What medication should be avoided in a multipara in active labor due to the risk of respiratory depression in the newborn?

Meperidine, also known as Demerol, is a medication that should be avoided in a multipara in active labor due to its potential risk of causing respiratory depression in the newborn. This is especially concerning because meperidine can cross the placenta and may have effects on the fetal respiratory system. Newborns, particularly those who are already vulnerable due to the stresses of labor, can experience significant respiratory complications if exposed to medications that depress their central nervous system.

Unlike some other opioids, meperidine has a unique metabolite, normeperidine, which can accumulate in the fetal system and contribute to respiratory depression. This makes it particularly risky for use during labor, as the newborn is still transitioning from intrauterine to extrauterine life, and their respiratory drive may be diminished by the medication.

In contrast, other opioids like fentanyl, hydromorphone, and oxycodone, while also capable of causing respiratory depression, do not have the same potential complications related to their metabolites and are often used more cautiously in labor settings under medical guidance. Therefore, while they still require careful consideration, meperidine's profile makes it especially important to avoid during active labor to safeguard the newborn’s well-being.