Pain control during labor and delivery is part and parcel of modern medicine. But if your infant is at risk of or diagnosed with fetal and neonatal alloimmune thrombocytopenia (FNAIT), you may be wondering whether standard pain management commonly administered during delivery might affect your child in any way.
Here’s what we know about pain management in the context of FNAIT-affected pregnancies.
Conservative management
Before your doctor prescribes advanced painkillers that can have unwanted side effects, your doctor is likely to advise you to find ways to reduce anxiety and stress by engaging in simple tasks such as breathing exercises and mindfulness.
Read more about FNAIT testing and diagnosis
There are myriad different ways to manage and experience pain during the delivery process. While some patients show deep distress during cervical dilation, others remain relatively calm. Preparing yourself mentally for delivery can help you better cope with pain, possibly without the need for additional painkillers.
Intravenous opioids
Opioids are strong painkillers that can offer substantial pain relief during birth. In fact, opioids are so potent that they are a highly controlled drug and only administered when medically necessary.
The good news is that opioids do not directly affect the platelet threshold of the fetus or newborn, which is the key concern in FNAIT. However, opioids are associated with respiratory depression, or like slower rates of breathing. Opioids may cross the placenta and affect the fetus in this way. Given that the fetuses are already biologically vulnerable to FNAIT, this may lead to unwanted complications down the line.
Epidural anesthesia
Most pregnant women have likely heard about epidural anesthesia, which is a painkiller injected into the spine to numb the lower body. If the mother has thrombocytopenia, there is an additional risk of epidural hematoma, which is a blood clot in the spine.
In FNAIT, the mother’s platelet count is not at risk; rather, it is that of the fetus or newborn. Fortunately, spinal anesthesia does not increase the risk of bleeding among fetuses.
Though many doctors have thought for decades that epidurals may prolong labor, particularly the second or pushing stage, a 2017 study conducted by Harvard Medical School showed an epidural made no difference in the duration of the second stage of labor.
But whatever the cause, if your labor is prolonged, your doctor may try to induce birth via steps such as the use of a vacuum. However, because this may cause bleeding in the brain, these steps cannot be performed in an infant with FNAIT as it is simply too risky.
Putting the health of the baby first
Ultimately, given that the baby is already in a delicate and vulnerable state due to FNAIT, doctors would want to try to minimize inadvertently injuring the infant and causing unexpected problems. Hence, any painkiller strategy must be in line with this goal.
The decision of whether to prescribe painkillers and the type lies solely in the hands of your OB-GYN, so if you have any worries about pain during childbirth, be sure to let your OB-GYN know so that the best management plan can be tailored for you.
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