Conclusion: 

1. Labour is almost always painful. 

2. Pain does not confer any benefit to the labouring woman or her baby. 

3. An ideal analgesic in labour is one, which is cheap, easy to use and effective with no adverse affects for the mother or baby. Such an analgesic is not available at present. 

4. Psycho prophylaxis, environmental modifications and physical treatments are very useful complementary methods that should be available to all mothers. 

5. A systemic opiate, Demerol (Pethidine), is the most frequently used analgesic in labour world-wide. It is safe and satisfactory for a multi-gravid where a short labour is expected and epidural service is not available. 

6. The lumbar epidural and spinal analgesia provide the most satisfactory labour analgesia. However, in the absence of specially trained personnel, equipment and protocols, the potential for major complication is high. 

Reference: 

1. Arthurs GJ, Rosen M: Self-administered intermittent nitrous oxide for labour. Anaesthesia 34:301, 1979. 

2. Crawford JS: Continuous lumbar epidural analgesia for labour and delivery. BMJ 1:72, 1979.

3. Crawford JS: Relief from pain and anxiety in labour, in Obstetric Analgesia and Anaesthesia. Churchill Livingston. Ch2: 47, 1984. 

4. Crawford JS: Lumbar Epidural Analgesia for Labour and Delivery, a personal view, in The Management of Labour. Ed. Studd J. Blackwell scientific publications. Ch16: 226, 1985.

5. Fishburne JI JR. et al: Response of the Gravid Uterine Vasculature to Arterial Levels of Local Anaesthetic Agents. Am J Obstet Gynecol. 133:753, 1979. 

6.. Glosten B: Local Anaesthetic Techniques in Obstetric Anaesthesia Principles and Practice. St. Louis Mosby-Year book, 354, 1994.

7. Jones CM, Greiss FC: Effects of Labour on Maternal and Foetal Circulating Catecholamines. Am J Obstet. Gynecol. 144:149, 1982.

8. Melzak R: The myth of painless childbirth. Pain 19:321, 1984.

9. Melzak R et al: Labour is Still Painful after Prepared Childbirth Training. CMAJ 125:357, 1981.

10. Moya F, James LS: Medical hypnosis for obstetrics. JAMA 174:2026, 1960.

11. Robson JE: Transcutaneous Nerve Stimulation for Pain Relief in Labour. Anaesthesia 34:357, 1979. 

12. Rosen M: Pain and its Relief, in Benefits and Hazards of the new Obstetrics. Ed. Chard T, Richards M. Spastics International Medical Publications, 1977. 

13. Trotter M: Variations of the sacral canal: The significance in the administration of caudal analgesia. Current researches in analgesia and anaesthesia 26:192, 1947. 

14. Waldron BA: General Pain Relief in Labour, in The Management of Labour. ed. Studd J. Blackwell scientific publications Ch15:213, 1985.

Dr. Indrani Kalaichandran, MBBS, MD, FRCPC
Consultant Anaesthesiologist

Dr. Sivasamboo Kalaichandran, MBBS, MD, MRCOG, FRCSC
Chief, Obstetrics and Gynaecology
Hotel Dieu Hospital, Cornwall, Ontario, Canada
(Word Processing and editing work done by their daughter Sakthi)

Back