Skip to main content Accessibility help
  • Print publication year: 2015
  • Online publication date: December 2015

9 - Non-regional analgesia techniques for labour

from Section 3 - Provision of anaesthesia


On 19 January 1847, James Young Simpson used diethyl ether to anaesthetize a woman with a deformed pelvis for delivery, to widespread opposition and consternation from his contemporaries, questioning its safety and his wisdom.

The controversy about the delivery of Queen Victoria's eighth child, Prince Leopald, in 1853 was such that her Court physicians publically denied that John Snow had anaesthetized her with ether to ease the pain. Four years later the issue was less controversial and it was widely acknowledged that Queen Victoria had received an anaesthetic to help her with the birth of Princess Beatrice, her ninth child. Anaesthesia for childbirth had become part of medical practice by 1860, in large part in response to the demands of women.

Our armamentarium for the management of labour has thankfully grown somewhat since the nineteenth century. This chapter will discuss the non-regional techniques (non-pharmacological and pharmacological) that are available in the UK.

The Cochrane Collaboration

In 2012 The Cochrane Collaboration summarized the evidence from Cochrane and non-Cochrane systematic reviews on the efficacy and safety of non-pharmacological and pharmacological interventions to manage pain in labour. This represented over 300 trials within 18 systematic reviews and they were able to categorize the interventions into: ‘What works’ (epidural, combined spinal and epidural, inhaled analgesia), ‘What may work’ (immersion in water, relaxation, acupuncture, massage, local anaesthetic nerve blocks, non-opioid drugs) and ‘Insufficient evidence to make a judgement’ (hypnosis, biofeedback, sterile water injections, aromatherapy, transcutaneous electrical nerve stimulation (TENS), parenteral opioids).

Non-pharmacological methods

Many non-pharmacological methods have been tried for the relief of labour pain, with varying success and much interindividual variability. Women may consider these options as an integral and important part of their labour experience, despite the benefits often being intangible and not easily documented by scientific method. It is important that the anaesthetic provider is aware of some of these techniques, their benefits and limitations, in order to be able to have a full and informed discussion with their patient. The 2012 Cochrane overview found some evidence to suggest that immersion in water, relaxation, acupuncture and massage may work, whilst there was insufficient evidence for hypnosis, biofeedback, sterile water injections, aromatherapy or TENS. Table 9.1 provides a useful summary.

Related content

Powered by UNSILO
Fairlie, F. M., Marshall, L., Walker, J. J. and Elbourne, D. (1999). Intramuscular opioids for maternal pain relief in labour: a randomised controlled trial comparing pethidine with diamorphine. Br. J. Obstet. Gynaecol., 106, 1181–1187.
Fortescue, C. and Wee, M. Y. (2005). Analgesia in labour: non-regional techniques. CEACCP, 5, 9–13.
Fernando, R. and Jones, T. (2009). Systemic analgesia: parenteral and inhalational agents. In Chestnut, D. H., Polley, L. S., Tsen, L. C. and Wong, C. A. (eds.) Chestnut's Obstetric Anesthesia: Principles and Practice, edn. Philadelphia, PA: Elsevier.
Harries, S. and Turner, M. (2008). Non-regional labour analgesia. In Clyburn, P., Collis, R., Harries, S. and Davies, S. (eds.) OSH Obstet. Anaesth. Oxford: Oxford University Press.
Smith, S., Scarth, E. and Sasada, M. (2011). Drugs in Anaesthesia and Intensive care, edn. Oxford: Oxford University Press.
Hinova, A. and Fernando, R. (2009). Systemic remifentanil for labor analgesia. Anesth. Analg. 109, 1925–1929.
Hughes, D. and Foley, P. (2013). The case for remifentanil PCA as labour analgesia. RCA Bull., 78, 6–8.
Jones, L., Othman, M., Dowswell, T. et al. (2012). Pain management for women in labour: an overview of systemic reviews. Cochrane Database Syst. Rev. 2012(3), Art. No.: CD009234.
Muchatuta, N. A. and Kinsella, S. M. (2013). Remifentanil for labour analgesia: time to draw breath? Anaesthiology, 68, 231–235.
Oloffson, C., Ekblom, A., Ekman-Ordeberg, G. et al. (1996). Lack of analgesic effect of systemically administered morphine or pethidine on labour pain. Br. J. Obstet. Gynaecol., 103, 968–972.
Tuckey, J. P., Prout, R. E. and Wee, M. Y. (2008). Prescribing intramuscular opioids for labour analgesia in consultant-led maternity units: a survey of UK practice. Int. J. Obstet. Anesth., 17, 3–8.