Pain relief in Labour

I was having a chat to an anethetist at work today and he was telling me about a trial he kicked off in Newcastle where they used a PCA (Patient Controlled Analgesia) device in labour containing a drug called remifentanyl. It sounds AWSOME. I'm wondering if anyone has heard about this; knows about it; has experienced it; overseen it (midwives)?

Also, for the mids out there, is it possible to request such a pain relief method during labour instead of gas, pethadine, epidural? I'm just researching at this stage...

I know Lyel Mcewin in Adelaide had this a while ago, not sure if they still do. I never used it just heard about it. REmifentanyl is a very short acting analgesia so you push the button whenever you have a contraction and the pain releif only lasts that long.

You may be able to request it as long as they have it at that hospital and the device. The staff would need to be trained too.

Definately ask it could be a good option

MG - I had a remifentanyl infusion (PCA) when I was induced and delivered our stillborn daughter. It was fantastic in an otherwise horrible situation. I get hypotensive with pethidine (not that it would have helped), hyperventilated with the entonox due to contractions every 2-3 minutes for most of the labour and I didn't want an epidural.

Happy to answer any questions you might have.

Thanks Michelle. How did you find it in terms of relief for the contractions in comparison to, say, gas. I had gas with DD, Peth, and an epidural and the epi was the only thing that worked... but it was very traumatic getting it in. I only know about this option because I was asking him alternatives for what I went through. I like the fact that it has such a short half life and has far less effect on the baby than pethadine, that it is a standard IV access and they don't have to go anywhere near my screwy back. I just don't know how I'd go getting it here in Melbourne... Unfortunately, he doesn't have "visiting rights" at any of the hospitals I'd be interested in birthing at. He is a HUGE advocate for VBAC though and I'd love to have him batting on my side!

Also Michelle, how long did you feel the effects for? I was told the trial locked out for 2 minutes after each press and I'd be worried that it might not cover the duration of the contraction... also, did you find you had to hit it early in your contractions to ensure maximum benefit or if you were a bit slow to hit it, it still worked?

Thanks so much.

MG

MG - I'm away for the weekend a doing this on the iPhone ;) I'll post a proper response when I get back on Sunday. It is worth it and better than the other options but it deserves a full reply.

ETA: Here are the answers to your questions!!

How did you find it in terms of relief for the contractions in comparison to, say, gas I found it to be far more effective. My contractions were every 2 minutes for many hours and exhausting. With the gas I had to start breathing at the beginning of the contraction and then wait for the effect which wasn't really much at all only to have the next contraction hit before it really worked. I ended up with carpopedal spasms from the hyperventilation and felt drunk. I couldn't talk or move but I could still feel the pain. I just couldn't tell anyone.

The remifentanyl was quickly effective - we gave loading doses until I was comfortable and then it was changed to PCA. I would press the button at the start of each contraction and it significantly reduced what I felt. It lasted for the duration and was still effective even if you missed the start. There is still some there in your body even though the half life is short.

It made the whole labour process far more *comfortable* in that I could feel some pain but it was more manageable and more like a good shot of morphine in sensation. The difference was that drugging effect wore off very quickly so I was completely alert when pushing and fully with it when Caitlyn was born so I could remember every moment and not be still in a drugged state or unable to move. It meant I could go home whenever I wanted as I didn't need to wait for any effects to wear off.

I hope this helps but ask away if you want to know more.

TBH - I found my inducted birth far more painful than my subsequent two which were both drug free labours. DS was heavenly - gentle progression of a breech labour until we needed the c-section for foetal distress at 7cm (his head was stuck) DD an intense and short posterior labour and a VBAC. I had an epidural inserted with her but she was born 15 minutes after it went in and before the test dose worked :rolleyes:

Answer done - better late than never :D

Thank you Michelle! I'm hoping I will be able to get the hospital I plan to birth my next at to give me a remifentanyl PCA. If my anethetist friend is working there, he said he's happy to organise it but I doubt he will be there! It would be nice if it was used more frequently given it's benefits.

Any news you wanted to share with an old belly buddy MG????????? :)

NETTYYYYYYYYYYYYY!!!!!!!!!!!!!!!!!!!!!!!!! :loveshower::leap::happyforyou: LOL, nope! Just researching before we decide after my awful experience bringing Abbey into the world. What about yoooooooooooooooouuuuuuuuuuuuuuuuu??????!!!!! Haha. I am so bad for not emailing. Believe it or not, its been on my "To Do" List for about 4 weeks! :redface: How are you guys?

MMMMMMMMMMMMGGGGGGGGGGGGGGGGGGGGGG!!!!!!! LOL :loveshower:
Dont worry about not emailing, I would probably take 4 weeks to reply, I am a shocker when it comes to emailing these days.

Did you end up having a ceaser with Abbey? Sorry brain is fuzz I cant remember.. it has been 2 years since we had them (holy sheet!!!) Sari is 2 on Friday!!! :birthday2:

Yep #2 is on the way!!! :hooray: :bellyrubs: 12 week scan end of next week! So glad it is going to be a winter pregnancy this time (at the end anyway). Feeling great tho lots of headaches, will ask my Dr about that on Thursday :)

Hey just go ahead and make #2, you got plenty of time to work on the best way to get it out LOL

xoxoxo :P