Abdollahi MH, Dareshiri S, Mallah F, Mohammadi S, Mojibian M, Naghavi-Behzad M, Pishgahi A Intravenous paracetamol versus intramuscular pethidine in relief of labour pain in primigravid women. Niger Med J. 2014; 55:(1)54-57

Alleemudder DI, Kuponiyi Y, Kuponiyi C, McGlennan A, Fountain S, Kasivisvanathan R Analgesia for labour: an evidence-based insight for the obstetrician. The Obstetrician & Gynaecologist. 2015; 17:(3)147-155

Anderson D A review of systemic opioids commonly used for labor pain relief. J Midwifery Womens Health. 2011; 56:(3)222-239

Anim-Somuah M, Smyth RMD, Jones L Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011; (12)

Argoff CE Clinical implications of opioid pharmacogenetics. Clin J Pain. 2010; 26:S16-S20

Bricker L, Lavender T Parenteral opioids for labor pain relief: A systematic review. Am J Obstet Gynecol. 2002; 186:(5)S94-S109

Dick-Read G Childbirth without fear: the principles and practice of natural childbirth, 3rd Edition. London: William Heinemann; 1954

Fairlie FM, Marshall L, Walker JJ, Elbourne D Intramuscular opioids for maternal pain relief in labour: a randomised controlled trial comparing pethidine with diamorphine. BJOG: An International Journal of Obstetrics and Gynaecology. 1999; 106:(11)1181-1187

Fletcher N IV paracetamol vs other opiates and analgesics. Arch Dis Child Fetal Neonatal Ed. 2010; 95

Foureur M Creating birth space to enable undisturbed birth. In: Fahy K, Foureur M, Hastie C Edinburgh: Books for Midwives

Gaskin IM Spiritual Midwifery, 4th Edition. Summertown, TN: Book Publishing Company; 2002

Goodson C, Martis R Pethidine: to prescribe or not to prescribe? A discussion surrounding pethidine's place in midwifery practice and New Zealand prescribing legislation. New Zealand College of Midwives Journal. 2014; 49:23-8

Green JM, Baston HA Feeling in control during labor: concepts, correlates, and consequences. Birth. 2003; 30:(4)235-247

Halls LK Maternal satisfaction regarding anaesthetic services during childbirth. British Journal of Midwifery. 2008; 16:(5)296-301

Healthcare Commission. Women's experiences of maternity care in the NHS in England: Key findings from a survey of NHS Trusts. 2007. (accessed 20 June 2017)

Hodgett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J Continuous support for women during childbirth. Cochrane Database Syst Rev. 2011; 2013:(2)

Howie KM, Millar S Usage of remifentanil patient-controlled analgesia in labour in the UK. Int J Obstet Anesth. 2011; 20

Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. 2012; 14:(3)

Lallar M, Anam H, Nandal R, Singh SP, Katyal S Intravenous paracetamol infusion versus intramuscular tramadol as an intrapartum labor analgesic. J Obstet Gynaecol India. 2015; 65:(1)17-22

Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2009; (2)

Leap N Working with pain in labour: an overview of evidence. New Digest. 2010; 49:22-49

Leap N, Sandall J, Buckland S, Huber U Journey to confidence: womens experiences of pain in labour and relational continuity of care. J Midwifery Womens Health. 2010; 55:(3)234-42

Leap N, Anderson T The role of pain in normal birth and the empowerment of women. In: Downe S London: Churchill Livingstone;

Lowe NK The nature of labor pain. Am J Obstet Gynecol. 2002; 186:(5)S16-S24

Madden KL, Turnbull D, Cyna AM, Adelson P, Wilkinson C Pain relief for childbirth: the preferences of pregnant women, midwives and obstetricians. Women Birth. 2013; 26:(1)33-40

Montgomery A, Whittaker V, Banerjee S A comparison of intramuscular diamorphine and intramuscular pethidine for labour analgesia: a two-centre randomised blinded controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2014; 121:(12)1574-1575

National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies: [CG190]. 2014. (accessed 16 April 2016)

National Institute for Health and Care Excellence. Preterm labour and birth [NG25]. 2015. (accessed 16 April 2016)

Nursing and Midwifery Council. Annexe 1 to NMC circular 07/2011 Changes to midwives exemptions. 2011. (accessed 24 June 2016)

Pathan H, Williams J Basic opioid pharmacology: an update. British Journal of Pain. 2012; 6:(1)11-16

Rawal N, Tomlinson AJ, Gibson GJ, Sheehan TM Umbilical cord plasma concentrations of free morphine following single-dose diamorphine analgesia and their relationship to dose-delivery time interval, Apgar scores and neonatal respiration. Eur J Obstet Gynecol Reprod Biol. 2007; 133:(1)30-3

Redshaw M, Henderson J Safely delivered: a national survey of women's experience of maternity care.Oxford: National Perinatal Epidemiology Unit; 2014

Reynolds F The effects of maternal labour analgesia on the fetus. Best Pract Res Clin Obstet Gynaecol. 2010; 24:(3)289-302

Reynolds F Labour analgesia and the baby: good news is no news. Int J Obstet Anesth. 2011; 20:(1)38-50

Shipton E Should New Zealand continue signing up to the Pethidine Protocol?. N Z Med J. 2006; 119

Thomson AM, Hillier VF A re-evaluation of the effect of pethidine on the length of labour. J Adv Nurs. 1994; 19:(3)448-456

Trescot AM, Datta S, Lee M, Hansen H Opioid pharmacology. Pain Physician. 2008; 11:(2)S133-S153

Tuckey JP, Prout RE, Wee MYK Prescribing intramuscular opioids for labour analgesia in consultant-led maternity units: a survey of UK practice. Int J Obstet Anesth. 2008; 17:(1)3-8

Tveit TO, Halvorsen A, Rosland JH Analgesia for labour: a survey of Norwegian practice—with a focus on parenteral opioids. Acta Anaesthesiol Scand. 2009; 53:(6)794-799

Ullman R, Smith LA, Burns E, Mori R, Dowswell T Parenteral opioids for maternal pain relief in labour. Cochrane Database Syst Rev. 2010; 08:(9)

Van de Velde M Remifentanil patient-controlled analgesia should be routinely available for use in labour. Int J Obstet Anesth. 2008; 17:(4)339-342

Wang K, Cao L, Deng Q, Sun LQ, Gu TY, Song J, Qi DY The effects of epidural/spinal opioids in labour analgesia on neonatal outcomes: a meta-analysis of randomized controlled trials. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2014; 61:(8)695-709

Wee MYK, Tuckey JP, Thomas PW, Burnard S A comparison of intramuscular diamorphine and intramuscular pethidine for labour analgesia: a two-centre randomised blinded controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2014a; 121:(4)447-456

Wee MYK, Tuckey JP, Thomas PW, Burnard S Authors reply to letter to the BJOG Exchange re: A comparison of intramuscular diamorphine and intramuscular pethidine for labour analgesia: a two-centre randomised blinded controlled trial. BJOG. 2014b; 121:(12)1574-1575

Zhou SF Polymorphism of human cytochrome P450 2D6 and its clinical significance: part I. Clin Pharmacokinet. 2009; 48:(11)689-723–00000

Pain in labour and the intrapartum use of intramuscular opioids—how effective are they?

02 July 2017
Volume 25 · Issue 7


Although widely used, there are observable differences in the level of satisfaction that women receive from opioids. This review examines some of the factors impacting this satisfaction, considering both physiological and psychological differences.

Many women choose pharmacological methods for pain management in labour, with 25% using an opiate-based analgesic (Redshaw and Henderson, 2015). Statistics suggest that the level of intravenous or intramuscular opiate ranges from 5% to 66% between hospital trusts (Healthcare Commission, 2007).

This review will consider the evidence and management options regarding the role of pain in labour; provide an overview of the research, evidence and practices concerning the intrapartum use of opiates versus other methods of pain management; detail the pharmacokinetics of opiates that are used in the UK and their effects on the woman, fetus and neonate; and identify some of the gaps in the literature.

In order to consider how to work with pain in labour it is important to understand its function in labour and birth. By understanding the physiological role of intrapartum pain, it is possible to evaluate the risk/benefit ratio of the use of pain management more accurately.

The term ‘pain’ itself is controversial in some circles. as some believe that the delicate hormonal balance of naturally occurring endorphins and birth hormones can be negatively influenced by a variety of psychological factors, including the use of language. Some authors therefore prefer to use alternative terminology (Gaskin, 2002). While considering the physiological aspects of pain, this review will use the matching medically orientated terminology.

During the onset of spontaneous, non-augmented labour, there is a complex interplay between naturally occurring hormones, such as ß-endorphins, that are stimulated by pain receptors and which subsequently stimulate the production of oxytocin (Lowe, 2002), forming a feedback loop and promoting the progression of labour (Foureur, 2008).

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