Pain Relief in Labour
Pain during labour is generally severe, with only 2-4% of women reportng minimal pain in labour
Analgesia during normal labour is not mandatory but all women should be aware of the optons available
to them.
Indicatons:
Recommended -
- Cardiac disorders
- Suspected difcult intubaton
- Breech
- Multple pregnancy
Mandatory -
- Assisted vaginal delivery
- Perineal repair
- Manual removal of placenta
- C-secton
Physiology of pain in labour:
- First stage of labour: Cervical dilaton and uterine contractons myometrial ischaemia pain
sensaton travels from uterus via visceral aferents/sympathetc nerves enter the spinal cord
through the posterior segment of the thoracic spine at T10-T12 Pain perceived by brain
- Second stage of labour: Distenton of the pelvic foor/vagina/perineum due to the presentng part of
the foetus Pain signals travel from these organs via sensory fbres of the sacral nerve at S2-S4
(pudendal nerve) Pain perceived by brain
Types/Details Advantages Disadvantages
NON- Holistc (Acupuncture, No/few side efects Not efectve for severe pain
PHARMACOLOGICA Hypnosis, Aromatherapy) -
L TECHNIQUES Unproven efects
Relaxaton – e.g. Warm
baths, Massage, Breathing
exercise, Psychoprophylaxis
/Lamaze classes
TENS – promotes
endogenous encephalin
release within the spinal
cord, where it inhibits pain
transmission.
GENERAL GA which is administered Very quick delivery Aspiraton
ENDOTRACHEAL through EDT. Pt remains (ideal in emergency Pneumonia or
ANAESTHESIA unconscious while gas is being C-secton, or Pneumonits
supplied through the tube. Instrumental) (‘Mendelson
Relaxes the cervix – syndrome’)
Agents: aids in breech Hypoxic cerebral injury
Lidocaine Low risk of (if EDT obstructed)
Fentanyl hypovolemia+ Neonatal depression
Propofol haemorrhage Upper airway injury
PPH (Atony)
SYSTEMIC Opiate agonists Opiate agonists – General
ANALGESIA - Pethidine IV (1mg/kg) Very effectve N+V
- Morphine IV Reversal agent Resp. depression
- Diamorphine IV available (naloxone) Over-sedaton
- Remifentanil IV (good Partal opioid Decreased FHR
alternatve to epidural agonist/antagonist – Opiate agonists –
if contraindicated) Few S/Es Delayed gastric
Pain during labour is generally severe, with only 2-4% of women reportng minimal pain in labour
Analgesia during normal labour is not mandatory but all women should be aware of the optons available
to them.
Indicatons:
Recommended -
- Cardiac disorders
- Suspected difcult intubaton
- Breech
- Multple pregnancy
Mandatory -
- Assisted vaginal delivery
- Perineal repair
- Manual removal of placenta
- C-secton
Physiology of pain in labour:
- First stage of labour: Cervical dilaton and uterine contractons myometrial ischaemia pain
sensaton travels from uterus via visceral aferents/sympathetc nerves enter the spinal cord
through the posterior segment of the thoracic spine at T10-T12 Pain perceived by brain
- Second stage of labour: Distenton of the pelvic foor/vagina/perineum due to the presentng part of
the foetus Pain signals travel from these organs via sensory fbres of the sacral nerve at S2-S4
(pudendal nerve) Pain perceived by brain
Types/Details Advantages Disadvantages
NON- Holistc (Acupuncture, No/few side efects Not efectve for severe pain
PHARMACOLOGICA Hypnosis, Aromatherapy) -
L TECHNIQUES Unproven efects
Relaxaton – e.g. Warm
baths, Massage, Breathing
exercise, Psychoprophylaxis
/Lamaze classes
TENS – promotes
endogenous encephalin
release within the spinal
cord, where it inhibits pain
transmission.
GENERAL GA which is administered Very quick delivery Aspiraton
ENDOTRACHEAL through EDT. Pt remains (ideal in emergency Pneumonia or
ANAESTHESIA unconscious while gas is being C-secton, or Pneumonits
supplied through the tube. Instrumental) (‘Mendelson
Relaxes the cervix – syndrome’)
Agents: aids in breech Hypoxic cerebral injury
Lidocaine Low risk of (if EDT obstructed)
Fentanyl hypovolemia+ Neonatal depression
Propofol haemorrhage Upper airway injury
PPH (Atony)
SYSTEMIC Opiate agonists Opiate agonists – General
ANALGESIA - Pethidine IV (1mg/kg) Very effectve N+V
- Morphine IV Reversal agent Resp. depression
- Diamorphine IV available (naloxone) Over-sedaton
- Remifentanil IV (good Partal opioid Decreased FHR
alternatve to epidural agonist/antagonist – Opiate agonists –
if contraindicated) Few S/Es Delayed gastric
