Women in labour on the NHS could be offered a new type of patient-controlled fast-acting pain relief under new health guidelines.
The opioid remifentanil has been billed as an alternative to an epidural, with an updated draft guidance from the National Institute for Health and Care Excellence (Nice) stating that the drug could be an option “for women who want ongoing pain relief during labour and birth but who do not want an epidural”.
An epidural is when women are injected into their back to stop them from feeling pain in the lower half of their body, whereas remifentanil is administered into the bloodstream through a tube. A machine which contains the drug is connected to a tube, and women will be able to control the medication themselves, meaning it will allow them to be more mobile than they would be with an epidural. A timer is connected to the matching to ensure they can’t take too much.
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As well as reducing the use of epidural, remifentanil also minimises the likelihood of giving birth with forceps or ventouse.
The draft guidance states that the Tens device, which omits tiny electrical impulses to the body through sticky pads, is not provided by the NHS. Women can choose if they want to use it in labour, but “there is very little evidence of its effectiveness in established labour, but no evidence of harm”.
This comes after several hospitals suspended gas and air as pain relief methods due to professionals’ concerns about medical staff being exposed to high levels of nitrous oxide for a long time.
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The guidance also advises on where women should choose to give birth, mainly noting that women with a body mass index score of 25 or over could face increased risks in labour and “they should take this into account when planning their place of birth”.
The Nice draft will be put out for consultation until June 6.