Obstetrics and Gynecology · MU Sofia

12. Pain relief in labor

Explains where labour pain originates in each stage, from uterine contractions and cervical dilatation in the first stage to perineal stretching in the second. It then covers non-drug options such as continuous support and water immersion, and sets out drug methods in a comparison table of nitrous oxide, opioids, epidural, combined spinal-epidural, pudendal block and local infiltration with their pros and cons. Epidural contraindications, management of hypotension, and anaesthesia choice for caesarean section close the note.

Inside: 3 sections · 1 table · 16 flashcards · 2 min

Topic 12 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 3 sections, about 164 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Non-drug methods
  3. Drug methods

Introduction

Labour pain comes from uterine contractions and cervical dilatation in the first stage (visceral, T10–L1) and from stretching of the vagina and perineum in the second (somatic, S2–S4, pudendal nerve). Good pain relief is part of safe care.

Non-drug methods

  • Continuous support from a companion or midwife (reduces need for analgesia and operative birth).
  • Mobility and position changes, warm water immersion, massage, breathing techniques, TENS.

Drug methods

Epidural: key points

  • Contraindications: coagulopathy or low platelets (usually < 70–80 × 10⁹/L), therapeutic anticoagulation, infection at the site, uncorrected hypovolaemia, patient refusal.
  • Give IV access and monitor BP and fetal heart; treat hypotension with fluids, left tilt and phenylephrine or ephedrine.
  • An epidural does not increase the caesarean section rate.

Anaesthesia for caesarean section

Regional (spinal or epidural) is preferred. General anaesthesia carries the risks of difficult intubation and aspiration (Mendelson syndrome), so antacids are given and rapid-sequence induction is used.

Epidural analgesia is the most effective method; its main early complication is maternal hypotension, which can cause fetal bradycardia.

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