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

3.  Dilatation and strengthening of the cervix.  Stretching of the perineum in the second stage of labour.

4. respect the woman’s wish

5.  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.

6. Non-pharmacological:  Relaxation.  TENS. Pharmacological:  Opiates.  Gas and air  Epidural.

7.  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.

8.  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.

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

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

11.  Nausea and vomiting.  Can cross the placenta causing respiratory depression in the new born.

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

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

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

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

16.  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

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

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

19.  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.