Opioid pain relief during labor: Understanding the Tradeoffs

Opioid medicines are one option for pain relief during labour. The experience depends on the medicine, how it is given and the stage of labour. An injection such as pethidine is different from a remifentanil pump, so ask exactly which treatment is being offered.

Discuss the expected benefit of an injection

Some opioid injections can make contractions easier to cope with or help you relax. They usually provide less complete pain relief than an epidural. The effect takes time to begin and can last several hours, depending on the medicine.

Ask what you are likely to feel and what can be offered if it does not help enough. Our labour pain relief guide compares these options. You can express a preference without needing to know a medicine’s name in advance.

Understand sleepiness and timing near birth

Opioids can cause nausea, vomiting and drowsiness. Staff may offer medicine to reduce sickness. Some opioids can also make the baby sleepy or affect breathing and early feeding if given close to birth, which influences when they are suitable.

Tell the team about any medicines you have already taken and report excessive sleepiness or difficulty breathing immediately. Ask for assistance moving around. Do not enter a bath or birth pool while drowsy or until the midwife confirms that it is appropriate after the medicine you received.

Remifentanil needs continuous supervision

Some obstetric units offer remifentanil through a pump attached to a drip. You press a button to receive a dose within the pump’s safety limits. Only you should press that button; a partner must not do it on your behalf.

Remifentanil acts and wears off quickly, but it can slow your breathing. Its use requires a trained midwife continuously present, observation of breathing and oxygen levels, and immediate access to oxygen and anaesthetic support. It is not an option for use alone or at home.

Ask whether the service offers it, whether it suits your circumstances and what would happen if it were not enough. Availability varies, and the team must have the appropriate supervision in place.

Revisit your choice as labour changes

Pain relief can be reviewed rather than endured once chosen. Tell staff what is working and what is not. An epidural may be another option when suitable, but it has its own assessment and practical requirements.

Before any opioid is given, ask about the likely benefit, side effects, monitoring and effect on your baby’s first hours. The best discussion is about the actual medicine and your care plan, not an assumption that all opioid treatments have identical effects.