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

02 July 2017
Clinical Practice
02 July 2017
Volume 25 · Issue 7

Abstract

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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Opiates
Pain management
Labour