Analgesia in labour

Question 1

epidural pros

Answer 1

Most effective way of relieving pain in labour

No need for more analgesia/general anaesthetic if instrumental or caesarean required.

No increase in perineal trauma and pelvic floor muscle weakness

Question 2

epidural cons

Answer 2

Dizziness or shivering may occur

It increases length of 2nd stage, and rates of operative vaginal delivery.

Transient hypotension

Greater levels of monitoring of mother and child required

severe headache in 50%.

Not available in the community

Question 3

combined spinal-epidural summary

Answer 3

Faster onset of pain relief
No difference in incidence: forceps delivery, caesarean section or neonatal admission

CSE women experience more itch

Question 4

entonox summary

Answer 4

during painful contractions during 1st and 2nd stages of labour

Under px control, works within seconds and wears off quickly with no side-effects

Half of women obtain satisfactory relief.

Generally considered safe, but case of severe hypoxaemic episode

Question 5

IM opiate summary

Answer 5

Pethidine IM - effective in 15 mins lasts 2-3 hours.

May work by reducing anxiety and discomfort.

Question 6

LA uses

Answer 6

no epidural but require forceps or vacuum extraction delivery.

Also for repair of episiotomy or perineal tear.

Question 7

TENS summary

Answer 7

block pain impulses, stimulate the body to produce natural endorphins.

o Poor evidence, but high patient satisfaction

Question 8

complementary therapies

Answer 8

Acupuncture & self-hypnosis may be useful

Water birthing may help

Question 9

non-pharmacological pain relief

Answer 9

massage
breathing & relaxation
water
mobilising