Family doctor

Overview:

• Alternative and traditional methods can be used to relieve pain in labour
• Self-hypnosis, acupuncture and TENS are non-pharmaceutical methods
• Nitrous oxide should not be used throughout labour
• Pethidine can be passed through the placenta and is not considered a good drug
• Epidural analgesia is considered the gold standard for pain relief
• There is little evidence it increases intervention during the birth process
• Spinal analgesia is used for Caesarian sections

Pain relief in labour

It is always amazing that analgesia in labour should in any way be a controversial subject. Epidural blockade, the most reliable means of pain relief is often associated with other forms of obstetrical intervention which all tend to be regarded as interference in what would otherwise be a satisfying natural event.

Methods other than traditional medications:

A friendly atmosphere, a good midwife, and homely surroundings are all believed to reduce the need for analgesia in labour.

Self-hypnosis, acupuncture and electro-acupunture all have a place.

Transcutaneous electrical nerve stimulation - TENS. The electrodes are used over the mid back and the strength of the current is adjusted gradually to the maximum amplitude to produce a pleasant sensation. The level can be increased during contractions - in a number of women this works well.

Traditional medications:

Inhalation analgesia. Nitrous oxide is the most widely used gas agent in the UK. Nitrous oxide mixed in a 50:50 mixture with oxygen is used. It's analgesic properties are nothing more than average. It can cause lightheadedness and nausea. During the transition stage to full dilation is it is useful but it's long-term use throughout labour should be avoided.

Pethidine is a powerful sedative. It increases the incidence of nausea and vomiting and it's analgesic efficacy is not great, producing only about a 20 percent reduction in pain. Pethidine crosses the placenta and can accumulate in the fetal tissues, causing respiratory depression in the newborn. It is not a good drug to be used in labour.

Epidural analgesia. An injection is given in the back which acts on nerves leaving the spine to the pelvic organs, perineum and legs. It is the gold standard of pain relief in labour. With modern methods of epidural blocks, mothers may even be able to walk around during labour.

Epidurals DO NOT prolong the first stage of labour. It may however reduce uterine activity in the second stage of labour.

There is little evidence that epidurals increase the instrument delivery rate. In fact, it may do the opposite. A painful second stage may affect cooperation. Time and patience in women with epidurals is often rewarded by a spontaneous vaginal birth.

Epidurals have never been shown to affect the baby.

Indications for epidural:

• Pain relief
• High blood pressure
• Trial of labour in women with a previous Caesarian section
• Forceps or vacuum delivery
• Pre-term labour
• Twins
• Breech delivery
• Caesarian section
• Contraindications
• A Bleeding condition
• Sepsis on the back
• A fused spine

Spinal analgesia

An injection into the back is given. This time into the spinal canal. The indications are usually for Caesarian sections or any other operative procedure requiring rapid analgesia. It cannot be topped up and the duration of effect is limited. The analgesia is excellent.