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Background The effect that the route of maternal fentanyl administration has on placental transfer of drug to the neonate is not well studied. Plasma concentration ratios are an indicator of fetal exposure, relative to the mother. Method A cohort study (n=30) was conducted to measure fentanyl concentrations in maternal plasma, and arterial and venous cord blood, among women administered with either intranasal or subcutaneous fentanyl for labour pain relief. Maternal and cord blood samples were collected within 30 min of birth to determine the fentanyl plasma concentration and to assess relative neonatal exposure. Neonatal outcomes were assessed by Apgar scores, need for resuscitation and nursery admission. The study was registered as ACTRN12618001012268. Results Thirty paired samples were obtained from healthy parturients with uncomplicated term pregnancies. Highest observed umbilical venous and arterial concentrations were 0.71 ng/mL and 0.56 ng/mL, respectively, and fetal to maternal fentanyl plasma concentration ratios ranged between 0.23 and 0.73, indicating low fetal exposure. While the total intranasal fentanyl dose administered was significantly higher than the subcutaneous fentanyl dose, this did not result in a higher fetal to maternal ratio. All neonates in both groups had 5-min Apgar scores >7, two neonates required short term stimulation and oxygen (unrelated to fentanyl) and no neonate was admitted to the nursery. Conclusion This study is the first to examine fetal and maternal fentanyl concentrations after subcutaneous administration. This research supports the safe use of fentanyl for labour analgesia for women.

Undergraduate midwifery programs across Australia have embedded simulation into their curriculum although there is limited but emerging evidence to support the use of simulation as an effective teaching strategy. The purpose of this study was to evaluate the impact that a simulated learning activity (insertion and management of a neonatal nasogastric tube), had on midwifery students' knowledge, confidence and skills post-simulation, and on completion of a clinical placement. A descriptive explorative study was undertaken in two phases. Phase 1: Midwifery students (n = 60) completed a purpose-designed questionnaire to assess their knowledge, confidence and skills, pre and post simulation. Phase 2: Students (n = 46) repeated the questionnaire to reassess their knowledge, confidence and skills after the completion of a neonatal nursery placement. The findings demonstrate that simulation is an effective learning strategy in an undergraduate midwifery program. Students' knowledge, confidence and skills increased significantly post-simulation activity (p0.001). A further increase in these areas was noted post-placement. Key aspects that contributed to student learning included; the demonstrators’ level of knowledge, expertise and currency of practice, as well as the role the student assumes in the simulation activity. usc Refereed/Peer-reviewed

Objective: to investigate the use of fentanyl for pain relief during childbirth administered by routes other than epidural or spinal (non-axial). In particular, aspects relating to the efficacy and safety of fentanyl for mother and neonate are explored. Background: currently, pethidine is the most widely used intramuscular opioid for the relief of labour pain but has been shown to have numerous side-effects on the mother and neonate. An alternative opioid, fentanyl, has been shown to have fewer side-effects on both mother and neonate than pethidine. Therefore, its use during childbirth was examined in this literature review. Review methods: a search of articles relating to the administration of fentanyl via non-axial routes was conducted using electronic databases, key journals and reference lists of selected research papers and reviews. Results: only studies of IV administration were identified from the literature findings from showed that IV administered fentanyl appeared to be a safe, efficacious opioid when administered for pain relief in childbirth. Fentanyl is a short-acting analgesic causing less sedation and nausea in adults than pethidine. In addition, no long-term fetal or neonatal effects of fentanyl were identified, with normal neonatal neurological and adaptive capacities at two hours and 24 hours after birth supporting its safe use in childbirth. Key conclusion: in the studies identified, fentanyl was found to be efficacious, providing prompt analgesia with minimal side-effects to both mother and infant when administered intravenously (IV) during childbirth. In addition, no long-term fetal effects were found. Recommendations for further research: there is a paucity of research relating to the maternal, fetal and neonatal effects of non-axial administered fentanyl other than that of IV. Further research should explore alternate routes of administration such as subcutaneous, sublingual and nasal which are less invasive and can be administered by midwives. Implication for practice: in confirming the safe use of non-axial administration of fentanyl during childbirth, benefits include midwives being able to offer women an alternative option for pain relief. Alternative routes, such as subcutaneous, can be managed by midwives through a standing order, potentially reducing the need for additional resources. In particular, this will benefit midwifery practice in rural and remote settings where resources and access to specialised services are limited Refereed/Peer-reviewed