Dr. L. Almaghur

To list the different types of pain relief used in labour.

To understand the advantages, disadvantages and contraindications to each methods.

Ischemia of uterine muscles. Dilatation and strengthening of the

cervix. Stretching of the perineum in the second

stage of labour.

respect the woman’s wish

Panadol + NSAID

Simple analgesia is usually ineffective in controlling labour pain

X

Good analgesia. Easy to administer. Safe to the mother and baby. Easily reversible if necessary. Does NOT interfere with uterine

contractions. Does NOT effect mobility.

Non-pharmacological: Relaxation. TENS. Hypnosis. Acupuncture Hydrotherapy.

Pharmacological: Opiates. Inhalational. Epidural.

Essential in all cases. Antenatal classes to educate the mothers

on what to expect. Helps mothers to cope with pain and

satisfaction with pain relief. Carries no risk to the mother and fetus.

Low grade electronic waves to nerves supplying the uterus via skin electrode.

Provides good pain relief to 25% of patients.

Not available in our hospital. Carries no risk to the mother and fetus.

Reported to be successful. Needs special skill and preparation. Carries no risk to the mother or fetus. ??? Placebo effect Does this matter????

Pethidine and diamorphine are the commonly used drugs.

Given inter-muscular or intravenous repeated when necessary.

Offers good pain relief for most patients. Short duration of action.

Nausea and vomiting. (antiemetic) Can cross BPB respiratory

depression in the new born. (Nalaxone)

The commonest is nitrous oxide. Self administered to the patient via face

mask. Given in a 50-50 mixture with oxygen

(Entanox).

Provides analgesia varying from good to ineffective.

Under control of the patient. Minimal adverse effects to mother and

fetus.

not adequate for second stage, instrumental delivery, suturing of perineum or manual removal of placenta.

Light headedness and nausea. Not suitable for prolonged use.

الوالدة بدون ألم

Plastic catheter introduced into the epidural space.

Catheter is left in and the analgesia is given continuously.

Bupivican and Fentanyl

The most effective pain relief. The absence of pain allows enjoyment

and control of labour. Reduces maternal fatigue and anxiety. Ideal in high risk pregnancies e.g. breech,

MP, and PET.

Restriction of movement during labour. Requires CTG. Requires resident anesthesia, cardio-

respiratory facilities and one to one care. ?increase rate of instrumental delivery. Beware of urine retention.

Failure 3%. Hypotension. Epidural tap (headache) ? Back pain. Paralysis !!!!!!!!!.

Nerve blocks. Spinal anesthesia. General anesthesia.

Performed by the obstetrician. Used for outlet forceps and vacuum

delivery.

Can be used for … Instrumental delivery. Manual removal of placenta. Repair of third degree tear.

Site. Onset. Duration.

Maternal refusal. Hypovolemia. Sever back deformities, Local infection. Coagulation disorders.

Manual removal of placenta. Third degree tear

Labour is a painful experience. Pharmacological and non-

pharmacological method are used for pain relief.

Each method had its advantage and disadvantage and the choice of method depends on the stage of labour and maternal preference.