Methods of Pain relief in labour

Methods of Pain relief in labour

1. Psychological method: 

This is the most important aspect ofpain relief, because a woman who is already apprehensive with labour pain will relax if she is admitted into a clean, well organized, calm and reassuring environment. The midwife must be sympathetic and understanding. These will alley her fears, relax more and be able to cope with the pain. The personality of the Midwife should reflex kindness, interest in the patient with kind words and deeds. These include:

·              giving of information: as necessary

·              Allaying of anxiety

·              Participating in Planning and care.

·              Giving of physical care.

Support during labour: Massage the back during contractions. Provide hygiene and comfort positioning Bladder and bowel care. Feeding;

2. The Use of Drugs (Chemotherapy)

It is not possible to classify accurately the action of groups of drugs. A small dose of narcotic would act as sedative, while a large dose of tranqullizer would act s hypotic. Since drugs are used for various reasons the Midwife must know the reason for administration of a drug that is to relief pain,alley apprehension, and induce sleep.

The Midwife must have a good knowledge and understanding of the principle underlying the administration of various drugs, and the main action of the drug she administers. Success and safety of drugs depend on:

The choice of the appropriate drug or combination of drugs,

Adequate dosage,

Proper timing, and

Checking the dose.

Drugs used in labour

Analgesics

These are drugs that are supposed to relief pain without rendering the patient unconscious. Examples are panadol, Aspirin fortral etc.

Narcotics: Allay anxiety and induce sleep – strong analgesicwith some sedative effect e.g. pethidine, morphine, pethilorfan, fortal, tramal

Hypnotics: Induce sleep, anti convulsant – chlorahydrate,welldone, Diazeperin, omnopon, paraldehyde

Tranquillisers: Calm patient: Phenegan

Sedatives: Induce sleep – Barbiturate groups.

Lytic cocktail

Refers to any of various mixtures of phenothiazine derivatives and Pethidine for intravenous administratin. E.g. chlorpromazine (Largactil) 50mg. Promethazine (Phenergen) 50mg. Pethidine 100mg.Mixed and given slowly intravenously until a state of sedative, tranquility and analgesia (ataralgesic) is produced.

Use: In the treatment of pre eclampsia and eclampsia, for forceps and breech deliveries and caesarean section.

Inhalational analgesia:

It is permitted by Midwife Board) It is used on healthy women in late first stage of labour or in 2^nd stage of labour. They are volatile agents which are excreted fairly quickly from the body. They include Entonox: Pre mixed nitrous oxide 50% and Oxgyen 50%.

Trilene (trichloroethylene)

A blue liquid evaporates easily into the air to form a non-inflammable vapour. It is an anaesthetic agent with analgesic action. The anaesthetic effect depends on the concentration. It is administered in Emotril Automatic inhaler apparatus.

Obsteric anaesthesia

Anaesthesia means absence of sensation and free from pain or reversible depression of all the senses.

Types of anaesthesia are:

General anaesthesia,

Regional anaesthesia(e.g epidural block, spinal anaesthesia, pudendal block), and Local anaesthesia(e.g. lignocan).

Spinal Anaesthesia:

Technique whereby local anaesthetic solution is injected into the subarachnoid space i.e. into the CSF.

Pudendal block – Local anaesthetic solution is injected adjacentto the pudendal nerves just below the ischial spines where they supply pelvic floor, vulva and perineum.

Paracervical block: These cases the paracervical plexus are blocked. It is used in prolonged labour – 10mls of 1% lignofcaine solution is injected into the lateral fornices of the vagina. It reduces pain and backache in the last 2-3hrs. There is risk of bradycardia – fetal death may occur due to spasm of uterine vessels.

Local anaesthesia

10mls of 0.5% Lignocain is infiltrated into the perineum for episiotomy. The technique used will depend on the type of episiotomy.