There are various forms of pain relief available during labour:

U.S. National Oceanic and Atmospheric
Administration (public domain).

Transcutaneous electrical nerve stimulation

Transcutaneous electrical nerve stimulation (TENS) is useful in the latent phase/early stage of labour. The mother can remain mobile.

Entonox (nitrous oxide)

Entonox consists of 50% nitrous oxide and 50% oxygen. It is self-administered and the peak action is about 30 seconds after the start of administration. It is exhaled unchanged by the lungs and therefore doesn't accumulate and has a rapid offset of action at about 60 seconds.

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Opiates (e.g. pethidine/diamorphine)

Opiates are given intramuscularly. They take 20 minutes to work and are effective for 2-4 hours. Note that opiates:

  • may slow the latent phase of labour
  • have no effect on the active phase of labour
  • can cause reduced variability on CTGs and neonatal respiratory depression

Regional (epidural/spinal)

  • Higher rates of maternal satisfaction with analgesia
  • May slow the latent phase and second stage of labour
  • Increases likelihood of requiring operative assistance (changes tone of pelvic floor and decreases urge to push)
  • Higher likelihood of SVD with delaying pushing for 1–2 hours to allow passive descent until strong urge to push
  • In nulliparous women, syntocinon in the second stage reduces need for forceps delivery

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