Treatment options for the relief of pain during childbirth.

Despite its severity, the disposition of women towards pain during childbirth is influenced by many complex personal and cultural factors. Such influences may inspire a degree of stoicism towards labour pain which would be extraordinary in other painful circumstances. Nevertheless, the majority of women who deliver in a modern obstetric unit request some form of pharmacological pain relief. An important component of proper antenatal education, therefore, is to provide impartial information about the various analgesic alternatives which are available within each centre. Regimens of analgesia which depend on the systemic absorption of drugs (e.g., parenterally administered opioids; inhalational analgesia) are simple to administer but they have limited efficacy and are commonly associated with unpleasant central side effects. While some innovations in actual drug administration have been introduced, it is unlikely that any further major improvements will be feasible using the systemic approach to analgesia. Epidural analgesia has become established as the most effective and consistently reliable method of providing pain relief in labour. Recent advances have demonstrated that many of the adverse effects traditionally associated with epidural analgesia can be substantially reduced by administering local anaesthetics in smaller doses. It is becoming apparent that additional patient benefits are possible when epidural opioids are also used in combination with local anaesthetics. Techniques which allow the mother to exercise personal control over her epidural analgesia requirements are received more favourably and may help reduce the need for obstetric intervention.