Non-neuraxial analgesia in labour

Abstract

Pain in labour is often described as one of the most severe pains experienced. Neuraxial techniques provide the most effective form of labour analgesia. However, not all women wish to have this or indeed want complete pain relief in labour. There are also subgroups of women in whom neuraxial techniques are contraindicated or attempted placement is unsuccessful. Therefore delivery units must be able to offer a range of non-neuraxial analgesia options for labour. Royal College of Anaesthetists CPD Matrix: 1A02, 1D02, 2B01Women in labour expect to have effective analgesia and are disappointed when this is not the case. The degree of analgesia desired varies widely, with two-thirds of women questioned wanting the minimum amount of drugs to allow them to cope with the pain of labour. 1 It is therefore important that we are able to offer a range of analgesic options and ensure we give goodquality information about the different options available to aid women in making a choice most appropriate to their needs. This article will focus on non-neuraxial techniques of analgesia: non-pharmacological and pharmacological (Table 1). Non-pharmacologicalLabouring women use a range of non-pharmacological techniques for pain relief with varying effects and evidence for their use. There is some evidence to support the use of relaxation, immersion in water, acupuncture and massage, but insufficient evidence for the use of transcutaneous electrical nerve stimulation (TENS), sterile water injections, aromatherapy, biofeedback and hypnotherapy. 2 Even the techniques with poor evidence of efficacy are found useful by many women and can improve maternal satisfaction. RelaxationRelaxation techniques (breathing exercises) are often taught in antenatal classes. By focussing on breathing, it helps women to stay in control and conserve energy. Relaxation techniques are thought to provide analgesia and better maternal satisfaction with childbirth. 3