9.7 Pain relief in labour

Question 1

Antenatal classes help prepare women for labour. What things can improve pain symptoms without need for medications?

Answer 1

• Understanding what to expect
• Having good support
• Being in a relaxed environment
• Changing position to stay comfortable
• Controlled breathing
• Water births may help some women
• TENS machines may be useful in the early stages of labour

Question 2

What simple analgesia in used in labour?

Answer 2

Paracetamol, plus codeine for more effect

not NSAIDs

Question 3

What is in entonox and what are the side effects?

Answer 3

50% nitrous oxide and 50% oxygen

can cause lightheadedness, nausea or sleepiness.

Question 4

What IM pain relief can be used in labour?

Answer 4

pethidine or diamorphine

also helps with anxiety and distress

Question 5

What are the side effects of using IM pethidine or diamorphine?

Answer 5

drowsiness or nausea in the mother

respiratory depression in neonate if too close to birth and may make the first feed more difficult.

Question 6

Other than IM pethidine and diamorphine what other opiate can be used in labour?

Answer 6

remifentanil

Question 7

How is remifentanil administered?

Answer 7

IV, set up as PCA bolus, quick acting at start of contraction.

Question 8

What else in needed nearby when using IV PCA remifentanil in labour?

Answer 8

anaesthetist input:

naloxone in case of resp depression

atropine for bradycardia

Question 9

What medications are used in an epidural?

Answer 9

local anaesthetics:

• levobupivicaine or
• bupivicaine

usually mixed with fentanyl

Question 10

What are some adverse effects of an epidural?

Answer 10

• Prolonged second stage
• Increased probability of instrumental delivery
• Headache after insertion
• Hypotension
• Motor weakness in the legs (if significant needs review - could be in subarachnoid space)
• Nerve damage