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36. Pain relief in labour

By Dr Joe Kabyemela, MD

Labour is painful. There is no argument about that.

The perception, of course, differs widely among individual women but many will tell you that labour was the most intensely painful experience of their lives.

The need for pain relief differs among individuals. The range is from those who are absolutely resolute that they do not want anything chemical or otherwise throughout labour to those who actually demand to be ‘put out’, an option which is of course unavailable in any labour ward repertoire.

There are four broad groups of pain relief in labour:

General measures: which include mobility, breathing exercises and warm baths (as in water-birth)

Light self-administered methods, which include the TENS machine and using entonox (‘gas and air’)

Systemic opiates, including diamorphine and pethidine (there are other related synthetic drugs used less often that are just as effective)

The so-called "regional analgesia" in the form of, an epidural.

Of all these, the epidural method is superior by a long way. It is the only method where complete pain relief can be promised and delivered. In a small minority of women, this is unfortunately not achieved. Moreover, in a small number of women, the epidural is not suitable or may even be contraindicated.

There are no absolute contraindications for any of the other methods.

Water birth may be unsuitable for some (see Chapter 40, "Water birth").

Overall, pain control in labour should be tailored according to the needs and wishes of the individual. One aspect that we have always regarded with dismay is a restrictive birth-plan. It is not unusual to find a birth-plan prepared antenatally which states categorically that "I do not wish to be offered an epidural under any circumstances at any stage of labour".

Such statements are commonly a result of pregnancy classes, where some so-called experts impose their personal opinions on unsuspecting and trusting women. Any such individual who influences such a decision deserves condemnation in the strongest possible terms.

It is the duty of anybody in that position to present the facts and facts only to his or her clients and allow them to make up their own minds. In the area of pain relief, the enduring wisdom is for the woman to be open-minded and to consider all the options, depending on her needs at the time. This is as long as she knows what each of the options entails.

Those are the facts she should be offered in the antenatal class and the facts that are presented here.

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TENS machine 'Gas and Air' Oral medication Injectables Epidural