World first research into pain relief drug used in childbirth

The research is world first.

Until recently, little was known about the impacts on both mother and baby of the pain relief drug fentanyl, which is commonly administered during labour.

World first research out of the University of South Australia has shown nasal or injected fentanyl is a safe option for mums and bubs.

The study is the first to assess fentanyl concentrations following subcutaneous fentanyl administration.

The study found that despite nasally administered levels of fentanyl being significantly higher than those by injection, all babies had lower levels of fentanyl in their systems than their mothers, regardless of administration method.

It looked at fentanyl levels in 30 mother-baby pairs (via maternal and cord blood samples taken with 30 minutes of birth)

All babies had 5-min Apgar scores within normal ranges; none required admission to the nursery for special care and levels of the drug were considered very low, well below those shown to depress breathing.

This is in contrast to cord concentrations of other drugs (such as pethidine and norpethidine) where other studies have shown levels have been shown to be comparable to their mothers and significantly supressed a baby’s behaviour in the first few weeks of life.

The university’s Dr Julie Fleet says it’s an important step in understanding the impacts of pain relief, and also less invasive options.

“Many women worry about managing pain during labour and the impact that their choices might have for themselves and their newborn child,” Dr Fleet said.

“For women who choose pain relief in labour, there are still very few options available – the most common are ‘gas’ (nitrous oxide and oxygen), injection of a narcotic or opioid (such as fentanyl, morphine or pethidine), or an epidural – but as with all analgesics, there are side effects.

“Negating and managing side effects is critical for both mother and baby, which means the need for choices in pain relief is all the more essential.

“Fentanyl is a popular choice for regulating pain during labour because it provides rapid pain relief while not restricting mobility and reduces incidents of adverse side effects such as nausea, vomiting or sedation.

“It can also be administered via nasal spray or small injection under the skin, enabling women more control over their pain.

“The strength of this research is that it confirms that fentanyl can be used safely for both mother and baby – regardless of whether it is administered nasally or via injection – giving strong supportive evidence of its use as an alternative pain relief option.”

In South Australia, subcutaneous administration of fentanyl is standard practice, with the nasal spray growing in popularity.

“Importantly, for women who choose pain relief in labour, fentanyl has been shown to reduce pain intensity while enabling women to work with the contractions,” she said.

“Additionally, women report it provides increased autonomy and satisfaction in birth – both important factors for ensuring a positive birthing experience.”