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Pain management

A trial involving first-time mothers, who were not planning an elective caesarean and did not have high blood pressure or psychological illness, across three NHS Trusts aimed to find out if self-hypnosis before birth affected epidural use.   Women in the trial were randomly allocated to usual care, or to usual care plus two self-hypnosis training sessions with a daily audio self-hypnosis CD.  The study found that going to the prenatal self-hypnosis groups did not reduce epidural use in labour, but did reduce expected levels of anxiety and fear during labour and birth, and cost less than £5 per woman.

The RESPITE trial compared the proportions of women receiving either remifentanil (via a patient-controlled pump into a vein) or pethidine (via injections) going on to have an epidural. Remifentanil halved the proportion of women who went on to have an epidural compared with pethidine.  Women in the remifentanil group were happier with their pain relief, and went on to have fewer instrumental vaginal deliveries than those in the pethidine group - it is known that epidurals increase the risk of an instrumental vaginal delivery (i.e. with forceps or suction).    More women in the remifentanil group were given extra oxygen; this did not affect the wellbeing of mother or baby, but this trial was not large enough to detect rarer safety outcomes. 

What might this mean for a woman thinking about pain relief in labour?

You may want to consider using self-hypnosis during pregnancy as a way of  relieving pain or anxiety during your labour. If so, you might need to investigate resources online or local sources of help. Your midwife will be able to tell you about the drugs that are used for pain relief in labour in the place where you are planning to give birth.

This section on pain management forms part of our Highlight on the Management of Labour which takes an evidence-based look at induction, pain relief, waterbirth and more . To read the Highlight in full click here

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