Clinical Review ABC of labour care

Relief of pain

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7188.927 (Published 03 April 1999) Cite this as: BMJ 1999;318:927
  1. Inger Findley,
  2. Geoffrey Chamberlain

    Labour is usually painful. Exceptionally, a very few women may not feel pain; others can control their response so as to reduce pain. Most women think that pain is going to be a major part of giving birth. Professionals can help to reduce women's fears by giving precise, accurate, and relevant information beforehand and explaining what pain relief will be available at the place where the woman will be in labour. If a women has plans about the sort of pain relief she wants, these should be discussed in advance with the woman and her partner.

    Causes of labour pain

    • Stretch of the cervix during dilatation

    • Ischaemia of the muscle wall of the uterus with build up of lactate

    • Stretch of the vagina and perineum in the second stage

    View this table:

    Percentages of women using pain relief (based on the reports of the National Birthday Trust surveys)

    The National Birthday Trust has performed nationwide surveys since the second world war, and the table shows the proportions of women going through labour using various methods of analgesia. Chloroform and trilene are no longer used; pethidine achieved a popularity that is now waning;nitrous oxide is a mainstay; and epidural and spinal methods are increasing in use.

    Equipment for self administration of nitrous oxide and oxygen (Entonox) with a mouth piece (top) and a face mask (bottom

    The trust's 1990 report, Pain Relief in Labour, is based on the experiences of over 10 000 women who delivered in the United Kingdom during one week. It is the best source of national statistics on both pharmacological and non-pharmacological analgesics. Much of this article is based on the report; some practices may have changed in the years since the survey—for example, the increased use of epidural and spinal anaesthesia for caesarean section.

    Pharmacological methods

    Nitrous oxide

    Premixed nitrous oxide and oxygen is now provided …

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