Labour pain relief: birthing ball

You might have heard that remifentanyl can be an alternative to an epidural for pain relief. Here’s the lowdown on its effectiveness and side effects…

What is remifentanyl?

Remifentanyl (also know as remifentanil) is a strong opioid painkiller that wears off quickly (OAA, 2019).

Why is remifentanyl used?

Your caregiver might suggest remifentanyl as an alternative to an epidural if you can’t have one of those (OAA, 2019). Reasons for not being able to have an epidural can include blood clotting issues or back issues (Royal Berkshire NHS Foundation Trust, 2016).

How is remifentanyl used?

Small doses of remifentanyl are given from a pump and through a tube that is inserted into a vein in your hand.

You can press a button to give yourself a dose when you feel a contraction (OAA, 2016). This is called patient-controlled intravenous analgesia (PCIA) (OAA, 2019). It takes 10 to 15 minutes to set up and then works in a few minutes (OAA, 2016).

How effective is remifentanyl?

It’s more effective than other opioids, like pethidine or diamorphine, but less effective than an epidural (Weibel et al, 2017). Research suggests it reduces the need for epidurals more than pethidine does (Wilson et al, 2018)

Effectiveness varies, and you might find you use Entonox as well (OAA, 2016). One in eight women have complete pain relief from remifentanyl, and one in 10 move to an epidural (UHS, 2014).

Is it suitable for everyone?

Remifentanyl might not be suitable if you have a BMI over 40. It’s also unsuitable for anyone with an allergy or sensitivity to morphine-like drugs (Corfe, 2017).

What do women say?

There is no research about this.

What are the side effects of remifentanyl?

  • You may feel sleepy or sick, and your breathing might be affected (OAA, 2016).
  • You may feel itchy (UHS, 2014).
  • Around one in 100 women may need to stop using it because it slows their breathing too much (OAA, 2019). But less than one in every 2,200 women need emergency resuscitation (UHS, 2014).
  • If used for a long time, remifentanyl may build up in the body, which increases the risk of side effects (OAA, 2019).
  • The baby might be slow to breathe at first (OAA, 2016). This is a similar side effect to the use of pethidine (Wilson et al, 2018).

How does remifentanyl affect labour?

The extra monitoring that comes with using remifentanyl may restrict you from moving freely. Using remifentanyl might increase the chance of an assisted birth (OAA, 2016).

How does remifentanyl affect breastfeeding?

One study suggested that remifentanyl had no effect on women breastfeeding within an hour of giving birth (Wilson et al, 2018). Yet as the research we have suggests the effect on the baby is similar to intramuscular opioids, we might assume that the effect on breastfeeding was similar.

Does remifentanyl have any long-term effects?

There is no research available on this as yet.

How long does the pain relief from remifentanyl last?

Remifentanyl wears off with each contraction, so it can be stopped at any time.

Where and when can I get remifantanyl?

As anaesthetists have to administer remifentanyl, it’s only available on obstetric units (Corfe, 2017).

This is a relatively new alternative that is not yet licensed for labour and so is not available in all UK maternity departments (Royal Berkshire NHS Foundation Trust, 2016; Corfe, 2017; Wilson et al, 2018).

How can my birth partner help if I’ve had remifentanyl?

Your birth partner can help you to remain in a good position, comfortable, hydrated and emotionally supported.

Can I use remifentanyl with other pain relief?

Remifentanyl cannot be used within four hours of morphine or pethidine (UHS, 2014). But you can use it with Entonox (OAA, 2016).

As with any opioid, you won’t be able to use it a birth pool (Corfe, 2017).

Would I need any extra procedures with remifentanyl?

The baby’s heartbeat may be monitored continuously with cardiotocography (CTG/electronic foetal monitoring) (OAA, 2016). Your oxygen levels will be monitored via a clip on your finger and you might need extra oxygen (OAA, 2016).

This page was last reviewed in August 2019.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy and life with a new baby.

Research from the Royal College of Obstetricians and Gynaecologists (RCOG) about the use of water as pain relief in labour.

Corfe J. (2017) Remifentanil patient control analgesia for pain relief in labour. Available at: http://www.nnuh.nhs.uk/publication/download/remifentanil-patient-contro… [Accessed 8th August 2019]

OAA. (2016) Pain relief in labour: how do the options compare. Available at: https://www.labourpains.com/assets/_managed/cms/files/InfoforMothers/Pa… [Accessed 5th August 2019]

OAA. (2019) FAQs Pain relief. Available at: https://www.labourpains.com/FAQ_Pain_Relief [Accessed 5th August 2019]
Royal Berkshire NHS Foundation Trust. (2016) Remifentanil PCA for labour guideline (GL769). Available at: https://www.royalberkshire.nhs.uk/Downloads/GPs/GP%20protocols%20and%20… [Accessed 8th August 2019]

UHS. (2014) Pain relief in labour: epidurals and remifentanil explained. Available at: http://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Preg… [Accessed 8th August 2019]

Weibel S, Jelting Y, Afshari A, Pace NL, Eberhart LH, Jokinen J, Artmann T, Kranke P. (2017) Patient‐controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour. Cochrane systematic review. 4:CD011989. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011989.pub2… [Accessed 8th August 2019]

Wilson MJA, MacArthur C, Hewitt CA, Handley K, Gao F, Beeson L, Daniels J; RESPITE Trial Collaborative Group. (2018) Intravenous remifentanil patient-controlled analgesia versus intramuscular pethidine for pain relief in labour (RESPITE): an open-label, multicentre, randomised controlled trial. Lancet. 392(10148):662-672. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)3161… [Accessed 8th August 2019]

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