Opioid Analgesics in Labour

Systemic opioid analgesics provide moderate pain relief during labour. They reduce but do not eliminate pain. Agents used in labour protocols include morphine, fentanyl, meperidine, butorphanol, and nalbuphine. Given IV or IM, they cross the placenta and affect the fetus. Respiratory depression is the primary safety concern for both the mother and the newborn. A maternal respiratory rate <12 breaths/minute is a threshold for withholding further opioid, assessing the client immediately, and contacting the provider. It is not a reason to wait for additional deterioration. Naloxone (Narcan) is the recommended reversal agent for opioid-induced maternal respiratory depression. Give an initial 0.04 mg IV bolus, then repeat 0.04–0.1 mg every 2–3 minutes to a total of 0.4 mg, according to the authorised emergency order or local protocol. Because naloxone may wear off before the opioid, continue respiratory and sedation monitoring after the response and escalate if depression persists or returns. Naloxone can precipitate acute withdrawal in an opioid-dependent client. That risk must be anticipated and reported, but it does not justify delaying indicated reversal of clinically significant respiratory depression. Airway and...