Pain relief in labour

objectives To list the different types of pain relief used in labour. To understand the advantages, disadvantages to each method

Why is labour painful? Dilatation and strengthening of the cervix. Stretching of the perineum in the second stage of labour.

Who needs pain relief? respect the woman’s wish

The ideal analgesic in labour Good analgesia. Easy to administer. Safe to the mother and baby. Easily reversible if necessary. Does NOT interfere with uterine contractions. Does NOT effect mobility.

Types of pain relief in labour Non-pharmacological: Relaxation. TENS. Pharmacological: Opiates. Gas and air Epidural.

Relaxation Essential in all cases. Antenatal classes to educate the mothers on what to expect. Helps mothers to cope with pain and satisfaction with pain relief. Carries no risk to the mother and fetus.

Transcutaneous nerve stimulation (TENS) Low grade electronic waves to nerves supplying the uterus via skin electrode. Provides good pain relief to 25% of patients. Carries no risk to the mother and fetus.

opiates Pethidine and diamorphine are the commonly used drugs. Given inter-muscular or intravenous repeated when necessary.

Advantages: Offers good pain relief for most patients. Short duration of action.

Disadvantage: Nausea and vomiting. Can cross the placenta causing respiratory depression in the new born.

Inhalational anesthesia The commonest is nitrous oxide. Self administered to the patient via face mask. Given in a 50-50 mixture with oxygen (Entanox).

Advantages Provides analgesia varying from good to ineffective. Under control of the patient. Minimal adverse effects to mother and fetus.

Disadvantage: not adequate for second stage, instrumental delivery, suturing of perineum or manual removal of placenta. Light headedness and nausea. Not suitable for prolonged use.

Epidural anesthesia Plastic catheter introduced into the epidural space. Catheter is left in and the analgesia is given continuously

Advantages: The most effective pain relief. The absence of pain allows enjoyment and control of labour. Reduces maternal fatigue and anxiety. Ideal in high risk pregnancies e.g. breech

Disadvantage: Restriction of movement during labour. Requires resident anesthesia, cardio-respiratory facilities and one to one care.

Complications: Failure 3%. Epidural tap (headache) Back pain. Paralysis !!!!!!!!!.

summary Labour is a painful experience. Pharmacological and non-pharmacological method are used for pain relief. Each method had its advantage and disadvantage and the choice of method depends on the stage of labour and maternal preference.

Remember what you get at the end !!