Pain relief during labour

Question 1

A 20-year-old G1P0 asks about pain relief during labour and potential side effects. How would you counsel her?

Answer 1

Impression
Pain in labour can be severe and significant, important to offer appropriate pain relief to patients who request it, important to discuss options for pain relief, pro’s cons’, Come to patient centred plan for delivery.

Question 2

pain relief during labour - history

Answer 2

History:
Not hugely relevant but gain all appropriate O&G details
sx: details of previous labour,
- expectations for coming birth, preferences for pain relief
- O&G Hx: GTPALS, yellow books, scans, vaccinations, etc
- PMHx, PSHx
- Fam Hx
- Medications, Allergies
- Psychosocial

Question 3

Pain relief during labour - Examination

Answer 3

Examination

• General + vitals
• Routine antenatal assessment

Question 4

Pain relief during labour - Investigations

Answer 4

Investigations

• nil relevant unless pathology detected on history/exam
• anaesthetic assessment pre-caesar/induction/labour

Question 5

Pain relief during labour - Management

Answer 5

Management
- patient education: involve MDT with midwives etc, birth planning,
Anaesthetic planning
- environment: chill, quiet, dark
- supportive people
- low-resource: breathing exercises, massage
- moderate: aromatherapyy, sterile water injection, TENS
- high: Nitrous oxide gas, Epidural block

GA only in high-risk pregnancy and c-section