I worked as in the OB department of our local hospital up until a year
ago doing L&D, postpartum, etc. Demoral, Nubain, and Stadol were
frequently used.  We also have a tub and I encouraged moms to utilize it
at every opportunity.  This year I worked for several months in a
clinical site in Oregon, completing my nurse-midwifery training, and was
actually surprised at how frequently my preceptor utilized pain meds.
Intrathecal narcotics have become much more popular there and here. I
never saw anyone with an epidural there and epidurals have never caught
on much at the local hospital, but are used in as many as 80% of moms in
some city hospitals in the Puget Sound.

In my opinion, non-pharmacologic methods of pain relief and provision of
labor support are often more immediately effective than meds and of
course, don't have the potentially negative side-effects.  With these
tools, it can be possible for the mom to need less medication if she
needs any at all.  I also think that it is reasonable to be concerned
about the side effects of certain meds. For instance, Demoral
(meperidine) has a metabolite, normeperidine, that has a fairly long
half-life, and it is my understanding, that the normeperidine can stay in
the baby's system for more than a week and cause difficulties with
sucking, infant irritability, etc.  In addition, in my experience with
non-labor patients who are in severe pain, demoral is often not the most
effective pain reliever.  I don't know if Stadol or Nubain have the same
problem with long-lived metabolites that affect the newborn, though I
know that some practitioners prefer them because they have a ceiling for
respiratory depression in babies with repeated doses. Intrathecal
narcotics seems to be vvery effective in relieving pain but have
drawbacks -- respiratory depression in the mom is one risk. Itching and
urinary retention and prolonged second stage are other not uncommon side
effects. Additionally, protocols for use vary, and though the mom can get
up and walk, and should be able to use a tub, or whatever,
theorectically, she may also be hampered by continual monitoring, pulse
oximetry, etc.  And sometimes, a mom really only needs a small dose of
something to help her relax (and make her feel more in control).

Interestingly, there was an article in the Journal of  Nurse-Midwifery
this past year that looked at medication administration and time to first
effective suckling. The medication most in use was Stadol, I believe, and
there seemed to be a longer interval between effective suckling when the
medication was admistered earlier in labor as opposed to the last few
hours.

One of the things on my wish list is that women would be always well
supported in labor and that practitioners would discuss both the known
and unknown effects of meds in labor and on the newborn beforehand.
Unfortunately, too many people seem to assume that if the baby doesn't
come out depressed, then the med must not have any adverse effect on mom
or baby.

Well, off my soapbox for the moment..... Happy New Year to all.

Ione Sims