Analgesia and anaesthesia in labour

Labour is one of the most painful experiences a human encounters. Modern practice encompasses a number of techniques to alleviate this, from complementary therapies to invasive procedures. Pain induces a physiological stress response which has a number of deleterious effects on the body. Pharmacological methods of pain relief are the most popular – namely nitrous oxide, opioids and epidural analgesia. The latter is by far the most effective and is regarded as the gold standard. Importantly, intrapartum opioid use is associated with the risk of neonatal respiratory depression. Nonpharmacological techniques comprise a number of modalities of varied efficacy. Of these, hydrotherapy, acupuncture, continuous labour support and intradermal water blocks show the most promise. None of the methods available constitute the ideal analgesic for labour and the choice should be based on maternal preference, with regular re-evaluation to ensure adequate effect.