Labour - Pain Management

Question 1

Valid non-pharmacological options for pain management

Answer 1

Breathing** -> allows maternal relaxation, and relaxation of pelvic floor (may tense due to pain) -> this can ease passage

Bath -> soothing, easier to move around, eases tension from weight

Heat- hot packs

Shower

Massage

Aromatherapy

Position change - any position she wants to be in is fine. Good to change around regularly 20 mins or so

Question 2

List the main pharmacological / more medical options for labour pain relief:

Answer 2

Nitroud Oxide
TENS machine
Narcotics:
- Pethidine
- Morphine
- Remifentanil
Epidurals

Question 3

Nitrous Oxide

Answer 3

Can be given with anything/anywhere
Mother can hold onto it, taking 4-5 breaths at a tme
Causes light-headed effect
SHould be given during contractions, NOT in the intervals in between

Can cause nausea/vomiting in some
Some don’t like light-headed feeling

Question 4

TENS

Answer 4

Electrical Nerve Stimulation
Patch electrodes attached to skin on back
Idea - to confuse nerve pain pathways

Woman can press the button when she feels the contraction coming, and will get tingling sensation

**Must be hired from physiotherapist - not supplied by hospital

**By transitional stage, many women find this useless

Question 5

Pethidine

Answer 5

Often given early in labour (ideally) due to half-life of 3-4 hours. Need to examine cervical dilation before administration. If 3-4cm dilated, ok to give ‘full’ dose of 100mg IM + 10mg maxolon (to preent nausea/vomiting)

If ~7cm dilated, can give 30mg IV (1.5 hour half-life)

Canot be given too close to delivery because will affect the baby - baby will emerge being affected by the narcotics

Question 6

Morphine

Answer 6

Can be given at 10mg IM or 2.5mg increments IV

Question 7

Remifentanil

Answer 7

is patient-controlled analgesia, given in tiny incremends. Very short acting - can be infused every 5 mins

Question 8

Epidural

Answer 8

End-of-the-line drug, safe in most cases

Can be given at any point up until the time when pushing starts (i.e. phase 2 of labour)

*Requires some planning ahead as requires anaesthetist which can take time.

Catheter inserted into epidural space, and remains there for rest of labour so more drug can be infused as necessary

Inserted under local anaesthetic

Question 9

Epidural Side effects

Answer 9

Can cause vasodilation with drop in blood pressure - thus BP needs to be monitored and IV fluids given. Initially, check BP every 5 mins, then every 30mins

Pain around site of insertion

Paralysis VERRRRRY RARE

Spinal Headaches - VERY severe headaches that can last for days, need to be put in dark room. Obviously disruptive to mother/baby bonding. Pretty rare.

Question 10

How can epidurals affect stage 2 of labour?

What is a potential negative outcome from this?

Answer 10

Mother won’t be able to feel to push.
Thus, Stage 2 tends to go for longer than usual, and also tends to require forceps / vacuum delivery

These manouvres increase risk of post-partum haemorrhage