Women in labour should be offered an alternative to an epidural spinal block injection, say new draft guidelines for the NHS, which recommend an option of a fast-acting drug that women can control themselves.
The National Institute for Health and Care Excellence (NICE) says remifentanil, which is a fast-acting morphine-like drug given intravenously, can be controlled by the patients, who merely press a button to get more of the drug for pain relief.
A timer ensures the user cannot administer too much of it, reports BBC News.
Women who decide to try remifentanil and do not like it could still decide to have an epidural instead if there is no medical reason why they should not.
They can use gas and air, also called Entonox, which is a mix of oxygen and nitrous oxide, at the same time.
Some hospitals in England recently paused the use of gas and air over concerns for maternity ward staff after finding high residual levels of nitrous oxide in delivery suites.
NICE says having remifentanil as a treatment option has advantages: it might enable women to be more mobile than with an epidural, which makes the legs numb and weak, for example.
Evidence suggests fewer epidurals might mean fewer births using instruments like forceps and ventouse vacuum suction, says NICE.
How does remifentanil work?
It is a strong painkiller that provides quick, short pain relief, acting within 20-30 seconds and wearing off in minutes.
Women in hospital can use it to manage painful labour contractions.
It does cross the placenta, meaning the baby will get a bit of the drug too, but it wears off speedily and its use in large numbers of women suggests this is safe, say experts.
Some women can experience side effects, including feeling temporarily sleepy, sick or dizzy.
The guidelines do not recommend aromatherapy, yoga or acupressure for pain relief but say that if a woman wants to use any of these techniques her choice should be supported.
Similarly, TENS (transcutaneous electrical nerves stimulation) machines are not usually provided by the NHS because there is “very little evidence” of effectiveness, but women can use their own if they want to, as there is “no evidence of harm”.
NHS draft-guideline
BBC News article – Alternative to epidural recommended for women in labour (Open access)
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