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Opioids, analgesia and pregnancy

Question #: 366

Question:

Should we withhold narcotics to treat a pregnant patient for pain management?

Answer:

The Analgesia Medical Directive allows you to use opioids to manage severe pain with the pregnant patient population.

In non-emergency situations, informed consent (ALS PCS - Consent to Treatment in Non-Emergency Situations) should be obtained prior to administering treatment. This includes administering opioids to manage severe pain.

Informed consent includes providing "information that a reasonable person in the same circumstances would require in order to make a decision about the treatment:

  • the nature of the treatment;
  • the expected benefits of the treatment;
  • the material risks of the treatment;
  • the material side effects of the treatment;
  • the alternative courses of action;
  • the likely consequences of not having the treatment;
  • responses to requests for additional information about those matters."

In the context of the pregnant patient population, some of the risks will change depending on the pregnancy trimester. For example, there are lower risks in administering opioids during the first and second trimesters, and in the third trimester, the risk for adverse events increases including side effects of opioids on the fetus.

The intent of the medical directive was not to manage pain related to active labour.

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