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Blog: Why Opioids are best avoided during labour & what are the alternatives? Part 1




Firstly, we need to understand what opioids are and how they work. Opioids are defined as natural or synthetic substances that bind to the opiate receptors in the body (found in the central nervous system and gastrointestinal tract) to produce a biological response. In medicine, they are frequently used for pain relief, to suppress conditions such as diarrhoea or cough. Morphine (and its derivatives) is of course the best known opioid used in healthcare today.


Let’s now have a look at some of the effects of opioids.


Effects of opioids


As pain-relievers, narcotic analgesics significantly alter consciousness. They affect the initial perception of pain as well as the emotional response to it making pain easier to bear. Morphine Sulphate, which is used intraspinally (also know as an epidural) will give up to 24 hours pain relief post operationally. However, this pain relief does not come without its own side-effects and consequences:


  1. Respiratory depression results in a decreased cough reflex
  2. Constipation often results as it reduces the contraction of the peripheral smooth muscle leading to decreased propulsive movement of the gastrointestinal tract.
  3. May cause venules (tiny blood vessels) to dilate leading to decreased blood pressure ( also known as postural hypotension)
  4. Urinary retention may occur and urethral stricture especially in new born babies (neonates)
  5. Other symptoms of sedation, confusion, nausea, vomiting and itch can occur.
  6. Neonates, especially premature infants, are highly sensitive to morphine and other opioids as they lack adequate metabolic pathways to eliminate opioids which then results in putting pressure on the infant’s liver and kidneys too.


The problems are then exacerbated when the side-effects of narcotics are in turn treated with more chemicals further compounding the side-effect profile.


Drug Interactions


If a patient is treated for side-effects of narcotics, for example bronchodilators and cortisone may be given in the case of respiratory depression, these drugs can increase the depressant effects of morphine.

You are then caught in a vicious cycle of adverse drug interactions.

At Pegasus, we believe that there is certainly a place for chemical drugs, especially in emergency situations such as post-partum haemorrhage or if a traumatic delivery anticipated. However, there are also well established alternatives to pain relief which we’ll explore in Part 2 of this series.