Hold Up, There's Fentanyl In Epidurals?
Jan 12, 2023
by Stephanie Larson
As your baby’s birth is coming closer, you’re probably starting to think about all of your choices for comfort in labor. There are two main categories to choose from: pharmacological and nonpharmacological. Pharmacological means drugs. Nonpharmacological means without drugs. Epidurals are in the pharmacological category. Are you planning to get an epidural? What if I told you that it’s likely there’s fentanyl in your epidural?
Epidural is a term that is so common in the context of birth, and seems so benign, you might take it for granted that you’re going to get one, without ever really questioning what it is, what it contains, what the risks are, and what you are exposing yourself and your baby to.
An epidural for childbirth typically contains a combination of drugs. The main drug is an anesthetic, usually lidocaine (a cocaine derivative), which numbs the lower half of the body and provides pain relief. Additionally, many epidurals also contain fentanyl, which is an opioid and provides stronger pain relief. The combination of the anesthetic and opioid provides a more effective pain relief than using one medication alone. These drugs are administered through a small catheter that is inserted into the epidural space in the lower back. Once the catheter is in place, the medication is delivered continuously through a small pump. The dose can be adjusted as needed to provide the desired level of pain relief.
According to the United States Drug Enforcement Administration, Fentanyl is a synthetic opioid that is 50-100 times stronger than morphine. Does that sound like something you want to pass to your baby in the womb during birth? “Any medication that a woman uses during labor enters the child’s body as well, through the umbilical cord. This includes painkillers and anesthetics delivered through epidurals.” (Institute for Quality and Efficiency in Health Care).
There is an ongoing opioid epidemic in the US and around the world. On December 31, 2022, NPR reported that overdose deaths, driven by fentanyl, reached a peak in March, and that “researchers found a staggering 110,236 people died in a single 12-month period, a stunning new record.” Since we're still in the midst of an opioid crisis, why are hospitals giving pregnant individuals (along with their babies in the womb) the powerful opioid fentanyl?
If it’s standard practice to put fentanyl into epidurals, which then passes to the baby during birth, that's like saying “Welcome to the world baby, you’re being born during an opioid crisis, here’s some fentanyl for you, so you’ll fit right in!” Another factor to consider is that many hospitals drug test all newborns. If your baby tests positive for fentanyl, you may be accused of drug abuse, which could potentially cause your baby to be separated from you. In states that criminalize drug use during pregnancy, this can lead to you needing to defend yourself from losing custody of your children and getting sent to prison. According to a recent study, babies whose mothers received greater than 100 mcg of fentanyl were most at risk for testing positive. Some epidurals contain 100 mcg of fentanyl hourly.
Fentanyl can cause slowed respiration and reduced blood pressure, nausea, fainting, seizures, death, sedation, confusion, drowsiness, dizziness, nausea and vomiting, urinary retention, pupillary constriction, and respiratory depression. Whether or not they contain fentanyl, epidurals have risks that include short-term and long-term side effects that may affect you or your baby.
Now that you know the shocking truth that epidurals often contain the highly addictive opiate fentanyl, what choice will you make? Be sure to ask your care provider what combination and dosage of drugs will be used, and what the risks are, if you're considering an epidural.
Sources:
https://www.dea.gov/factsheets/fentanyl
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
https://www.sciencedirect.com/topics/medicine-and-dentistry/cocaine-derivative
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Pregnancy and birth: Epidurals and painkillers for labor pain relief. 2006 Mar 3 [Updated 2018 Mar 22].Available from: https://www.ncbi.nlm.nih.gov/books/NBK279567/
Rayburn W, Rathke A, Leuschen MP, Chleborad J, Weidner W. Fentanyl citrate analgesia during labor. Am J Obstet Gynecol. 1989 Jul;161(1):202-6. doi: 10.1016/0002-9378(89)90266-4. PMID: 2750805. https://pubmed.ncbi.nlm.nih.gov/2750805/
