Dr. L. Almaghur

 To list the different types of pain relief used in labour.  To understand the advantages, disadvantages and contraindications to each methods.

 Ischemia of uterine muscles.  Dilatation and strengthening of the cervix.  Stretching of the perineum in the second stage of labour.

respect the woman’s wish

Panadol + NSAID Simple analgesia is usually ineffective in controlling labour pain X

 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.

Non-pharmacological:  Relaxation.  TENS.  Hypnosis.  Acupuncture  Hydrotherapy. Pharmacological:  Opiates.  Inhalational.  Epidural.

 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.

 Low grade electronic waves to nerves supplying the uterus via skin electrode.  Provides good pain relief to 25% of patients.  Not available in our hospital.  Carries no risk to the mother and fetus.

 Reported to be successful.  Needs special skill and preparation.  Carries no risk to the mother or fetus.  ??? Placebo effect  Does this matter????

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

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

 Nausea and vomiting. (antiemetic)  Can cross BPB respiratory depression in the new born. (Nalaxone)

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

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

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

الولادة بدون ألم

 Plastic catheter introduced into the epidural space.  Catheter is left in and the analgesia is given continuously.  Bupivican and Fentanyl

 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, MP, and PET.

 Restriction of movement during labour.  Requires CTG.  Requires resident anesthesia, cardio-respiratory facilities and one to one care.  ?increase rate of instrumental delivery.  Beware of urine retention.

 Failure 3%.  Hypotension.  Epidural tap (headache)  ? Back pain.  Paralysis !!!!!!!!!.

 Nerve blocks.  Spinal anesthesia.  General anesthesia.

 Performed by the obstetrician.  Used for outlet forceps and vacuum delivery.

Can be used for …  Instrumental delivery.  Manual removal of placenta.  Repair of third degree tear.

 Site.  Onset.  Duration.

 Maternal refusal.  Hypovolemia.  Sever back deformities,  Local infection.  Coagulation disorders.

 Manual removal of placenta.  Third degree tear

 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.