In new draft guidelines for the NHS, NICE is recommending remifentanil be offered to women in labour for pain relief as an alternative to an epidural, and says that the advantages include more mobility during labour and might lead to fewer births using instruments like forceps and ventouse.
NICE (National Institute for Clinical Excellence) is a public body that provide national guidance and advice to improve health and social care.
Is remifentanil an alternative to an epidural?
There is a range of pain relief options available in labour, but an epidural is a popular choice as it is usually very effective and can last several hours. It does have side effects and as it involves a spinal injection it is a significant procedure that can take time to set up, but it is generally thought to be safe.
One of the downsides to an epidural is that it causes numbness in the lower body so that women cannot walk around during labour and are often confined to the bed. Also, the inability to feel the sensations of labour can hinder a woman in delivering her baby herself, and some suggest that it increases the prospect of needing instruments such as forceps or a ventouse.
Although entirely safe when used correctly, forceps and ventouse instruments can cause injuries to the newborn baby and also to the mother. Unfortunately, in assisting those bringing medical negligence claims arising from childbirth, we in the clinical negligence team at Tozers see these all too frequently.
How does remifentanil work?
The new draft guidelines for “Intrapartum care for healthy women and babies” recommend that remifentanil which is a fast acting morphine-like drug, now be offered to women in labour. This is administered into a vein and can be controlled by the women herself, with a timer which prevents overuse. It is reported to be a strong pain killer that provides quick, short pain relief within 20 – 30 seconds and wears off in minutes.
Like all medication, it can have side effects, but experts suggest that remifentanil is safe and effective. It is however not available in all maternity units at present.
Time will tell if remifentanil will deliver what is promised, and there is certainly some debate on this by obstetric and midwifery commentators. However more options for pain relief so that women in labour can choose what is right for them and their baby is welcomed.
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