Posted by My OB said WHAT?!?.
Feb
8
Posted by My OB said WHAT?!?.
“Nubain…It’s Just Like Tylenol.”
“It won’t make you sleepy, it’ll just make the pain go away. It’s just like Tylenol.” -CNM to mother when she asked what the side effects of Nubain where.
There are 32 comments to this post.
Well, not JUST like Tylenol….wow. !!!! I really dislike when medical professionals downplay drugs…I swear the ones I have met seem to consider an epidural as 100% simple and totally low-risk…sigh.
*For what it’s worth, my dr with my recent VBAC said that she preferred to offer Nubain instead of Demerol (if a laboring woman asked for some painkillers) since it has a much shorter half-life. That made more sense to me than simply acting like it WASN’T a narcotic.
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“And then if it’s not fully out of your system by the time you deliver, your baby will experience the side effects for about two weeks afterward, making nursing a nightmare.”
It was easier for me to deliver unmedicated than with Nubain. :-b
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I just observed an obstetric simulation that was a training situation for nursing students. Part of the simulation (which, for the most part, was an excellent and commendable training) involved a standing order for one simulated patient for nubain for her delivery. The trainer said it was an appropriate order since “it won’t affect the baby.” Groan.
I discussed informed consent with the trainer and students, more in the area of pitocin and epidurals, not nubain (it was before the trainer made the comment). I hope they look up the contraindications and possible complications of that drug before they just parrot that unfact.
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This was me. Besides having to deal with the regular issues that come with the mother and baby being drugged during and after the birth, I had to deal with the scary sensation of being drugged which I was totally not prepared for. I expected to wait 1/2 hour for some pain relief, and then it would slowly go away, just lie Tylenol…
Instead I was knocked out, and had insomnia for months afterward because falling asleep felt like being drugged!
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Tracy Reply:
February 8th, 2010 at 10:21 am
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This drug did the exact same to me, and I think they gave it to me to try to convince me to get an epidural while I was half out of it. Didn’t work.
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Sheva Reply:
February 8th, 2010 at 4:16 pm
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The midwife actually told this to me during a prenatal visit, so it was in my birth plan!
And they did convince me to take an epidural at 4 centimeters, although when the anesthesiologist came in 15 minutes later, I felt like pushing. They still wanted to put it in (they didn’t believe me when I said I was ready – I was drugged) but my normally quiet mother said, “Don’t touch her until you check her!” Thank goodness she did because I was “a smidge before ten” and the whole room went into panic mode because they weren’t ready for a birth!
Drugs also make for a quieter mother – I couldn’t talk much and couldn’t tell the docs to get their fingers out of me – I lost count how many times I was checked.
Switched to a home birth midwife and had a planned home birth-turned hospital birth because she was early. Next two were at home.
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Jennifer Z. had this to say,
Feb 8, 2010 @ 7:03 am
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I don’t think the problem here is that Nubain was chosen, but that the CNM did not provide informed consent. I have no problems with women choosing pain medications as long as they first told the risks, benefits and alternatives to them.
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I have a friend who was given Nubain during the birth of her 4th child, and ended up giving birth very soon after the drug was administered. Her baby did not start breathing after birth and they had to work on her to get her breathing, which was obviously very scary for the parents. Only then did one of the medical professionals comment “Yeah, we see this a lot, nubain babies sometimes need help breathing…”
She had her fifth child at home.
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Jena Reply:
February 8th, 2010 at 9:59 am
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Can’t imagine why she’d want to have the next one at home after something so easily fixed. I mean, the baby’s fine after she starts breathing, right?
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Angel J Miller, CNM Reply:
February 11th, 2010 at 4:35 pm
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IF the Nubain was administered shortly before birth, it did not have time to cross the placenta, thus not affecting the baby. If it is less than an hour prior to administration, it does not affect the baby. I am not a fan of Nubain, and it is NOT like Tylenol. Just be aware, it was probably not the Nubain affecting babe if less than hour prior to administration.
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Kat Reply:
February 11th, 2010 at 6:22 pm
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I am assuming since the hospital staff were the ones saying it was the nubain, that they had reason to believe the nubain caused the problems with the baby.
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Kathy Reply:
February 11th, 2010 at 6:34 pm
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Angel, this strikes me as odd — I know that blood rapidly circulates through the system, which includes the uterus and placenta. Also, the PDR says, “The placental transfer of nalbuphine is high, rapid, and variable with a maternal to fetal ratio ranging from 1:0.37 to 1:6. Fetal and neonatal adverse effects that have been reported following the administration of nalbuphine to the mother during labor include fetal bradycardia, respiratory depression at birth, apnea, cyanosis, and hypotonia. Some of these events have been life-threatening” [emphasis mine].
Can you direct me to a source that says that it takes an hour from the time of injection for a fetus to be negatively affected and/or the newborn to have breathing difficulties? Because I’m confused. “High, rapid” placental transfer sounds like it would be fast, and the closer to injection time, the more the baby would be affected. And as the mother metabolizes the drug (being bigger and with a more efficient liver) as time passes, the less likelihood of the baby being born drugged. Thanks!
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Angel J Miller, CNM Reply:
February 12th, 2010 at 7:35 am
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I actually learned this in my pharmacology course. I will try and find the source. I remember that if meds were administered within an hour of birth (or less) it shouldn’t affect the baby. I will see what I can find…
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Informed consent only works when the patient is INFORMED. This is negligence, pure and simple and is worthy of a lawsuit.
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Jennifer Z. Reply:
February 8th, 2010 at 8:59 am
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I think there has to be damages to get a lawyer to take on a case and to have something to sue for. You can’t sue based on principle.
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If its just like Tylenol why didn’t they just give Tylenol?
I know with an epidural they have an informed consent form that clearly spells out all the risks of the epidural. Even if the care provider pushes the epidurals the concent form still needs to be signed.
For IV meds like Nubain, Demoral, Fentanyl, and Pitocin there is no such form. Just having an IV port gives providers free reign to give whatever they want with the misinformed consent such as this.
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Michelle Potter Reply:
February 8th, 2010 at 10:13 am
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Maybe that explains why hospitals insist on an IV, or least a heplock, for all moms on admission.
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Heather P Reply:
February 9th, 2010 at 6:27 pm
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Yep. With my first the nurses were okay with my going without the hep-lock but the doctor was not. She was very pushy about it. I signed an AMA to not get it. I didn’t want this doc to have an open port.
Finally she did something to scare me and got me to consent to one two pushes before my baby was born. Totally unneccesary.
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Is nubain the same as pethidine- ie a synthetic opiate with the same potency as morphine? Also, what is tylenol? Is it like codeine? Or is it an NSAID like diclofenac or ibuprofen?
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Andy Reply:
February 8th, 2010 at 1:01 pm
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Just looked it up. Tylenol is what we call paracetamol. Nubain looks like it is similar to pethidine, which we give for labour pain. It is more common in England. When I worked in Scotland, we gave diamorphine, which is pure heroin. Pethidine is nothing like paracetamol, firstly because paracetamol can be bought in the local garage, whereas pethidine is highly sought after by addicts and is a Class A controlled substance! For the record, pethidine (and by extension, nubain) 1) depresses respiratory effort; 2) makes you dopey and can give you hallucinations; 3)crosses the placenta and affects the baby- baby is less active, the heartbeat is often flatter; 4)makes the baby slow to feed and occasionally breathe, requiring resuscitation in extreme cases; 5)makes you vomit; 6) sometimes doesn’t work, giving all the side effects but no analgesia.
It is a fairly easy choice when you look at it really, isn’t it?
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Andy Reply:
February 8th, 2010 at 1:06 pm
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Having said that, pethidine does have its uses. For example, in the early stages, or when the woman is having a loooooong latent phase with an OP baby, it can give a bit of relaxation and allow her to sleep, letting her body regroup for active labour. If she can relax, and reduce the catecholamine levels so her oxtocin can build, along with her endorphines, then it just might let her body get on with its job and establish in labour.
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Kathy Reply:
February 8th, 2010 at 2:41 pm
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Nubain is not controlled in the US; from what I read, when it was originally released in the early 70s, it was a C-II (same as Demerol and Morphine/pethidine), but is now not a controlled substance. Prescription-only, for sure; but not “controlled.” It’s certainly a step up from Tylenol/acetaminophen/paracetamol, but not as strong (addictive) as morphine, or else it would be controlled. It may be similar to morphine, but it’s not as strong.
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Informed consent should occur during prenatal visits, not when in labor. It is sad when women are lied to. Personally from what I observe at the hospital, I dislike nubain and of course, it depends on the timing in relation to delivery. It appears that if given between 1-4 hrs before delivery, that babies cry and cannot be consoled like they had a huge headache and when I looked up side effects, headache is mentioned first. Fentanyl is short acting, so preferable. Demerol is old school and horrible for newborns because of how long it stays in her system.
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The Deranged Housewife had this to say,
Feb 8, 2010 @ 6:21 pm
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Yeah, just like Tylenol. It doesn’t do sh!t for the pain. Supposedly it’s in the same drug ‘family’ as Morphine.
I had this in labor (half dose) instead of an epi, and really, I’m sorry I did, because I felt everything. I didn’t think there was much point in it, really. However, the nurse, to her credit, did say it wouldn’t take the pain away, but rather just the edge off – it helped me relax in between ctx because I had almost no sleep that night and went into labor at around 4 a.m, and this was about 10 a.m. But I was awake the whole time. I suppose everyone reacts differently, though.
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According to the pharmokinetics section in the evidence based clinical pharmacology online database offered by my medical school library:
Pharmacokinetics:
Nalbuphine must be administered parenterally due to extensive first-pass and GI mucosal metabolism. Nalbuphine exhibits low protein binding and crosses the placenta. The placental transfer of nalbuphine is high, rapid, and variable with a maternal to fetal ratio ranging from 1:0.37—1.6. The half-life of the drug is approximately 3—6 hours in healthy subjects and about 2.4 hours in pregnant women in active labor. Metabolism of nalbuphine occurs in the liver with excretion of the drug and metabolites via the urine, bile, and feces.
•Route-Specific Pharmacokinetics
Oral Route
The analgesic effects from oral administration are roughly one-fifth of those from intramuscular administration.
Intravenous Route
Intravenous administration provides the most rapid onset of action (2—3 minutes), with peak effects seen within 30 minutes.
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I don’t think you can generalize the one hour rule to this drug.
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Given the choice between nubain and OTHER meds, and leaving off the phenergan that they add for nausea (which amplifies the does and WILL make you sleepy!!), and getting a quarter or half dose…she’s not completely off the mark. But all doses are not created equal!!
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