Fentanyl is the strongest opiate known to man and works on the opiate receptors.  There is never a reason to use such vehicles during birth because birth is not that painful, but rather fear is the greatest problem.  Opiates remove fear effectively.  Women can get much safer opiate analgesia  by walking in the woods  accompanied by a trained birth attendant.    

A common side effect of Fentanyl are Fentanyl itches cause the chest to turn red and itchy, which means the fentanyl is systemic despite a successful epidural in the correct position.    

  Homebirth midwives have much to teach hospital practitioners , should anyone be interested in learning the optimal methods of removal of the fear of childbirth.    

Marleny

I am not entirely clear whether you are asking about the suitability of using fentanyl alone as an epidural infusion for labour or what its mechanism of action is.

Fentanyl is not generally used alone as an epidural infusion to provide labour analgesia, but it is frequently used as an adjuvent added to low concentrations of local anaesthetics such as bupivacaine or more commonly these days, ropivacaine.

The mechanism of action would be at a local spinal level via absorption through the sensory nerve roots or centrally in the brain via absorption to the blood from the epidural space. In combination with local anaesthetics there is evidence that its principal effect is at a spinal level, and I recommend you read the excellent paper by D'Angelo and colleagues:

Robert D'Angelo, MD; J. C. Gerancher, MD; James C. Eisenach, MD; Brenda L. Raphael, MD. , Epidural Fentanyl Produces Labor Analgesia by a Spinal MechanismVol.88,  Anesthesiology 6 1998, 1519-1523.

The main advantage is it permits a reduction in local anaesthetic concentration, with reduced motor block and facilitates so called "walking epidurals" (are they still fashionable?), although I have never seen a labouring woman and her attendant embark on sylvian excursions.

Judy,

FYI fentanyl is an opioid, not an opiate, and sufentanil, remifentanil, and carfentanil are much more potent.

Itching can be an issue, but it does not necessarily imply systemic absorption. It is possible that it is at least in part a physiological response to the rapid reduction or elimination of pain.

While I respect your beliefs in the possibility of painless labour, and I believe it can occur, for many women this is not the case (to the extent of biblical reference). The severity of pain experienced in labour has been likened that of traumatic amputation of a digit by some who have experienced both. Any fear of labour associated with the anticipated severity of pain can be assuaged by knowledge of the immediate availability of an epiduralist (availability assuming that she is not searching the woods looking for her previous customer!!).

Best Wishes

Thanks for the correction, but the difference appears to be unimportant to practice but rather distinguish  how they are made- whether they are synthetic or not.   It appears they all have the same action on the pain receptors, regardless of method of synthesis. "Opioids are substances that act on the nervous system in a similar way to opiates such as morphine and codeine.[1] In a medical context the term usually indicates medications that are artificially made rather than extracted from opium.[2] "         As far as the fentenyl itches being a result of the relief of pain,   that would not explain the fact that the woman has a red erticaria on her chest.    I would like to know the reason for why relief from pain would routinely result in an itchy chest, rather than a different symptom for each woman.    There is research suggesting that babies after births with epidurals are less interested in nursing, and the theory is that they received some fentanyl and or the epidural drugs administered.  SO that means there is research documenting  2 likely indications of systemic proliferation of the drug- itches and sleepy babies.                                                                                                                                  the most compelling argument is that all doctors once they have experienced or attended homebirth, find it the obvious preferable way to birth.    It is only people who have no experienced homebirth, who stand behind birth being as painful as having a digit amputated (without anesthesia, i presume).     I have never heard that, and even though i have many clients who were prisoners in siberia for being jewish, none compared labor to any of the torture they received there.    several women have told me that ear infections they had were more painful than labor.      The bible quote you refer to- suggesting that women give birth in pain,  is not translated correctly from the hebrew.    The hebrew word means  that women will work to have their children, just as men will from now on work the field to produce food.   The word is work,  not pain, although it is often mistranslated into pain when it comes to the women, but for men it is always translated that they will have to do work.                 The fact that you wrote, means there is a glimmer of hope that you will perhaps follow my publications.     I having in press letter at BJOG showing maternal mortality to be a product of hospital birth, largely cesareans  1 in 3000 die, and inductions which kills 1 in 15,000 women.    This is avoided by homebirth.   I also have in press a letter at AJOG showing that uterine rupture has never happened in an unscarred uterus in the absence of medical induction or augmentation.      A big problem with hospital birth is that 50% receive medical augmentation with Pitocin and this does greatly increase the pain.   It is important to note the research showing that epidurals only work 85% of the time.  The other 15% of women are beached on a bed connected to a monitor and an epidural but not getting pain relief- the worst of all worlds, with an IV Pitocin running.   Yes, that might be similar to taking off a finger without anesthesia.    Yes.  By the way,  there is no quality  research supporting induction for postdates.  This is another article of mine in J ObGyn Res that you might enjoy reading.     Sincerely   JS Cohain

Dear Judy

As i said, I respect your beliefs, I just don;t share them.

If you are interested in the pain/itch story you might be interested in: 

Martin Schmelz. Itch and pain. Neuroscience and Biobehavioral Reviews 34 (2010) 171–17

Apropos the biblical references (not exhaustive I'm sure):

Genesis 3:16 

John 16:21

Revelation 12:2

Hosea 13:13

Isaiah 13:8

Isaiah 21:3

Isaiah 26:17-18

Isaiah 42:14

Micah 4:9

Micah 4:10

Psalm 48:6

Jeremiah 4:31

Jeremiah 13:21

Jeremiah 22:23

Jeremiah 49:24

Jeremiah 50:43

Matthew 24:8

1 Thessalonians 5:3

Romans 8:22

Which was the mistranslation? As you can see, some of the references are new testament, so would have been in Greek. From about the third century BC until the diaspora many Jews would have been reading the texts in Greek alongside others reading the Hebrew, I'm surprised nobody picked up on the mistranslation then. The Septuagint  was an astounding miracle, made doubly miraculous by all 70 translators making the identical error!

Cheers

 B'etzev Tildee Banim.  In " Etzev" you will raise or give birth to Sons.  Etzev is not used to mean  pain in the other places where it is used  in the Torah. It says in the Torah dictionary that it means : sad or depressed in the other places.   A psychological sadness.  B'etzev Tildee Banim could  mean psychological pain of worrying about your children rather than physical pain. Often the Torah is vague.    It is used elsewhere in Genesis to mean  an emotional pain, it might be emotional difficulty- to be tormented.  It might be sadness.  Today, Atzuv means sad.  Etzev today also is the medical term for NERVE.  It is difficult to raise children.   Overall, i highly recommend everyone watching a woman who I attended give birth

https://www.youtube.com/watch?v=zX1FEJ9SMEw

First birth, with no medical pain relief or any pain relief except being home with friends. That will give you an idea of what i am talking about.

i am a practicing Orthodox Jew who is fluent in Hebrew and studies Torah for one hour daily, every day.   It should not be surprising to you that the Greeks translated something to please their tastes. Even you today, prefer your own translation. Here i am saying that I speak hebrew daily, study Torah daily, am 60 years old. at least minimally intelligent, and you dont want to hear that the hebrew and the greek and the english are different. 

Thank you very much for the video. It certainly bears out your argument and the value of the squatting position. That natural pain-free labour is possible was never in dispute.  My example of the bible was to argue that references to pain going back two and a half thousand years suggested that pain-free labour is by no means the norm.

Regarding your comments about language, I bow of necessity to the opinion of a Torah scholar! (However, I have the suspicion that if i were to place two Torah scholars in a room it might generate a three way debate as to interpretation!)

It's not that I don't want to hear your argument, which I have heard before for the Genesis reference and I accept it in this case. Particularly so as the King James version (My favorite - on the language used rather than any putative accuracy) also translates this as sorrow. But what of the other references?

Isaiah 21:3-4 is a good example, referenced in the book of Daniel (Aramaic) as pain, and in the Arabic version as pain. What was the Hebrew word used here? The book of Daniel was written in Aramaic wasn't t? And while the Arabic version might have been taken from the Greek version, would they not have had access to the Hebrew? Were all based upon the same dragoman's error?

I agree that all translations are subject to personal preference, but this is an argument that works both ways.

I'm a labor nurse. I love an unmedicated labor. I had no fear of labor, I prepared myself quite well and surrounded myself with supportive, loving people.  I did have pain, probably due to an OP baby. Either way, I did get pain meds while they repaired the damage.

Women come to my facility from the local birth center, or their homes, because they want pain relief in the form of medications. We can offer that in the hospital. Often it's because of a prolonged labor that various non-pharm techniques didn't resolve. 

Birth is different for everyone. When you start trying to put everyone in the same box, you are doing a terrible disservice to women, who all have such a varied history. 

I use pain medications.  It is a mistake on anyone's part to assume that because I am against the use of EPIDURAL in labor, that I am against pain medication.   That  reflects an inability to think outside the box a bit.

I use Percocet 5 mg or 10 mg, depending on weight of the client.  Has no effect on the baby.  Relieves pain.  The woman continues to walk around freely,  No monitor attached to her stomach, no beached whale with a Epidural catheter in her back, no 15% of women who get no pain relief but are told they are, even though they dont feel any.   I welcome any questions.    I am not closed minded.     I wish all women would ask questions.   I can tell you this.   When i give women who need pain relief a Percocet in labor and they find it works perfectly and they get to continue to walk and move and push in whatever position they want,   they ALWAYS ask me,  why dont they offer that in the hospital? They are dumbfounded why such an effective perfect method of pain relief is withheld from women.    ANd my question to you is that-  WHY DONT THEY OFFER EFFECTIVE MEANS OF PAIN RELIEF IN THE HOSPITAL THAT ALSO EMPOWER THE WOMAN TO CONTINUE TO CONTROL her body?