Key content
The rising trend in levels of advanced care for women in labour has prompted the recommendation for the development of safe and effective alternatives to regional analgesia.
The most powerful influence on a woman’s satisfaction with pain relief appears to be the attitude and behaviour of her caregiver.
Despite the continued lack of any high-powered randomised controlled trials, there are a number of simple and safe nonpharmacological options available for pain relief.
Evidence suggests that intramuscular diamorphine is a better analgesic than intramuscular pethidine.
Remifentanilpatient-controlled analgesia has emerged as an alternative to regional anaesthesia but there are concerns with its safety.
Epidural analgesia remains the most effective form of pain relief for labour.
Learning objectives
To provide an overview of the different types of analgesia available
for labour.
To understand the mechanism of action, dosages and adverse effect
profiles of pharmacological analgesics.
To discuss regional analgesia and their indications
and contraindications.
Ethical issues
Should regional analgesia be offered on request to women who are
at or near full dilatation?
Should all women with a raised body mass index be encouraged to
have an early epidural in labour?
What is an acceptable time to wait for an epidural in labour?
Keywords: anaesthesia / analgesia / labour
Introduction
Non-pharmacological methods
Continuous one-to-one support and the care provider
Music
Acupuncture and acupressure
Birthing balls and posture
Transcutaneous electrical nerve stimulation
Pharmacological methods
Nitrous oxide (gas and air)
Non-opioid analgesics
Opioids
Patient-controlled analgesia
Conclusion
Analgesia in labour plays a crucial part in affecting maternal satisfaction during one of the most painful periods of a woman’s life.
provides an overview of the evidence for the analgesic options
discussed. Also key to providing the best possible analgesia for
the labouring woman is the provision of appropriate and
relevant information on labour analgesics and continuous oneto-
one support from a trained individual provider during
labour. While a number of pharmacological and nonpharmacological
options exist for labour pain, epidural
anaesthesia remains the gold standard for severe pain. Over
the last decade, the biggest changes in labour analgesia in the
UK have been the spectrum of non-pharmacological
treatments available and the advent of remifentanil PCA.
Continuing safety concerns and issues with clinical
effectiveness with prolonged use have, however, limited the
widespread adoption of remifentanil PCA.