Nubain: A magic Pill?

Wednesday, February 10, 2021

 Nubain: A Magic Pill?

I think that a lot of times when people think about pain relief in labor, they think about unmedicated or they think about at the general use and it doesn't necessarily have to be one or the other. There's actually a spectrum of pain relief that you can choose from when it comes to your birth.

So if you need to be induced for some reason- what the reason is may also play a role in what your options are for pain relief. These are all discussions that you'll have to have with your doctor, but you really need to be having those discussions if you don't know what your options are. You need to empower yourself going into your labor. So that is why I wanted to talk about Nubain and Staidol in labor.

A lot of people, when they think about having a baby, the first thing they think about is the pain and what it is going to feel like to actually have a baby. While this is a valid thought and concern, it is not necessarily where you need to start. You need to . And it's going to be like to actually feel having a vape maybe while this is obviously a super valid thought and concern. And you know, you definitely want to, to be mindful of that. That's not enough sincerely where you need to start. You need to start with understanding normal physiological birth and the normal variations of labor.

I believe this SO strongly it's literally part of the CONTROL method that I teach in The Birth Lounge. We spend time reviewing just what does normal physiological labor look like? What are all the normal variations? How can you stay in control from start to finish? That's where I would recommend you start.

But now that we're having this conversation about pain relief a lot of people, they think there's only two options, unmedicated or epidural. THERE ARE NOT. You have more choices! So in between there, you have saline papules, you have nitrous oxide, you have injectable narcotics (where Nubain and Staidol fall).

Before I dive into the risk and the benefits, I want to tell you why I particularly love Nubain and Staidol as a resource for pain relief during labor. Also, just to clarify, Nubain is a drug and Staidol is a drug, but they are very similar drugs so we generally use them interchangeably. I find that a hospital will generally offer one, not both.

So why do I love them? Well, because I've seen both do really amazing things. I have been with clients as they labor for a long time, they decide to head into the hospital hoping to be 7-9 centimeters, and they find out they are 2-4 centimeters along. We know that if we get an epidural before that 6 centimeter mark, it has a potential to really slow down labor. So what do you do before that? This is where Nubain or Staidol can come in. This is where I love to offer it as a discussion point for you and your doctor to say, you know, 'Is this an option? Is this safe for me to use right now?'

What are the benefits? I love it so much because it's short acting. It is going to be an injectable and then within about four hours later, you're probably going to start to feel the medicine kind of wearing off. During this time, you're going to get some good sleep and rest to prepare for the rest of your labor. However, it does not stop your contraction. So this is nice. It allows you to sleep and get some rest, take a little nap, but your contractions still are working. Your body is still working.

So we get there at 2-4 centimeters. We get the Nubain or Staidol. You take a little nap, you recharge your battery. You wake up. It is possible that you are somewhere 7-10 centimeters when you wake up. You may be ready to push when you wake up, that is so ideal. You get to rest, your body still does the work. It doesn't slow down your labor. It allows your body to relax, right? This narcotic allows your muscles to relax. If there's any tension, if there's anything that's really holding up your baby, this is going to allow for your body to open up and create space for your maybe and allow your cervix to dilate.

You will have to be on electronic fetal monitors and your blood pressure will be monitored. We are injected in narcotics. So we want to make sure that we're keeping you guys safe. Also, with these narcotics we can't really administer it past 6-7 centimeters because of that 4 hour life cycle. We don't want your baby to come before that because there are some things you need to be aware of as far as risk. This is going to come along with the use of any sort of narcotic.

The first thing to be aware of is that it does cross the placenta. So it is going to impact your baby or get to your baby. The risk of it impacting your baby is with things like central nervous system, respiratory challenges at birth impaired, it can impact early breastfeeding, altered neurological behaviors, and decreased ability to regulate their own temperature. Now, some of these are also associated with epidural use. So when you comparing, you want to just bring it back and make sure that we're comparing apples to apples here and that we are truly looking at things across the board. However, that is the reason that we can't give it pass that 6-7 centimeter mark.

There's some things for you to know too about yourself if you choose to take Nubain or Staibol. You might experience nausea, vomiting, itching, dizziness, sedation, decreased gastric motility, loss of protective airway reflexes (respiratory distress), and then hypoxia due to respiratory distress (low oxygen levels). These are all things associated with epidural use as well. So again, make sure that you're just comparing apples to apples.

I'm bringing this to the table today so you can have it in your toolbox. So that if you get to the hospital and you get numbers that are not what you expected, but you have a healthy respect and concern for not slowing down your labor with an epidural being administered too early. Yet, you really need some medical pain relief. A lot of times this kind of, feels like an impossible challenge to people, but it really doesn't have to be because you have options here. You were hoping that you were more dilated than you are and you don't want the epidural yet. You could ask about Nubain or Staidol. You might be able to get some rest, wake up , and then you can evaluate things.

Nubain is so cool because it really is that magic pill. It allows your body to relax enough, to give your baby the space that they need to navigate out, and allows your labor to continue to progress. While you get to rest and you get to sleep. One other big key is that with the epidural, it is placed in your spine for the narcotic use. With Nubain and Staidol it's going be an IV. So it'll be in your arm rather than in your spine. So keep that in mind as well. That's a, that's a pretty big difference.

Of course, you guys know I'm a huge fan of Evidence-Based Birth. So I had to take a look and see what Rebecca Dekker has up for opioid use and narcotic steering labor. And I actually found out about a drug that I had not previously known about, um, and it's called Remifentanil. It is going to be done through an IV. You get relief in about 20 to 90 seconds after the dose is administered, whereas for Nubain and Staidol all it's generally 5 to 10 minutes after the dose. So it is much quicker. Remifentanil has a higher risk of breathing problems in the birthing parent, but a lower risk of breathing problems in the newborn. So, definitely something to be mindful of. Finally, there was actually a Cochrane review done to compare a bunch of randomized trials that looked at Remifentanil compared to other narcotics use in labor as pain relief. They actually did not find that it was more effective in pain relief, however, they did find suggestions that having it being controlled with a PCA might give a placebo effect that it provides more pain relief. Very interesting psychology there.

I want to help you be prepared so that you can have an informed and confident birth, no matter what comes your way during labor. And we can do that through intentional preparation and research fact education. This is what to do in The Birth Lounge. I teach you the CONTROL method, where I teach you how to protect yourself against all of the like slippery slopes of labor and how to make sure during labor you are in control. And if you're not in control, I help you to identify where the control is and how you can take the control and put it back in your hands. I am preparing you for all of the variables in those normal variations in labor and what is a cause for concern in labor. That is how you stay in control. We hand control over when we get into a place where we don't know the research and we don't have the backing to have these informed conversations so that we can confidently navigate birth.

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