Pain management follows a stepwise approach

Non-pharmocological methods

• Exercise/movement
• Heat e.g. warm bath, heat pack
• TENs stimulation
• Acupuncture
• Hypnosis
• Massage

Gas and air (Entonox)

• Contains 50% nitrous oxide and 50% oxygen
• Used during contractions for short term pain relief
• Side effects: Lightheadedness, nausea, sleepiness, ⬇️ vit B12 synthesis

Simple Analgesia

Paracetamol is frequently used in early labour. Codeine may be added for additional effect. NSAIDs are avoided.

Opioids

• Pethidine and diamorphine, usually given IM
• Side effects: drowsiness, nausea in the mother (can also happen in baby). Resp distress in baby if given too close to birth