Qualitative exploration of women’s experiences of intramuscular pethidine or remifentanil patient-controlled analgesia for labour pain

Abstract

ObjectivesTo explore women’s experiences of remifentanil or pethidine for labour pain and infant feeding behaviours at 6weeks post partum.DesignQualitative postnatal sub-study to the randomised controlled trial of remifentanil intravenous patient controlled analgesia (PCA) versus intramuscular pethidine for pain relief in labour (RESPITE). Semistructured telephone interviews were conducted at 6 weeks post partum, and thematic analysis was undertaken.SettingWomen recruited to the RESPITE trial from seven UK hospitals.ParticipantsEighty women consented and 49 (30 remifentanil group and 19 pethidine group) completed the interview.ResultsEight themes emerged which encompassed women’s antenatal plans for pain management (Birth Expectations) through to their future preferences for pain relief (Reflections for Future Choices). Many women who used remifentanil felt it provided effective pain relief (Effectiveness of Pain Relief), whereas women in the pethidine group expressed more mixed views. Both groups described side effects, with women using pethidine frequently reporting nausea (Negative Physiological Responses) and women using remifentanil describing more cognitive effects (Cognitive Effects). Some women who used remifentanil reported restricted movements due to technical aspects of drug administration and fear of analgesia running out (Issues with Drug Administration). Women described how remifentanil enabled them to maintain their ability to stay focused during the birth (Enabling a Sense of Control). There was little difference in reported breastfeeding initiation and continuation between pethidine and remifentanil groups (Impact on Infant Behaviour and Breastfeeding).ConclusionsQualitative insights from a follow-up study to a trial which explored experiences of intravenous remifentanil PCA with intramuscular pethidine injection found that remifentanil appeared to provide effective pain relief while allowing women to remain alert and focused during labour, although as with pethidine, some side effects were noted. Overall, there was little difference in reported breastfeeding initiation and duration between the two groups.Trial registration numberISRCTN29654603.

Systematic review and meta-analysis to examine intrapartum interventions, and maternal and neonatal outcomes following immersion in water during labour and waterbirth

“…Our results show that water immersion has the potential to make a meaningful contribution to the global agenda towards promoting physiological birth 75–79. Labouring and/or giving birth in water can reduce maternal pain with no increased risk of an adverse event, and without the risk introduced by epidural and opioids 80–83. Differences between birth settings in intact perineum and PPH suggest water immersion in an obstetric setting may result in outcomes similar to those achieved in midwifery-led settings.…”

“…[76][77][78][79][80] Labouring and/or giving birth in water can reduce maternal pain with no increased risk of an adverse event, and without the risk introduced by epidural and opioids. [81][82][83][84] Differences between birth settings in intact perineum and PPH Open access suggest water immersion in an obstetric setting may result in outcomes similar to those achieved in midwifery-led settings. This interpretation is supported by the results of subgroup analysis of studies in an obstetric setting that episiotomy is reduced with water immersion, and maternal satisfaction is increased.…”

Causes of perception of insufficient milk supply in Western Australian mothers

“…In addition, although nitrous oxide has been shown to have no effect on full breastfeeding (Torvaldsen, Roberts, Simpson, Thompson, & Ellwood, 2006), pethidine administration during labour can affect the delay of the infant's first breastfeed after birth and their sucking technique (Righard & Alada, 1990). Another study found no difference between pethidine and remifentanil anaesthesia in breastfeeding within an hour of birth, but a significant decrease in the rate of any breastfeeding at 6 weeks after birth among the mothers who received pethidine (Moran et al, 2019).…”

Update on Non-neuraxial Labor Analgesia

“…Most studies have not reported duration of remifentanil administration [ 18 ]. The maternal labor experience was reported using surveys and postpartum telephone interviews on women from the RESPITE study; 30 received remifentanil IV-PCA and 19 IM meperidine [ 1 ]. Some women who received remifentanil IV-PCA reported effective pain relief and ability to remain alert and focused during labor, while some reported restricted movements and a fear that the remifentanil infusion would run out.…”

“…The ability to choose efficacious analgesia options is an essential contribution to the labor experience. Prior to labor, women may seek information regarding labor analgesia options and may not necessarily have a fixed decision regarding the analgesia they prefer [1][2][3]. Many factors may impact the decision regarding labor analgesia, including concurrent comorbidities such as high body mass index, cardiac disease, obstetric history such as prior cesarean delivery, preeclampsia, and available monitoring options.…”