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Pethidine: to prescribe or not to prescribe? A discussion surrounding pethidine's place in midwifery practice and New Zealand prescribing legislation

Abstract:

Changes to the New Zealand Misuse of Drugs Act (1975) regarding the prescription of opioids by midwives are currently under discussion. At this time, pethidine is the only controlled drug able to be prescribed by New Zealand midwives. Pethidine is a synthetic opioid which affects the transmission of pain signals to the central nervous system and induces a state of euphoria and sleepiness. It was first used in midwifery in the United Kingdom to sedate anxious women and was never intended to be prescribed for pain relief. Despite the widespread belief that pethidine is effective at reducing pain and shortening women’s labours, the available evidence does not support this. Significant side effects for both the woman and the baby raise further questions about the suitability and safety of pethidine use in New Zealand maternity care. Relevant New Zealand legislation is currently under review with the potential for changes enabling midwives to offer a wider range of opioids. This article represents sections of a case study submitted as part of the requirements for the third year of study towards a Bachelor of Midwifery at Christchurch Polytechnic Institute of Technology (CPIT). It investigates the use of pethidine as a pharmaceutical method of pain relief in the New Zealand context, and the effects of its administration on the length of a woman’s labour and on neonatal outcomes. Considerations for, and potential changes within, midwifery prescribing practices are then discussed.

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analgesia, midwives, New Zealand legislation, opioids, Pethidine, prescribing