Stadol (Butorphanol) During Labor

During your pregnancy, you may worry about the pain of childbirth. Most expecting mothers do. And, while some want to have a natural, medication-free birth, many women welcome medication to relieve pain. Doctors use different types of pain medication during labor and delivery. Butorphanol, also called Stadol, is one option. Here’s what you need to know about the effectiveness and safety of butorphanol during childbirth. 

Stadol During Labor

Stadol is the brand name of a pain reliever developed and sold by the Bristol Myers Squibb pharmaceutical company. It is now discontinued. However, the drug is still available in the US under the generic name of butorphanol as well as in other countries under different brand names. Butorphanol is a narcotic analgesic medication and an opioid agonist-antagonist. Doctors may prescribe this medication to treat migraine headaches, relieve pain after surgery, or help with the pain during labor.

How It Works

A narcotic analgesic can relieve moderate to severe pain during labor. It can make you feel more comfortable by:

• Calming anxiety.
• Helping the body relax.
• Relieving the intense pain of contractions.
• Making you sleepy so you can rest between contractions.

This type of pain reliever can help to lessen the pain, but it does not block it completely. So, it allows you to feel enough to participate in your labor as well as cooperate and push during the delivery. 

Pain medication affects women in different ways. Some women feel much better after a dose of analgesic pain medication if it allows them to rest or relax their body. While others feel uncomfortable, dizzy, or out of control and do not like how it makes them feel. Still, others experience nausea and vomiting, don't get pain relief, and don't like the medication at all. 

When It Is Given

You do not need to see an anesthesiologist to have this type of medication. Your doctor can prescribe it, and a doctor or nurse can give it to you. 

It can be given:

• Once the doctor determines you are in real labor and not false labor.
• In early in labor (more than four hours away from giving birth) to prevent side effects for you and the baby. 
• After delivery to relieve the pain of an episiotomy or c-section.

The doctor may recommend this medication or a similar type of drug if:  

• You are in too much pain, and it's interfering with the progression of labor.
• Your labor is getting too long or complicated, and it may impact your health or the health of your baby.
• You need delivery assistance with forceps or a vacuum extractor.

How It Is Given

Butorphanol is a liquid injected into the body in two ways. 

Intravenous (IV): A dose of 1-2 mg is given every three to four hours through a small, plastic, strawlike tube in your vein, which delivers the medicine directly into your blood. Medication through an IV begins to work quickly within a few minutes, and the relief lasts up to four hours.

Intramuscular (IM): A dose of 1-2 mg is given every three to four hours through a shot that delivers the medicine into your muscle. Medication through an IM injection begins to work in about 10 to 15 minutes, and the relief lasts for up to four hours. 

Side Effects

During labor, the goal is to relieve the pain without putting you at risk for harm or severe side effects. Studies show that butorphanol is a safe, low cost, and effective medication for pain relief during labor. However, like all medications, side effects are possible. They can affect both you and your baby.

Side Effects for Mothers

The side effects you may experience as a mother include:

• Pain at the injection site
• Nausea and vomiting
• Drowsiness or sedation
• Dizziness
• Muscle weakness
• Itching
• Urinary retention

Side Effects in the Baby

Medications given during labor and delivery can pass to the baby. Before the baby is born, butorphanol can affect the baby's heartbeat. It is associated with an increased risk of a specific condition called a sinusoidal fetal heart rate pattern. However, the research suggests that babies do not show any negative effects of this heart rhythm after birth. Other studies show that a sinusoidal pattern is not necessarily more likely to occur with butorphanol.

In healthy full-term babies, the side effects after birth are often mild and without long term consequences. They can include:

• Slow breathing in the baby
• Sleepiness
• Poor feeding or breastfeeding
• Apnea

And while the side effects in a healthy baby are rare, they are more likely to appear in these situations. 

• You receive the medication within two hours of delivery.
• You get multiple doses. 
• You take it along with other pain medication or sedatives.
• The delivery is premature.

Safety

While you are taking this medication, you may have to follow some safety precautions.

• You may not be allowed to walk around if you are drowsy or dizzy.
• You may not be allowed to eat or drink.
• You may need IV fluids.
• You may need oxygen.
• You and your baby may need more monitoring.

When Not to Use It

There are also some contraindications to using butorphanol. This medication is not recommended if you have certain health issues. Be sure to talk to the doctor and hospital staff about your health history, any medicine you take, and any current symptoms you may have.

Tell your health care providers if: 

• You have a history of drug use. 
• You are in recovery for an addiction.
• You are taking methadone or another opioid antagonist to combat addiction.
• You have a breathing or lung condition.
• You have liver or kidney disease.
• You have a history of seizures.
• You had a head or brain injury.
• You have high blood pressure.
• You have symptoms of preeclampsia.
• You have heart disease. 

Complications

There are benefits to taking medication during labor, but there are also risks. Complications can develop from the use of an opioid pain reliever during labor. Butorphanol can cause: 

Allergy. An allergic reaction such as hives, itching, difficulty breathing, or swelling in the face, neck, tongue, or throat.

Respiratory depression. Too much of this medicine can lead to an overdose with symptoms that include difficulty breathing, changes in your pulse, or passing out.

Withdrawal symptoms. In women who use drugs, butorphanol can cause sudden withdrawal in both mom and baby.

Addiction. Opioid medicine can be addicting and lead to dependence and drug abuse. 

Reversing Side Effects and Complications

Narcan (naloxone) is a medication that reverses the side effects of narcotic drugs. It can be given to a mom or baby if they are experiencing difficulty breathing or any severe side effects from butorphanol or another narcotic medication. A small dose of Narcan through an IV works very quickly.

Choosing to Use Pain Medication

At some point, most expecting mothers give at least a little thought to how they want to get through labor. Some moms wish to as natural a birth as possible without any medications, and others know they want medicine at the first sign of labor. Many things can influence your choice.

These include:

• Concern about the dangers of pain medicine
• Fear of pain
• How much you know about the medications
• How familiar you are with your options
• Your previous experiences with pain
• Your previous pregnancies and deliveries
• Where you give birth (home, birthing center, hospital)
• If there is medicine available
• If an anesthesiologist is available
• Your health and your baby’s health
• Your culture

You may decide to have your baby without taking any medication for pain. You might take childbirth classes, practice breathing exercises, and learn all the non-pharmacological pain relief techniques you can.

The pain could be very manageable, or it may be much more than you expect. 

The pain you feel during labor, and your desire for pain medication may depend on many factors, including:

• The size of your baby.
• The strength of your contractions.
• Your tolerance for pain.
• How prepared you are for labor.
• The support you have during labor.

It's wonderful if you can have a natural birth. But, it is also OK to plan for a medication-free birth and then change your mind. You can certainly start off without any drugs. But, if your labor is long, very painful, and exhausting, you may choose to add pain medicine to your birth plan. Your doctor may also recommend that you take something to help you rest and relax your body.

You should not feel disappointed or guilty if you need or want something to relieve your pain. You can feel good knowing that you tried and that you are doing what’s best for you and your baby.

Butorphanol and Other Pain Relief During Labor

Breathing exercises and natural pain relief methods often work in early labor. But, if they stop working during the first stage of labor, narcotics, such as butorphanol, are often the first medication choice for pain relief. 

The type of pain medicine you have during childbirth depends on a few things: 

• The stage of labor you're in
• Your health
• Your baby's health
• Your preference 
• Your doctor's recommendation

Butorphanol is not the only analgesic medication used during labor. Drugs that are similar to butorphanol are:

• Demerol (meperidine)
• Morphine
• Fentanyl
• Nubain

Other methods of pain relief during labor include:

• Non-pharmacological comfort measures
• Sedatives
• Inhalants (nitrous oxide)
• Patient-controlled analgesia (PCA)
• Local anesthesia
• Epidural block
• Spinal block
• General anesthesia

You may also choose to use a combination of medications and comfort techniques.

Breastfeeding

When butorphanol is given at least four hours before delivery, the chances of it interfering with breastfeeding are low. But, when used close to birth, narcotic medication can cause drowsiness in both the mom and baby. The effects could lead to difficulty with feeding and breastfeeding after the baby is born.  

If a mom is using butorphanol after birth, it can pass in the breast milk and cause drowsiness that way, too. Although, the AAP states that the level of butorphanol that makes it to the breast milk is minimal and insignificant. Therefore, when a narcotic pain reliever is necessary, butorphanol, morphine, and hydromorphone are preferred over codeine and hydrocodone. 

If possible, it's best to use a non-narcotic medication after birth to prevent a sleepy baby and mom. However, if you are in pain, relieving that pain can improve breastfeeding. So if an opioid is needed, the smallest dose to manage pain is best for breastfeeding.

A Word From Verywell

Labor can be painful, but there’s no need to suffer. Butorphanol is just one of many pain relief options to consider as you prepare for the birth of your child. When the right amount of narcotic medication is given at the right time during labor, it can be safe and helpful.

However, everyone responds to medication and pain differently. So, it may not work well for every woman. You should talk to your doctor about your concerns and all of your options. And, try to stay flexible with your birth plan during your labor. Remember, the need for medicine to help you through a painful or difficult birth is in no way a failure. The ultimate goal is to have a safe delivery and a healthy baby. That’s the definition of success no matter how you get there.