Any reason morphine during birth would be a good thing?

[lhowlett]

I just switched to a birth center (not attatched to a hospital) CNM and had my first visit yesterday. When I got there they mentioned that a mom had just come in in labor so she'd be a few minutes letting me know whether she could still see me that day or not. Anyway, she comes out and mentions to the nurse that was there (RN who happens to own the birth center as well, I didn't know an RN has to be present at every birth there though) to give her a shot of morphine and tell her to get some rest (she did rest there at the bc, they didn't send her home). And I recall this CNM saying something about this when we interviewed with her months ago, that sometimes when a mom's been in labor for a while and is tired but isn't very far along and nothing is happening, that a shot of morphine can be good so mom can get some rest.
That just rubs me wrong. While I understand something local for being stitched up, it seems wierd to use a drug like that during a natural child birth. What effects could it have on the baby?

[SublimeBirthGirl]

IME, it's never a good idea. It reaches the baby in large quantities, may increase their risk of drug dependency as adults, and definitely increases the risk of breathing problems. It doesn't take the pain away, but rather makes you "high" so you care less. It may make you loopy, confused, out of it. It may cause nausea or vomiting. IMO, narcotics during labor are lose/lose.

[maxmama]

Originally Posted by lhowlett

I just switched to a birth center (not attatched to a hospital) CNM and had my first visit yesterday. When I got there they mentioned that a mom had just come in in labor so she'd be a few minutes letting me know whether she could still see me that day or not. Anyway, she comes out and mentions to the nurse that was there (RN who happens to own the birth center as well, I didn't know an RN has to be present at every birth there though) to give her a shot of morphine and tell her to get some rest (she did rest there at the bc, they didn't send her home). And I recall this CNM saying something about this when we interviewed with her months ago, that sometimes when a mom's been in labor for a while and is tired but isn't very far along and nothing is happening, that a shot of morphine can be good so mom can get some rest.
That just rubs me wrong. While I understand something local for being stitched up, it seems wierd to use a drug like that during a natural child birth. What effects could it have on the baby?

MOrphine does the same thing that it does to mom: makes him/her sleepy. This is an issue if given close to delivery. It's not when given in prodromal labor, especially with primips.

When we use morphine for prodromal labor, it's usually because mom has been contracting for days (and nights), isn't making cervical change and is exhausted. Morphine and vistaril will give usually about 4-6 hours of solid rest, and many times when mom wakes up, she's in a more effective labor pattern.

[maxmama]

Originally Posted by SublimeBirthGirl

..definitely increases the risk of breathing problems.

When given close to delivery. Important distinction here.

Narcotics are a tool. Tools can be misused. They're not inherently evil.

[lhowlett]

When we use morphine for prodromal labor, it's usually because mom has been contracting for days (and nights), isn't making cervical change and is exhausted. Morphine and vistaril will give usually about 4-6 hours of solid rest, and many times when mom wakes up, she's in a more effective labor pattern.

But doesn't it still have the same narcotic effect on the baby even if given early in labor?
Wouldn't giving mom something that would "depress" her and baby's system be something that would require constant monitoring? Because that certainly isn't something I could get away from the hospital.

I'm certainly not planning on any drugs during labor and know I can say no to anything, but it just makes me nervous that I could potentially be in that situation and I don't know how I'd respond. Of course I'd want rest, but I don't like exposing myself or my baby to drugs. I'd hate to have to make the decision of morphine's safety while in labor
hmmmmm

[dinahx]

I had Nubain in my labor and I would *much* rather have had a simple shot than by IV . . . It was more a function of the stressful hospital environment that I even needed it at all, but the first shot did help . . . I was scared of the hospital (having transferred from a HB), everyone else had been up all night, and I was on the 3rd day of labor and hadn't made too much cervical change since transferring to the hospital . . . It definitely allowed me to mellow out and progress.

Now do I think smoking a little opium would have been way better than getting an opiate by IV? Hell yes, but you know, here we are in the USA . . . I am way glad, though, that an epidural wasn't my only option. If I had gotten an epidural, I would have definitely had a section, IMO, my baby's heartrate was already a little "fragile".

The second shot that I got when the first one wore off definitely was a bad idea and definitely (along with being flooded with fluids) interfered with pushing, IMO . . .

[maxmama]

Originally Posted by lhowlett

When we use morphine for prodromal labor, it's usually because mom has been contracting for days (and nights), isn't making cervical change and is exhausted. Morphine and vistaril will give usually about 4-6 hours of solid rest, and many times when mom wakes up, she's in a more effective labor pattern.

But doesn't it still have the same narcotic effect on the baby even if given early in labor?
Wouldn't giving mom something that would "depress" her and baby's system be something that would require constant monitoring? Because that certainly isn't something I could get away from the hospital.

I'm certainly not planning on any drugs during labor and know I can say no to anything, but it just makes me nervous that I could potentially be in that situation and I don't know how I'd respond. Of course I'd want rest, but I don't like exposing myself or my baby to drugs. I'd hate to have to make the decision of morphine's safety while in labor
hmmmmm

We give mom morphine and send them home. It's not permanent. It goes away, albeit more slowly in a fetus than in mom. We don't monitor them or anything. It's IM morphine, not general anesthesia.

[maxmama]

Originally Posted by dinahx

I had Nubain in my labor and I would *much* rather have had a simple shot than by IV . . . It was more a function of the stressful hospital environment that I even needed it at all, but the first shot did help . . . I was scared of the hospital (having transferred from a HB), everyone else had been up all night, and I was on the 3rd day of labor and hadn't made too much cervical change since transferring to the hospital . . . It definitely allowed me to mellow out and progress.

Now do I think smoking a little opium would have been way better than getting an opiate by IV? Hell yes, but you know, here we are in the USA . . . I am way glad, though, that an epidural wasn't my only option. If I had gotten an epidural, I would have definitely had a section, IMO, my baby's heartrate was already a little "fragile".

The second shot that I got when the first one wore off definitely was a bad idea and definitely (along with being flooded with fluids) interfered with pushing, IMO . . .

Morphine in prodromal labor is usually given IM, because it lasts much longer.

[lhowlett]

Originally Posted by maxmama

We give mom morphine and send them home. It's not permanent. It goes away, albeit more slowly in a fetus than in mom. We don't monitor them or anything. It's IM morphine, not general anesthesia.

Neither is an epidural but constant monitoring is advised for that as well as other narcotics in labor, right? I'm totally not trying to argue, just understand.

[maxmama]

Originally Posted by lhowlett

Neither is an epidural but constant monitoring is advised for that.

Epidurals drop mom's blood pressure precipitously because it removes your body's ability to respond appropriately to pressure changes. It's regional anesthesia. IM morphine is a narcotic, which does not significantly affect your body's ability to maintain homeostasis. In the doses given, it doesn't even create respiratory suppression. Apples and oranges.

[SublimeBirthGirl]

Originally Posted by maxmama

When given close to delivery. Important distinction here.

Narcotics are a tool. Tools can be misused. They're not inherently evil.

Took me 24 hours to get to 4 cm, then less than an hour to complete with an urge to push. There is no way to know how close a woman is to birth.

A student of a friend of mine went to the hospital in active labor, not even 1 cm, sent home. It was a long drive home so they went to a hotel near the hospital. Less than an hour from the time they were sent home with really no dilation at all, the baby was born quickly in the hotel room.

Unless you're psychic, you don't know when a baby is coming.

[SublimeBirthGirl]

Oh, and a little wine worked great for prodromal labor for me, with fewer risks than powerful drugs.

[blissful_maia]

I think that if a mom has been in prodromal or early labour for days, it can be a useful tool. For example, if mom has been up all night with annoying ctx but not really progressing or hydrating herself, a little Nubain etc. may help her relax enough to drink some tea with honey, have a little rest. I'd rather that than have a mom get to a point where she feels she needs to have to have an epidural, and ends up with the subsequent Pitocina, huge epis. and possibly an operative delivery. That having been said, it's super crucial that it not be given anywhere near delivery, and that is often difficult to discern.

[maxmama]

Originally Posted by SublimeBirthGirl

Took me 24 hours to get to 4 cm, then less than an hour to complete with an urge to push. There is no way to know how close a woman is to birth.

A student of a friend of mine went to the hospital in active labor, not even 1 cm, sent home. It was a long drive home so they went to a hotel near the hospital. Less than an hour from the time they were sent home with really no dilation at all, the baby was born quickly in the hotel room.

Unless you're psychic, you don't know when a baby is coming.

True, but I can count the number of times I've had to use naloxone on a depressed newborn on the thumb of one hand. And that baby was born to a mom on methadone maintenance.

Morphine just isn't that risky.

[maxmama]

Originally Posted by blissful_maia

I think that if a mom has been in prodromal or early labour for days, it can be a useful tool. For example, if mom has been up all night with annoying ctx but not really progressing or hydrating herself, a little Nubain etc. may help her relax enough to drink some tea with honey, have a little rest. I'd rather that than have a mom get to a point where she feels she needs to have to have an epidural, and ends up with the subsequent Pitocina, huge epis. and possibly an operative delivery. That having been said, it's super crucial that it not be given anywhere near delivery, and that is often difficult to discern.

I don't find it super crucial, and it's rarely an issue in terms of timing. If a baby is born depressed, that's what naloxone is for.

[blissful_maia]

Originally Posted by maxmama

I don't find it super crucial, and it's rarely an issue in terms of timing. If a baby is born depressed, that's what naloxone is for.

If the caregiver is skilled and careful, you're right... it is usually a non-issue. But I have seen it used irresponsibly too many times in the hospitals. Also, even if respiratory depression is fixed with naloxone, there is still narcotics in the baby's blood stream that can affect willingness to nurse, etc.

I would rather not even head down that road. Maybe we're just different-minded when it comes to midwifery?

[rnchrista]

Originally Posted by SublimeBirthGirl

IME, it's never a good idea. It reaches the baby in large quantities, may increase their risk of drug dependency as adults, and definitely increases the risk of breathing problems. It doesn't take the pain away, but rather makes you "high" so you care less. It may make you loopy, confused, out of it. It may cause nausea or vomiting. IMO, narcotics during labor are lose/lose.

I just don't agree with this "it's never a good idea". Things just aren't that black and white. Every labor is different and for those women who have had days of prodromal labor, and have tried options like a glass of wine, a bath, or Benadryl, and still can't get rest, Morphine may be beneficial. The mom can get a few hours sleep, wake up, and things start progressing. If I had my choice between Morphine used as therapeutic rest or a c/s for FTP or maternal exhaustion, I'd take the Morphine.

[maxmama]

Originally Posted by blissful_maia

If the caregiver is skilled and careful, you're right... it is usually a non-issue. But I have seen it used irresponsibly too many times in the hospitals. Also, even if respiratory depression is fixed with naloxone, there is still narcotics in the baby's blood stream that can affect willingness to nurse, etc.

I would rather not even head down that road. Maybe we're just different-minded when it comes to midwifery?

I've seen a lot of labors and births. I was vehemently opposed to narcotics when I first started working L&D. But morphine works well for some women, and I haven't seen it have negative effects for mom or baby. On the contrary, it has given a mom who was completely exhausted and asking for a section a whole new ability to work with her labor.

[Malga]

Neither is an epidural but constant monitoring is advised for that as well as other narcotics in labor, right? I'm totally not trying to argue, just understand.

In the OB unit where I work the monitor has to be on if any drugs are introduced (morphine, stadol, epidural, or pitocin for example). You can definitely see an immediate effect on the babies variability after narcotics are given. I can't remember what we did at the birth center I used to work at (because that was done so infrequently) I can't remember if we monitored them or not after giving drugs.

[BetsyS]

Originally Posted by maxmama

I've seen a lot of labors and births. I was vehemently opposed to narcotics when I first started working L&D. But morphine works well for some women, and I haven't seen it have negative effects for mom or baby. On the contrary, it has given a mom who was completely exhausted and asking for a section a whole new ability to work with her labor.

This has been my experience as well. Morphine seems to do a really good job of allowing moms to rest. They either wake up feeling refreshed or in active labor.