn't for me as you can tell i'm still pist off about it!)

[Indiana]

Oh dear - sounds like you had a frustrating time...I wondered whether Diamorphine is now administered as first time round I hadn't heard of it (was told about gas & air, pethidine & epidural but not diamorphine).....and I am under the impression that not all hospitals 'do' diamorphine?

I would be interested to hear from anyone who has recently given birth at Kings who was offered and/or had Diamorphine and whether they had a positive experience.

Thanks!

[Saila]

oops - sorry i thought diamorphine was teh same as pethidine

i dont think they do offer that then - at least i wasn't offered that and i'd have accepted anything

[nabz]

i dont think they do give it...i was offered pethidine but only had it once and fell asleep for an hour and that was that lol. i think to have it more effective you need to be contantly using it or nearer to the birth? I was only told about epidural gas and air and pethidine

[sillywoman]

No, not yet - I think it's being 'discussed' by those who matter though.

[reren]

What is the difference between diamorphine and pethidine? Does diamorphine have a different impact?

[rachel83]

I didn't notice any effect from the pethidine. However the oral morphine that they gave me after my C-Section was good stuff!

[sillywoman]

Pethidine is a sedative that sometimes also can work as a pain reliever. Diamorhine is a painkiller. Both are narcotics which cross the placenta and affect the baby, often leading to initial breathing problems, lethargic babies and thence to problems with breastfeeding.

[Saffron]

reren Wrote:

-------------------------------------------------------

> What is the difference between diamorphine and

> pethidine? Does diamorphine have a different

> impact?

I'd have to look this up to be sure, but I believe compared to diamorphine that pethidine has a more rapid onset though also shorter duration of action. And, diamorphine is more potent than pethidine. The effects a patient would feel --"different impact"-- would also depend on what type of labour pain you were experiencing and how much of the drug you were given. Both drugs have the potential for opioid-associated side effects such as N&V.

[minder]

I wouldn't have thought King's would have made diamorphine available during labour.

Couldn't you ask your midwife (if she's based at King's)?

[Indiana]

Thanks for the responses - I will ask my midwife when I next see her but that's in a couple of months.

I know quite a few hospitals now offer Diamorphine but it seems Kings is probably not one of them. Second time round for me (after a home birth ending up at Kings last time) so starting to update myself on all the options. From what I read diamorphine acts/works differently than Pethidine (which I did not have last time).

The only reason I knew about it was seeing that midwife give birth on One Born Every Minute (!) and she asked for it during her labour and it seemed to really help her deal with the pain but still be able to push/progress.

[Saffron]

Pethidine and diamorphine are both classified as narcaotic analgesics. "Narcoticc" means "yielding somnolence" (sleepiness), while "analgesic" means relieving pain. Both can yield sedation, and both are painkillers, as are all opioid analgesics. Pethidine is a synthetic opioid analogue, while diamorphine is a semisynthtic opium derivative. Pethidine may have more drug-interactions than diamorphine. Before receiving either, medical staff should always be informed about what other medication a patient is receiving.

If pain is inhibiting labour and epidural anaesthesia is contraindicated for whatever reason, then a narcotic analgesic may be recommended. Narcotic analgesics are much more potent pain-relievers than NSAIDs like ibuprofen, and do not carry the associated risk of bleeding.

It's definitely something you need to discuss in depth with your midwife/consultant if you think there is a valid medical reason that this type of painrelief would be beneficial to you.

[Saffron]

http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.1995.tb13596.x/abstract

The aim of this quasi-experimental study was to examine the effects of maternal pethidine during labour on the developing breast feeding behaviour in infants in the first 2 h after birth compared with infants not exposed to pethidine. Forty-four healthy infants were observed immediately after birth. They were placed skin-to-skin on their mothers' chests. The development of mouth and sucking movements as well as rooting behaviour and state of sleep/wakefulness were noted. The observer was blind as to the pain relief the mother had received during labour. Of the 44 mothers 18 had received pethidine. The main findings were that infants exposed to pethidine had delayed and depressed sucking and rooting behaviour. In addition, a smaller proportion of infants exposed to pethidine started to suckle the breast. Rooting movements which are expected to be vigorous at 30 min after birth were affected both by administration of pethidine and a longer second stage of labour. It is suggested that the differences found in sucking behaviour may be a central effect of pethidine. Depression of rooting movements in the pethidine group may be caused by exhaustion due to a longer second stage of labour and administration of pethidine. It is recommended that pethidine-exposed mother-infant couples stay together after birth long enough to enable the infant to make the choice to attach or not to attach to the nipple without the forceful helping hand of the health staff.

So the authors here appeared to conclude that pethidine-treated mothers should be given plenty of time post-birth to establish breastfeeding w/o staff excessively interfering. Amen to that.

The">http://www.biomedcentral.com/content/pdf/1746-4358-1-25.pdf

The interesting and important paper by Torvaldsen and colleagues provides further circumstantialevidence of a positive association between intrapartum analgesia and feeding infant formula. Not allresearch supports this association. Before 'failure to breastfeed' can be adjudged an adverse effectof intrapartum analgesia, the research evidence needs to be considered in detail. Examination ofthe existing evidence against the Bradford-Hill criteria indicates that the evidence is not yetconclusive. However, the difficulties of obtaining funding and undertaking large trials to exploreputative adverse drug reactions in pregnant women may mean that we shall never have conclusiveevidence of harm. Therefore, reports of large cohort studies with regression models, as in thepaper published today, assume a greater importance than in other areas of investigation.Meanwhile, women and their clinicians may feel that sufficient evidence has accumulated to justifyoffering extra support to establish breastfeeding if women have received high doses of analgesicsin labour

This paper also suggested that analgesic-treated mothers may need more breastfeeding support, though extensive analgesia during labour does not mean that breastfeeding won't be possible.

[Indiana]

Thanks Saffron - interesting reading - I will discuss with my midwife and my consultant.

Luckily she was a good breastfeeder from the start last time, it was me who medically suffered for 6 months afterwards (including two operations) following epidural/episiotomy/forceps delivery.

Am therefore looking at alternatives to epidural in case I have a similar labour. I recognise the possible effects of pethidine/diamorphine but I guess in my case these need to be balanced with trying to prevent the same medical problems I had last time. It's good to know though that if I have this kind of assistance I should not presume breastfeeding will be as 'easy' as last time and I may need support whilst in hospital.

Oh the joy!

[sandy_rose]

I think the risk of affecting the baby is to do with how close to the actual birth it's administered. They won't give you pethidine if they think you're less than a certain number of hours away from giving birth. I had it administered at home by my midwife and can't say it made any difference whatsoever. Baby born some 21 hours later latched on straight away, and had an apgar score of 10.

I found the birthing pool and gas and air much more helpful than pethidine.

[MrsAk]

One of the only things on my birth notes was 'no pethadine' However about 20 hours in I had some, it really helped me to calm down and get a bit of rest in what turned out to be a 52 hour labour. I suppose you've got to see how you feel at the time but for me it helped!

[sillywoman]

Yes, that's right sandy-rose, although it can be very unpredictable. Because Pethidine is a sedative, it often relaxes womens' bodies/muscles, & if their bodies are relaxed then often the labour will progress much quicker than expected. So, for example, you might have Pethidine at 2cms dilated (after having been there for a long time & being quite exhausted)and 2 hours later you find you are 10cms and pushing baby out! Kings have got much better in recent years at only offering Pethidine early on in labour though.

For you - by 21 hours later any pethidine would have been out of yours & your baby's system, hence the high apgar.