Pain Relief in Labor: A Long and Winding Road

More documents

Recommendations

Info

Spinal Cord Pain Control Options • First Stage of Labor: • Paracervical nerve block (rare) • Epidural/spinal (common) • Narcotics • Non-pharmaco. (hypnosis, massage, breathing techniques) • Second stage of labor: • Pudendal nerve block • Epidural/spinal • Non-pharmacologic Pudendal and paracervical blocks Epidural Pudendal Nerve Block Paracervical Nerve block Part III: “Non-Medical Therapies” • Hypnosis- best studied • Education • Massage • Breathing techniques • Water • Walking Hypnosis • Multiple theories of how it works, including altered neuro-transmitters, increased natural narcotics (endorphins), suppression of excitatory neurons. • Evidence is that it works well as an adjunct during painful surgical procedures. • Evidence is that it works well during labor. 8
Hypnosis as adjunct to minor surgery Hypnosis for Pain Relief in Labor and Childbirth: a Systematic Review • Br. J. Anaesth, 2004 • 5 Randomized Clinical Trials, 3 of good quality • Results of these three combined: “Metaanalysis” • Need for pain relief drugs • Self rating of pain Hypnosis: Systematic review Hypnosis: Advantages/Disadvantages • 50% decrease in women requesting other analgesics • Of those choosing narcotic injection, they received less than non-hypnosis patients • Hypnosis patients rated their pain as less severe compared to control patients • PROS: • No drugs • No allergic reactions • No needles • No placental drug transfer • Potential costsavings • Limitations • Patient commitment • Preparation: typically at least 6 sessions • Hypnotist available • Substantial number still go on to receive IV drugs or epidural Education • Grantly Dick-Read stressed prenatal education as a key to less pain • Less fear=less pain • Scientific evidence is lacking: no randomized clinical trials. • Non-randomized studies: lower pain scores and less analgesics if prenatal classes attended. Massage, Counter-pressure • No randomized, placebo-controlled scientific study • No harm likely. • May have benefit 9
Page 1 and 2: Pain Relief in Labor: A Long and Wi
Page 3 and 4: The Fallout William Benson, Archbis
Page 5 and 6: Bier Footnotes • 1944: Mrs. Bier
Page 7: Grantly Dick-Read: Natural Childbir
Page 11 and 12: What do epidurals do to natural lab

Pain Relief in Labor: A Long and Winding Road

Create successful ePaper yourself

Delete template?

Save as template?