Choice of analgesia in labour on neonatal outcomes, delivery and maternal satisfaction with pain relief

Abstract

Aim: to examine the use of pethidine, epidural or no analgesia during labour on neonatal outcomes, delivery and maternal satisfaction with pain relief.Design: a prospective cohort study was undertaken in one maternity unit in the East Midlands. Four hundred and seventy-one consecutive women assessed as low risk were recruited to one of three groups depending on their choice of analgesia: pethidine only, epidural only or no analgesia.Outcome measures: neonatal Apgar score at 1 and 5 minutes, base excess/arterial pH, type of delivery and maternal satisfaction with pain relief during labour.Results: results indicated that type of analgesia appeared to have no significant adverse effects on neonatal outcomes, at least in the short term, with the exception of a slight reduction in arterial pH for babies in the pethidine group. Babies born of women who had epidural block had significantly lower Apgar scores at 1 minute compared with babies of mothers who had no analgesia. However, these differences did not persist for Apgar scores at 5 minutes. Women receiving epidural analgesia were significantly more satisfied with their level of pain relief during labour than women in either the pethidine or no analgesia groups. A large proportion of women requested an epidural because of dissatisfaction with the level of pain relief pethidine provided. Women who had epidural block were more likely to need oxytocin augmentation to progress labour, tended to have longer time in labour and were more likely to have instrumental delivery or caesarean section than women in either the pethidine or no analgesia groups.Conclusion: we conclude from our study that while epidural analgesia is an effective method of pain relief, for most women during labour who choose it, it is not without possible side effects on the progress of labour and the delivery. There is a need for good-quality research to investigate the long-term effects of epidural analgesia on mother and infant, as well as research into the relative effectiveness and side effects of opioids that might be used as alternatives to pethidine in the relief of labour pain. In the light of current knowledge, women need to be made aware of the benefits and possible side effects of epidural analgesia and pethidine that might be considered for use during labour.