Opioids

Welcome to our section about opioids. We will discuss what opioids are, when you can get one, and the side effects. We will also talk about common concerns.

What are Opioids?

Opioids are medicines used to manage pain. They can be injected into a muscle or through an intravenous catheter. Opioids reduce the feeling of contractions.

Definitions

Opioids: A type of medicine for pain Intravenous Catheter (IV): A small plastic tube placed inside your vein. Medicine is given in the tube.

When can I get Opioids?

1. Early Labor Pain: Opioids may be given in the early stages of labor. This can help if labor is expected to take a long time. They can help you relax and rest

2. Pain Relief Between Contractions: Opioids reduce pain during contractions. This can give the mother a moment of relief. This can help the mother rest and save energy.

3. Ineffective Epidural: If an epidural does not take away enough of the pain.

4. When you can't get an Epidural: There are times when you cannot get an epidural. This can be because of an allergy or other conditions. Opioids may be the only option your doctor can give you for pain relief.

Benefits of Opioids

1. Pain Relief: Opioids can work really well in treating pain and discomfort.

2. Works Fast: Opioids work fast because of how they are given. Relief comes in a few minutes.

3. Flexible: You can choose how much medicine to get. Your doctor and nurse will work with you to make sure you are safe.

4. Less Anxiety: Opioids can help reduce anxiety during labor. This can also help with pain.

Side Effects & Complications

Common side effects include:

Itching
Nausea/Vomiting
Drowsiness
Trouble focusing

Your nurse can give you medicine for nausea and itching.

Overdose is rare, but it can happen. Signs of overdose include:

Trouble breathing
Coma

Opioids and Your Baby

Opioids can affect the baby's breathing and heartbeat for a short time. Opioids can also make your baby sleepy and make it hard to breastfeed. Doctors may not recommend opioids if you are close to delivering and other pain management options are available. If you receive opioids close to when baby is delivered and there is a concern of opioids affecting your baby at birth, the neonatal intensive care team will be ready to care for your baby until the opioids wear off.

Definitions

Neonatal Intensive Care Team: Providers that are trained to care for newborn babies.

FAQs

1. Are opioids safe for everyone?

Opioids are usually safe during labor. Your doctor will check if opioids are safe for you.

2. Can I still have an epidural if I have had opioids for pain relief?

Yes, you can. Our goal is to make sure you're comfortable. Let your doctor know as soon as you can. There are times when you cannot get an epidural. These times include allergy or if the epidural is unsafe for you. Please see our epidural section for more info.

3. Is there a difference between Pharmaceutical Fentanyl and Street Fentanyl?

Pharmaceutical fentanyl is a medication prescribed by doctors to treat severe pain. However, most cases of fentanyl-related overdose are linked to illegally made fentanyl (street fentanyl), because they are often added to other drugs to make them cheaper, more potent, more addictive, and more dangerous.

4. Is there a risk of addiction when opioids are used during labor?

Opioids are given for pain under close watch by your doctor. Addiction can be a concern but it is rare. Opioids are given to you for only a short time. Addiction usually occurs with long-term, unsupervised use.

5. Can I reduce the risk of addiction to opioids during labor?

To reduce risk, healthcare providers monitor your medicine carefully. They will use the smallest dose possible to give you relief. They will stop your opioids when it is safe.

6. Can I ask for other pain relief options if I'm concerned about addiction?

Yes, you can discuss other pain relief options with your healthcare provider.

7. Will my provider know if I am at high risk for opioid addiction?

Providers look at a patient's health history when deciding on pain relief options. Open communication with your healthcare team helps give you the safest care.

Where Did We Get This Information?

References

Barash, P. G., Cahalan, M. K., Cullen, B. F., Stock, M. C., Stoelting, R. K., Ortega, R., Sharar, S. R., & Holt, N. F. (2017). Clinical Anesthesia (8th ed.). Elsevier

Centers for Disease Control and Prevention. (2023, September 6). Fentanyl facts. Centers for Disease Control and Prevention. https://www.cdc.gov/stopoverdose/fentanyl/index.html#:~:text=Pharmaceutical%20fentanyl%20is%20prescribed%20by,for%20its%20heroin%2Dlike%20effect.

Dekker, R. (2018, February 28). Pain management series: Effects of IV opioids during labor [Video]. YouTube. https://www.youtube.com/watch?v=K8Rl1oCOX3I&t=146s

Grant, G. J., Hepner, D. L., & Barss, V. A. (2011). Pharmacologic management of pain during labor and delivery. UpToDate.

Nanji, J. A., & Carvalho, B. (2020). Pain management during labor and vaginal birth. Best Practice & Research Clinical Obstetrics & Gynaecology, 67, 100-112.

Pino, R. M. (2021). Clinical Anesthesia Procedures of the Massachusetts General Hospital (10th ed.). Wolters Kluwer Health. https://wolterskluwer.vitalsource.com/books/9781975154431

Satin, A. J. (2022). Labor: Diagnosis and management of the latent phase. UpToDate. May, 10.

Seligman, N. S., Rosenthal, E., Berghella, V., Saxon, A. J., & Friedman, M. (2019). Overview of the management of opioid use disorder during pregnancy.