Hi Jean, what jumps out at me is the meperidine. Not sure how soon before delivery this was given, but, if it was not immediate (meaning the baby received the maternal dose by the time it took to be delivered), that would cause numerous problems.

Dr Hale says the pediatric half life of meperidine in neonates is 13 hours. Meperidine breaks down to normeperidine, which has an extensive half life, 63 hours. He also states that infants of mothers treated with meperidine were neurobehaviorally depressed after 3 days.

In addition, the mother was suffering nicotine withdrawal - how about the baby? The combination of nicotine withdrawal as well as opiate detox, well that'd be enough to send anyone over the edge, let alone a tiny neonate with the same blood levels as the mother!

There's probably not much you can do about the nicotine - that's a mother's choice to smoke. But, the meperidine could be replaced with other less harmful medications. You mentioned loprazolam, a benzodiazepine, which is also sedative in nature. The half life if loprazolam is about 11 hours, 19 in the elderly (which could possibly take in the baby, as well). 

Are your mothers in labor up and walking, or tethered to bed? If they are up, active, involved, their need for medications could be reduced. 

Unfortunately, if your facility requires mothers to be in bed, pain is increased, and the likelihood of reducing pain meds is not good. A change in meds, away from the lengthy half-life meds, might help. Things like Morphine, Hydrocodone or Fentanyl are what Dr. Hale suggests in Med/Mother's Milk.

Otherwise, you are doing a great job of supporting the mothers after the train wreck - that's a draining position to be in!

Best wishes,
Sam Doak

---- Jean Ridler <[log in to unmask]> wrote: 
> I am looking for tips in how to deal with a very common problem where I
> work.  I will illustrate it with a case from last week - some variation of
> this is the norm!
> >>

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