Alternative methods of pain relief in pregnancy

Abstract

The relief of pain in labour continues to be one of the more controversial issues in current obstetric practice and little has changed over the last 100 years since the use of chloroform was introduced by Simpson in Edinburgh and popularised by Snow in London by its use by Queen Victoria. Simpson's actions resulted in wide and acrid divisions of opinion in the public, the medical profession and the clergy. The perception of pain was at the root of the controversy. At one end was the view that pain was a punishment, at the other that pain was physiological, occurred in good health and any method which could modify or influence the pain was worthy of consideration. The Bible could be used to support either point of view and thus there was no easy answer to the issue. The use of chloroform, probably unnecessarily by Queen Victoria, did much to allay the controversy. Relief had been sought from the pain of labour for centuries, and many weird potions had been prepared, applied and consumed with variable effects. Alcohol, witchcraft, the laying on of hands and the use of the opiates had all been used in attempts to modify or alleviate the pain over the centuries. Today, the move to home delivery or in the small obstetric unit deprives the mother of the choice of pain control, as only the simpler methods will be available in small units. The availability of epidural analgesia, the most effective form of pain relief, governs its use, and in units with a 24 hour epidural sevice the mother's desire for pain relief varies considerably. Frequently, the mother's first choice is not to obtain complete relief of pain and will wish to accept epidural analgesia only when all else fails. Accurate methods of assessing the benefits of the various techniques are also available but many widely used techniques have been very poorly investigated.