PCIA is available in some hospitals if an epidural (an injection into your back to numb the lower half of your body) is not possible or you do not want one.
PCIA allows you to give yourself small doses of opioids when you feel that you need them. You have control over the amount of opioid you use. For safety reasons, the PCIA limits how often you can take the opioid and how much you can have. However, if you use the PCIA for a long time, some opioids may build up in your body which may increase the side effects of the opioid on you and your baby.
Remifentanil
In a few maternity units, you may be offered PCIA using an opioid called remifentanil. Your body breaks down remifentanil very quickly, so the effects of each dose do not last long. This opioid has a strong effect on pain but it is also more likely to slow down your breathing, so your breathing needs to be checked carefully.
About one in 100 women using remifentanil PCIA may have to stop using it because their breathing slows down too much. However, it's rare for breathing to be slowed down so much that it becomes a serious problem.
Remifentanil PCIA has very little effect on your baby.
In some maternity units remifentanil PCIA may be given with Entonox (‘gas and air’).
Sources:
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Volmanen P, Akural E, Raudaskoski T, Ohtonen P, Alahuhta S. Comparison of remifentanil and nitrous oxide in labour analgesia. Acta Anaesthesiologica Scandinavica 2005; 49: 453-458.
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Volikas I, Butwick A. Maternal and neonatal side effects of remifentanil PCA. British Journal of Anaesthesia 2005; 95: 504-509.
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Lavand'homme P, Roelants F. Patient-controlled intravenous analgesia as an alternative to epidural analgesia during labor: questioning the use of the short-acting opioid remifentanil. Survey in the French part of Belgium (Wallonia and Brussels). Acta Anaesthesiologica Belgica 2009; 60: 75–82
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Muchatuta NA, Kinsella M. Remifentanil for labour analgesia: time to draw breath? Anaesthesia 2013; 68: 231–235.
