For many pregnant women, their biggest concern about labour is how they will cope with the pain.
Many women hope for a natural labour, using techniques such as breathing, water and relaxation to help them achieve a drug free birth.
Even so, most women want to know what medical pain relief options are available if the need arises or a medical emergency occurs.
Medical pain relief for labour hasn’t changed a great deal in the last 50 years. Most pain relief medications used in labour are derived from opioids, administered as either an injection into the muscle, through an IV or as an epidural. These medications are given to the labouring mother and require monitoring in case she and her baby experience side effects.
Nasal Spray Pain Relief For Labour?
New research from the University of South Australia shows pain relief may soon be provided to women in labour via a nasal spray. Researchers have found the anaesthetic drug fentanyl, delivered via nasal spray, can provide effective labour pain relief.
The research team, led by Dr. Julie Fleet, found fentanyl nose spray to be as effective as pethidine injections. Pethidine, a commonly used drug which crosses the placental barrier, works by mimicking the effects of endorphins – our own bodies’ natural morphine-like painkiller. The side effects of pethidine are often nausea, vomiting and drowsiness in mothers.
Babies can also be affected by the action of pethidine for several days after birth. Common problems seen in babies are respiratory distress, which requires medication and a stay in a neonatal intensive care unit. The drug also affects babies’ suckling reflex, which can have serious effects on breastfeeding in the early weeks.
Fentanyl in the past has commonly been used for providing pain relief to children and in emergency departments. The study of 156 women who were given fentanyl during labour showed the drug was as effective as pethidine for pain relief. Over 80% of the women in the study who had fentanyl said they would use it again, compared to 44% who had pethidine.
So what are the pros and cons of using a nasal spray compared to more convention pain relief methods?
Benefits of Fentanyl Nasal Spray
- It’s not processed in the body in the same way as pethidine and has less chance of causing problems for the baby
- The drug is excreted from the mother and baby’s body much faster than other drugs, limiting the severity of side effects
- It doesn’t interfere with a woman’s ability to move or block sensation, unlike an epidural
- The mother is able to move and is aware of her baby and body working
- The drug starts working very quickly
- No need for invasive procedures such as cannulas inserted or injections
Disadvantages of Fentanyl Nasal Spray
- The effect is short lived, lasting around 45 minutes
- While it’s excreted quickly, ongoing use over many hours increases the chance of opioid related side effects such as nausea, vomiting and drowsiness
- If used within 45 minutes of birth, the baby is more likely to experience respiratory depression, requiring medication, NICU stay and possibly interfering with the early stages of breastfeeding
- Can cause dizziness and confusion
- Some women may not experience the sort of pain relief they expect, as the effects are very individual
- Acts like other opioid pain relief by blocking the pain receptors in the brain, and the effects vary from woman to woman
- Cannot be used if the woman has an allergy to opioid drugs
- It’s FDA pregnancy category C. It’s not unknown if fentanyl will harm an unborn baby
Is This The Breakthrough Women Have Been Waiting For?
Dr. Fleet has been granted funding to extend her research into fentanyl, looking at whether the nasal spray can reduce the need for epidurals. While less invasive pain relief methods would be welcome, the reality is any medication does not address the underlying issues that led to the request for pain relief.
In high-income countries, current levels of induction are well over 25%. Most cases of induction are for non-medical reasons like post dates, suspected big baby or maternal/care provider convenience. Induction often leads to requests for pain relief, due to the increased level of pain from the artificial, intense contractions.
Providing More Support And Education May Be The Better Option
Women who have continuous support from a known midwife are less likely to request for pain medication and epidurals, yet many women are unable to access one to one support.
Many women receive very basic birth education through the hospital they are attending and may not be fully informed about the natural birth process. They may be unaware of alternative, natural coping strategies and the benefits of being undisturbed during labour. They may not know they have the right to refuse procedures that can lead to interventions that may increase their need for pain medication.
Fentanyl has a short-lived action and does not always provide adequate pain relief. The expectation of successful pain relief can mean disappointment and a sense of failure if the method doesn’t provide enough relief. And while many women would welcome alternatives to less invasive pain relief methods, more research is needed on the effects of fentanyl on babies.
Melbourne midwife Kate says, “While it is great that we are developing more options for women that MAY delay or prevent an escalation to further pain relief such as an epidural, (which we know increases risks to both mother and baby) providing more robust childbirth education and funding models of care that research already supports reduces epidural and c-section rates is probably a better way to achieve the same outcome.”
The choice to have pain relief medication during labour is one often based on the expectation that pain will be too hard to cope with. Being well informed about the birth process, provided with continuity of care from a doula or known midwife, and given every opportunity to labour undisturbed, can allow women to experience a positive and empowering birth without need for medication.