• Labour analgesia
    • Non-pharmacological
      • TENS
      • Immersion
      • Massage
      • Accupuncture
      • Hypnosis
    • Pharmacological
      • Pethidine
        • 1mg/kg - max 150mg
        • Nor-perthidine is a convulsant
        • Bound to α1-acid glycoprotein but passes placenta by passive diffusion
        • Ion trapping occurs
          • Can cause neonatal respiratory depression
      • Morphine
        • Bound to albumin
        • Crosses the placenta but maternal metabolism prevents a high fetal drug load
      • Diamorphine
        • More rapid onset than morphine
        • Rapidly eliminated by the placenta
      • Fentanyl
        • May accumulate in foetus and parturient
        • 20μcg bolus, 5 min lockout
      • Remifentanil
        • 0.5μcg/kg 2 min lockout
      • Inhalational
        • Entonox
        • Addition of isoflurane improves analgesia
    • Epidural
      • May have higher incidence of operative delivery
      • Gold standard for pain relief
      • Prolong labour
      • No increase in back pain
      • No consistent differences identified in fetal pH
      • Maternal pyrexia can occur
      • Low dose techniques offer best chance of SVD
      • Opioids added improve maternal satisfaction
      • Walking ok but needs supervision
      • Clonidine not widely used
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/5/1/9.full.pdf
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/4/4/114.full.pdf