Pain Relief in Labour

Question 1

Non medical management of pain in labour

Answer 1

Antenatal classes:

• 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

Simple analgesia

Answer 2

Paracetamol is frequently used in early labour

Codeine may be added for additional effect

NSAIDs are avoided

Question 3

Gas and Air (Entonox)

Answer 3

Gas and air contains a mixture of 50% nitrous oxide and 50% oxygen.

Used during contractions for short term pain relief.

The woman takes deep breaths using a mouthpiece at the start of a contraction, then stops using it as the contraction eases.

Question 4

Side effects of entonox

Answer 4

It can cause lightheadedness, nausea or sleepiness

Question 5

Intramuscular Pethidine or Diamorphine

Answer 5

Opioid medications

Helps with pain and may help with anxiety and distress

Question 6

Side effects of IM pethidine or diamorphine

Answer 6

Drowsiness or nausea in the mother

Can cause respiratory depression in the neonate if given too close to birth.

The effect on the baby may make the first feed more difficult

Question 7

Patient Controlled Analgesia

Answer 7

Patient-controlled IV remifentanil

Involves the patient pressing a button at the start of a contraction to administer a bolus of this short-acting opiate

Requires careful monitoring, input from an anaesthetist and facilities in place if adverse events occur

Question 8

Side effects of patient controlled analgesia

Answer 8

Respiratory depression

Bradycardia

Question 9

How to treat respiratory depression

Answer 9

Naloxone

Question 10

How to treat bradycardia

Answer 10

Atropine

Question 11

Epidural

Answer 11

Involves inserting a catheter into the epidural space in the lower back

Local anaesthetic medications are infused into the epidural space, where they diffuse to the surrounding tissues and through to the spinal cord

Offers good pain relief during labour

Question 12

Epidural space

Answer 12

Outside the dura mater, separate from the spinal cord and CSF

Question 13

Local anaesthetic options for an epidural

Answer 13

Levobupivacaine or bupivacaine, usually mixed with fentanyl

Question 14

Adverse effects of an epidural

Answer 14

Headache after insertion

Hypotension

Motor weakness in the legs

Nerve damage

Prolonged second stage

Increased probability of instrumental delivery

Question 15

If woman develop motor weakness

Answer 15

Urgent anaesthetic review

Epidural may be in the subarachnoid space