Taking the alternative route: Women's experience of intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for labour analgesia

• Published in: Midwifery 2017-10, Vol.53, p.15-19
• Main Authors: Fleet, Julie-Anne, Jones, Meril, Belan, Ingrid
• Format: Article
• Language: English
• Subjects: Administration, Intranasal - standards; Adult; Analgesia; Analgesics; Analgesics - administration & dosage; Analgesics - therapeutic use; Autonomy; Childbirth & labor; Content analysis; Drug administration; Drug delivery systems; Drug-Related Side Effects and Adverse Reactions - psychology; Emotional responses; Female; Fentanyl; Fentanyl - administration & dosage; Fentanyl - pharmacology; Fentanyl - therapeutic use; Humans; Injections, Intramuscular - standards; Injections, Subcutaneous - standards; Labor Pain - drug therapy; Labour; Meperidine - administration & dosage; Meperidine - pharmacology; Meperidine - therapeutic use; Midwives; Narcotics; Nasal sprays; Nursing; Opioid; Pain management; Pain Management - methods; Pain relief; Patient Satisfaction; Pethidine; Postpartum period; Postpartum women; Pregnancy; Qualitative Research; Quantitative analysis; Sense of control; Side effects; South Australia; Telephone surveys; Womens health
• ISSN: 0266-6138; 1532-3099
• DOI: 10.1016/j.midw.2017.07.006

To compare women’s experience of receiving either intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for labour analgesia. A content analysis was undertaken as part of the third phase of a larger randomised controlled trial, using the per-protocol dataset to examine women’s experiences of treatment received. Healthy women birthing at term, who received intranasal fentanyl (n=41), subcutaneous fentanyl (n=37) and/or intramuscular pethidine (n=38) for labour analgesia, were contacted at 6 weeks postpartum to complete a phone questionnaire. A tertiary and regional maternity unit in South Australia. Over 80% of women who received intranasal or subcutaneous fentanyl reported that they would use the treatment again compared to 44.8% of women who had received pethidine (self-administered intranasal fentanyl provided more expressive responses emphasising the route provided a strong sense of control and enablement. Route of administration influenced the women’s experience, more women who self-administered intranasal fentanyl reported positive emotional responses, with women reporting increased autonomy and satisfaction. Whereas, women who relied on the midwife to administer subcutaneous fentanyl or intramuscular pethidine, were more often focused on the physical effect of the drug. Pethidine was the least preferred option due to adverse effects. For women requesting parenteral analgesia, fentanyl administered by less invasive routes offers women additional options that may better meet their emotional, cognitive and physical needs than the current practice of administering intramuscular pethidine. •This study identified route of opioid administration influenced the women’s experience.•Women who self-administered intranasal fentanyl reported positive emotional responses that demonstrated an increased sense of autonomy and satisfaction.•Responses from women who received pethidine predominately focused on negative effects, even when pain relief was achieved.