Coping with pain in labour

Pethidine and other drugs for pain relief during labour and birth

5 min read

Pain-relieving drugs such as pethidine can help you to relax during labour and focus on having your baby. Find out about pethidine, the side effects and what alternatives are available.

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What is pethidine?

Pethidine is a drug similar to morphine, and is given by injection. It’s a common form of pain relief used to help women cope with pain during labour.

Why might I want to use pethidine?

If you’re tense or feeling a lot of pain in early labour, pethidine can help you relax and allow you to rest. As a result, your labour might speed up, or you may become sleepy and less bothered by the pain of contractions, so the time passes more quickly. Pethidine can even make some women feel a bit ‘high’, helping them to cope.

A quarter of women who go into labour use pethidine or a similar painkiller to cope with the pain, according to a 2018 survey by the Care Quality Commission (CQC).

Are there any problems with pethidine?

Pethidine may make you feel sick, although you can have another injection to reduce the likelihood of this. After having pethidine, you may feel drowsy, disoriented or out of control. If this happens, it could reduce your ability to make decisions about your care during labour.

The effects of pethidine last for a few hours before they wear off so, if you don’t like the feeling, you’ll have to live with it for a while. Once you’ve had pethidine you’re also less likely to move around and use upright positions for labour, which could lead to your labour lasting longer.

Can pethidine affect my baby?

Your baby can be affected by pethidine, particularly if the birth happens soon after the injection was given. The effect of pethidine can last for up to 48 hours in the baby, making them drowsy, have difficulty feeding or have breathing difficulties. For this reason, it’s best not to have pethidine too close to the baby’s birth.

If a baby does have breathing problems due to the effects of pethidine, he or she can be given an injection of another drug to reverse the effects.

What are the alternatives to pethidine?

There are ways of coping with pain without using opioid drugs, such as using gas and air or Tens machines – find out more about other ways of coping with pain in labour. There are also a number of other similar drugs (called opioids) which are used instead of pethidine:

1. Diamorphine and meptid

Diamorphine is a purified version of heroin that can be safely used in the right doses under the supervision of a health professional. Diamorphine can be a more effective painkiller than pethidine, but it can also affect the baby’s breathing.

Meptid (the brand name for meptazinol) is a similar drug and is less likely to have side effects for the baby, but it can cause more nausea and vomiting than pethidine.

2. Morphine sulphate (Oramorph)

Some maternity units offer a liquid solution or tablets of morphine sulphate (also called Oramorph) for women who are having painful contractions in early labour. This can help them rest and conserve the energy that will be needed in the later stages of labour. Some women go home to rest after taking morphine sulphate rather than staying in the maternity unit, and return later when their contractions are stronger.

3. Remifentanil

Remifentanil is a strong opioid drug that can be used instead of an epidural. It is given via a drip in your hand or arm, which is connected to a pump that you control yourself.

Unlike pethidine, remifentanil starts working very quickly, and also the effects wear off quickly. Each time you have a contraction, you can press a button that will send a small dose of remifentanil into your bloodstream, helping you relax and cope better with the contraction. This needs to be repeated with each contraction.

It can be used in combination with gas and air (entonox), as it does not provide total pain relief. It also has similar side effects to other opioid drugs, such as causing drowsiness, nausea or vomiting. Some women need to take extra oxygen while using it. Remifentanil can also have an effect on the baby, but has been shown to be safe when given as small intermittent doses, as the effects wear off quickly.

Can I use pethidine wherever I give birth?

At least one of the opioid drugs (pethidine, or the similar diamorphine or meptid) will generally be available in all labour wards, although you won’t usually be able to choose which one of these you have. You can check which opioid your chosen labour ward uses by looking on our maternity unit pages found through our Birth Choice tool. Remifentanil is not used in many units.

If you’re planning to give birth in a birth centre or at home, and would like the option of using pethidine or another opioid, you should check that it will be available. If you’re having a home birth, you may need to get a prescription, as these are strong drugs subject to controls, and midwives will not carry them.

However you feel about using pethidine or similar opioid drugs, being informed about their availability and their pros and cons can help you confidently make decisions about where to have your baby, and about your pain relief options once you’re in labour.

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These are the sources of information used in this article:

Care Quality Commission, Maternity Services Survey 2018 (2018)

Redshaw M, Henderson J, Safely Delivered: a national survey of women’s experience of maternity care 2014, NPEU, University of Oxford (2015)

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