omen in labour who need pain relief could be given a fast-acting drug instead of an epidural, under new guidelines.
The opioid remifentanil would be given through a tube into the bloodstream and controlled by the woman herself, meaning it could allow women to be more mobile than during an epidural.
The draft guidance from the National Institute for Health and Care Excellence (Nice), states it could be an option “for women who want ongoing pain relief during labour and birth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 an injection into the back for pain relief in the lower body, commonly used during childbirth.
The drug is connected to a tube with a machine which allows women to self-administer, but also has a timer to ensure they cannot take too much.
The guidance states that compared to opioids given by injection, remifentanil has been shown to reduce the use of epidurals, and also reduce the likelihood of birth with forceps or ventouse.
It comes after a number of hospitals suspended the use of gas and air as a method of pain relief over concerns about medics’ exposure to high levels of nitrous oxide.
The draft NHS guidance also states that Tens devices, which deliver small electrical impulses to the body through sticky pads, can be used by women in labour if they wish, but will not be provided by the NHS.
“There is very little evidence of its effectiveness in established labour, but no evidence of harm,” it says.
The revised guidance also gives new suggestions on where women should choose to give birth in certain circumstances.
Medics should “advise women that having a BMI at booking of 25 kg/m2 or more may be associated with increased risks for them and their baby, and that they should take this into account when planning their place of birth,” it states.
The draft guidance is being consulted upon until June 6.
