Labour pains is one of the most severe pain known to mankind. Pain relief during labour has always been associated with religious and social taboos. However there has been a quest to develop pain free and safe delivery to mother and child.

As shown above labour pains are some of the worst pains known. Pain during childbirth varies greatly among women. The parity status, fear, anxiety, expectation, socio cultural factors, induction of labour with prostaglandin’s and degrees of changes with the progress of labour, all influence the labour pain.

History

The First  record of ether in labour was by Simpson and the first Lady to get anaesthesia in labour was Fanny Longfellow wife of poet Longfellow in 1847.   In 1853, John Snow  administered Queen Victoria chloroform to relieve labor pain during the birth of Prince Leopold, ending any moral opposition to pain relief during childbirth. In 1956, Pope Pius XII approved pain relief during childbirth. Then began the era of twilight sleep by German obstetricians Bernhardt Kronig and Karl Gauss. It used the process of sedation and had many adverse maternal and perinatal outcomes. In the 1940s, Hershenson established the first “Division of Obstetric Anesthesia” in the US at the Boston Lying-In Hospital. In 1953, Apgar invented her simple “score”, “the Apgar”, which defines the condition of all of today’s new babies, and correlates with their immediate outcome.

Modern day practices

Regional analgesia is currently the gold standard of practice for pain control in obstetrics and is likely to continue. Epidural analgesia with epidural narcotics is used in present day practice. It gives good pain relief and minimises adverse outcomes in labour.

Non-pharmacological methods

These methods are easier to administer; however, some may be expensive, and there is not enough research/evidence supporting their efficacy.

• Transcutaneous electrical nerve stimulation (TENS)
• Relaxation/breathing techniques
• Hypnosis
• Massage

Pharmacological Methods:

Inhalation: Nitrous oxides commonly known as laughing gas.

Systemic analgesics

• Meperidine (Pethidine)
• Morphine
• Diamorphine
• Fentanyl

Epidural Analgesia:

In this a thin catheter is passed in the epidural space of the lumbar spine and a combination of drugs is infused. Motor nerve block isn’t there so the lady can participate in labour. But it gives good pain relief. It is relatively safe and doesn’t have major perinatal side effects.
“Placing a child in arms of pain free mother has always been the dream of obstetricians.”