pain relief in labour

what may be causing pain during the first stage of labour?

ischaemia of cervical wall from contractions

what is ischaemia?

lack of blood suppy to tissues

what does visceral pain mean?

pain that develops from your internal organs

what does somatic pain mean?

pain that develops from your skin, bone, muscle, ligaments, tendons and joints

what is the difference between visceral and somatic pain?

visceral - dull and poorly localised

somatic - sharp and easily localised

what nerve roots usually transmit visceral pain?

T10-L1

what nerve roots usually transmit somatic pain?

S2-S4

what type of pain occurs in the first stage of labour?

visceral pain

what may be causing pain in the second stage of labour?

stretching of pelvic floor, perineum and vagina

what type of pain occurs in the second stage of labour?

somatic pain

what are 4 different types of pain management?

- systemic analgesics

- regional techniques

- pain modulation

- psychological approaches

what are 2 examples of systemic analgesics?

- opioids

- nitrous oxide

how is nitrous oxide administered?

- 50:50 mix with oxygen (entonox)

- inhaled

how quick is the onset/offset of nitric oxide?

rapid - within a few breaths

what are the wanted effects of nitric oxide? (2)

- analgesia

- sedation

what are the negatives of nitrous oxide? (2)

- pollution

- concerns about staff having prolonged exposure

what are 2 examples of opioids?

- diamorphine

- remifentanil

is diamorphine a drug or prodrug?

a prodrug of morphine

how long is the onset of diamorphine?

peaks around 10-20 minutes

what is the half-life of morphine?

2 hours (quite long-lasting)

how long is the onset of remifentanil?

peaks around 2 minutes

what is the half-life of remifentanil?

around 3 minutes

what are some disadvantages of opioids? (4)

- nausea

- respiratory depression

- baby can be sedated

- remifentanil in particular needs intensive monitoring

what are two examples of regional techniques?

epidural and pudendal nerve block

what does epidural mean?

above the dura mater

where is the dura mater located in the spine?

outer layer surrounding the spinal cord

what are the effects of an epidural? (2)

- blocks nerve transmissions

- fairly localised effect

how is an epidural administered? (3)

- local anesthetic is given to numb an area on the back

- a needle is inserted into the lower back near the spinal cord

- a catheter is threaded into the epidural space and medication is injected

what are some disadvantages of epidurals? (4)

- likely to make instrumental delivery more likely (e.g. use of forceps)

- risk of headache

- low blood pressure

- needs intensive monitoring

what is an example of pain modulation?

TENS (neuromodulation)

what are the effects of TENS?

small electrical impulses are delivered to affected area, which can reduce the pain signals going to the brain and spinal cord

how is TENS delivered?

small patches applied to target area and small electrical impulses are sent from machine

is TENS useful in labour and why/why not?

no - not strong enough!

what is an example of a psychological approach?

hypnobirthing

why can hypnobirthing work?

pain and psychology strongly related

what is the pain ladder in labour?

1) non-pharmacological methods

2) nitrous oxide

3) simple analgesia - paracetamol

4) opiate analgesia

5) epidural

6) pudendal nerve block

what are examples of non-pharmacological methods?

- exercise

- heat therapy

- acupuncture

- hypnosis

- massage