The Use of Stadol in Childbirth

One of the most common interventions used in labor these days is a does of the drug known as Stadol (butorphanol). It is often presented as "something to take the edge off your contractions" as a woman's labor progresses to the point where coping with contractions becomes difficult.

This seems innocuous enough. However, at least according to anecdotal evidence, it may not be as simple as that. Many women find the effects of Stadol to be a relief, allowing them to rest between contractions, and lose some of the tension that has been building during the labor. Incidentally, many migraine sufferers find that the benefits of the drug far out way the negative effects. But there are negatives, by some accounts.

According to one drug review site, a common effect of Stadol is a "high as a kite" feeling. ¹ Now, some might not mind this, but many do. Most women do not anticipate or look forward to hallucinating, "losing time" and feeling "crazy" or fearful while birthing their child. Interestingly, on the review site Stadol received a rating of 3.4 (out of 5) and the vast majority of positive reviews were from migraine sufferers who found the drug allowed them to live a more normal life. The majority of negative experiences were from women who had found that they didn't appreciate hallucinating during labor or the sensation of "lost time" or any other neurological affect the drug had on them.

This matches my own experience, that of my sister, and those of other women I have asked in some "informal polling" about Stadol. Negative experiences were surprisingly common, given that negative side-effects are mentioned as rare or insignificant in the literature.² Particularly for women who were hoping for childbirth to be as natural as possible, the side-effects of Stadol turned out to be a nasty surprise. Being told that the drug "takes the edge off" contractions gives one the impression that there will be some pain relief. Caregivers sometimes fail to take the time to explain that this is not the case, or to list side effects beyond giving a joking comment about making the patient feel "loopy".

According to drugs.com, Stadol does cross the placental barrier, but does not harm the fetus except in rare cases.³ In one study its use was also associated with transient fetal heart rates, which can lead to other interventions, but which did not result in poor outcomes for the baby at delivery.⁴ There are no studies demonstrating that labor outcomes are different with or without the drug.⁵ However, given the number of women who have experienced frightening and upsetting side effects, it would seem wise to consider this aspect before accepting the drug. Women who are going to be offered Stadol in labor should at least be aware of the potential side effects so that they can make a truly well-informed decision about the drug and its benefit to them.

¹STADOL, askapatient.com

²Stadol: Side effects, staff, mayoclinic.com

³Butorphanol, staff, drugs.com

⁴Butorphanol: Labor and Delivery, staff, drugs.com

⁵Double-blind comparison of intravenous butorphanol (Stadol) and fentanyl (Sublimaze) for analgesia during labor. Atkinson BD, Truitt LJ, Rayburn WF, Turnbull GL, Christensen HD, Wlodaver A., PubMed.gov