Labour Analgeisa

Question 1

What are the drug-free techniques for labour analgesia?

Answer 1

• Ball
• Bath
• TENS
• Hypnobirth
• Aromatherapy

Question 2

What are the simple drug therapies for labour analgesia?

Answer 2

• Entonox
• Diamorphine
• Reminfentanil PCA (patient-controlled analgesia)

Question 3

What is entonox?

Answer 3

• “gas and air”
• Breathed in on contraction
• 1/2 nitrous oxide
• Takes 30 seconds to work
• Don’t take between contraction

Question 4

What are the pros of entonox?

Answer 4

• Can be used alongside many other analgesics
• Safe
• Patient in control
• Works and wears off quickly

Question 5

What are the cons of entonox?

Answer 5

• Dizzy, dry mouth, sick
• Helps patient cope with pain but does not remove it
• Takes practice

Question 6

What is diamorphine?

Answer 6

• Opioid

* Given as leg injection

Question 7

What are the pros of diamorphine?

Answer 7

• Works in 30 mins
• Lasts 4 hours
• Relaxes
• Helps patient cope

Question 8

What are the cons of diamorphine?

Answer 8

• Nausea
• Lethargy
• slows breathing
• Similar effects on baby - can be given injection after birth to reverse effects

Question 9

What is reminfentanil PCA?

Answer 9

• Opioid
• Short-acting
• Attached to hand cannula
• Overseen baby midwife and anaesthetic team
• NIV O2 required when using
• Takes a minute
• Timing takes practice
• Max 1 dose every 2 minutes
• Only patient can press button to avoid side-effects

Question 10

What are the pros of reminfentanil PCA?

Answer 10

• Patient is in control
• Works and wears off quickly
• Strong pain killer

Question 11

What are the cons of reminfentanil PCA?

Answer 11

•May slow breathing - extra O2 and monitoring
•Drowsy, sick, itchy
•Cannot use if diamorphine within last 4 hours
•Cannot walk around once using
(•Side-effects wear off quickly)

Question 12

What are the advanced techniques for labour analgesia?

Answer 12

•Epidural

Question 13

What is an epidural?

Answer 13

• Small plastic tube which sits in the lower back
• Local anaesthetic supplied through tube
• Anaesthantist consultation
• Sit-up while the epidural is put in
• Takes 20 mins to work - can still use entonox
• Connected to epidural pump
• Button for extra medicine - limited

Question 14

What are the pros of an epidural?

Answer 14

• Most work well
• Unlikely to affect baby
• Patient in control - to an extent
• Can be used for theatre

Question 15

What are the cons of an epidural?

Answer 15

• Can slow pushing phase of delivery
• Risk of forceps/ventouse
• Drop in blood pressure
• Itching, fever
• Sore area on back
• 1% develop headache

Question 16

What are the serious but rare complications of an epidural?

Answer 16

• Temporary nerve damage
• Nerve damage lasting for more than 6 months
• Epidural abscess
• Meningitis
• Epidural haematoma
• Accidental unconsciousness
• Severe injury