ELECTROPHYSIOLOGICAL METHODS IN NOCICEPTION RESEARCH

Women have an intense pain in the labor. Amount of pain varies greatly and it depends on the emotional, mental, physical status of women and environmental factors. The pain is caused by various physiological factors and triggers a cascade of biochemical reactions in the woman’s body. Intense pain brings suffering to women and can do damage to the fetus. Effective and safe anesthesia delivery is extremely important task for modern medicine. The article describes the essence of the most popular methods of pain relief during labor, discussed their positive and negative properties. Search literature for the review of various special medical and general Internet search engines. There are medication and non-medication methods of pain relief in labor. Non-medication method is non-invasive and healthier for a maternity patient and a child but their effectiveness is disputable. Medication methods of pain relief are presented injection of opioid analgesics and non-opioid analgesics, inhalation and neuroaxial anesthesia methods. Every method has advantages and disadvantages. Opioid analgesics reduce the pain for a few hours however cause a large number of undesirable effects such as nauseaand sleepiness of maternity patient, respiratory distress and depression of consciousness of newborn. Study of non-opioid analgesics showed a high analgesic activity but it was not study enough to use for pain relief in labor. Today the most common method is neuroaxial analgesia. It relieves the pain effectively and has no effect on the fetus but it has some disadvantages.The question of the influence of the neuroaxial methods of anesthesia on the duration of the labor is controversial. Promising is the use of inhaled anesthetics in particular xenon. But these methods are not study enough. All currently used labor pain relief methods are not ideal as far as each method has its own characteristics and bad effects. In each particular case the method of labor pain relief must be selected individually, it’s necessary to take into consideration the psychological and physical condition of the woman and obstetric situation.

Background: Global access to social media has supposedly changed women’s awareness about the pharmacological and alternative methods of pain relief during vaginal delivery. The purpose of the study was to analyze changes in women’s preference and opinion about different forms of labor analgesia over the past decade. Materials and methods: The study was designed as an anonymous survey with questions about women’s knowledge and preference of different forms of pain relief in labor. The survey was conducted in 2010 and 2020, with data collected from 1175 women in 2010 and 1033 in 2020. Results: There were no differences between 2010 and 2020 in the proportion of women who wanted to receive analgesia in labor, at, respectively 67.9% of women in 2010 and 73.9% in 2020. About 50% of women chose epidural analgesia as the only efficacious method of pain relief in labor both in 2010 and 2020. There were no differences between the two time-points in the distribution of chosen methods of pain relief. In total, 92.3% of women in 2010 and 94.9% in 2020 thought that they should have the possibility of independent choice of analgesia method before the delivery (p < 0.04). Conclusions: A high proportion of Polish women choose EDA over other pharmacological and nonpharmacological methods of pain relief in labor, and this preference has not changed over the last decade. Increasing women’s knowledge about different methods of intrapartum pain relief may lead to wider use of nonpharmacological methods of pain relief.

Background/Aims In the UK, women and neonates from ethnic minority groups are more likely to experience poor outcomes. Ineffective pain relief for Black women may contribute to disparities in outcomes. This study's aim was to evaluate methods of intrapartum pain relief accessed by Black African and White British women. Methods This evaluation gathered data from Black African (n=7) and White British (n=40) women's intrapartum records at a hospital in Birmingham. Data were analysed descriptively. Results White British women used more pharmacological and non-pharmacological methods of pain relief and accessed water immersion. When a single method of pain relief was used, White British women were more likely to use epidural analgesia, whereas Black African women were most likely to use Entonox. Conclusions This study highlights the need for further research to understand the differences between Black African and White British women's use of pain relief during labour and birth. Implications for practice By summarising the provision of intrapartum pain relief across Black African and White British groups, this study aids both professional reflection and insight into why identifying women's specific ethnic group in policy, practice and research may improve understanding of ethnic disparities.

Introduction: Pain following surgery is a universal phenomenon; it is often underestimated and undertreated. Epidural analgesia is considered to be the best method of pain relief after subcostal cholecystectomy. Epidural is effective technique that offers comparable analgesia and better side effect profile. Design: Quasi Experimental study. Period: Jan2010 to June 2010. Setting: Military Hospital Rawalpindi. Material and methods: This is a prospective, randomized control trial. The main objective of this study was to compare the number of rescue doses for postperative pain relief, after subcostal cholecystectomy under epidural anesthesia, in patients receiving continuous epidural infusion of bupivacain 0.125% with those receiving intermittent boluses. Thoracic epidural catheter was placed for post operative pain relief. Patients were divided into two equal groups. Patient receiving continuous epidural anaesthesia were placed in group A and those receiving intermittent doses were included in group B. Sampling technique: Purposive (non probability) sampling. Result: Patient who received intermittent boluses (group B) required less rescue doses of nalbuphine as compared to the patients who received continuous infusion of 0.125 bupivacain. Conclusions: Intermittent boluses of 0.125% bupivacain are considered a better method of postoperative pain relief than continuous infusion of 0.125 % bupivacain.

Epidurals are a method of long-term pain relief administered by injecting and continuously delivering an anesthetic via catheter in the spine. This method of pain relief is often used for patients in the Obstetrics/Gynecology unit as well as those in pre- and post-operational care. For almost 2 million singleton vaginal deliveries across 27 states in 2008 (representing 65% of all US singleton vaginal births in 2008), 61% of patients received some form of an epidural or spinal injection [1]. Additionally, this number has been increasing. For the 18 states for which 2006 and 2008 data are available, the average of the state-level increases in epidural/spinal injections is approximately 4.2% revealing an overall increase in these injections. Just between 2000 and 2010, the use of epidural injections increased by 160% [2]. Commonly, epidural catheters are inserted into the patient’s back in the appropriate location and then secured to the body with an adhesive medical dressing. Movement and subsequent dislocation of the catheter beneath the adhesive medical dressing can result in inefficient anesthetic delivery, increased patient discomfort, and repeated administration of the epidural. Secondary migration of epidural catheters is a problem responsible for failure in approximately 6.8% of epidurals administered [3]. Requiring an anesthesiologist to repeat the procedure is also an increased cost. A solution to secondary migration of epidural catheters would ensure effective delivery of the anesthetic to the patient, reduce the need for a repeated procedure, and prevent unwanted additional healthcare expenses.

The article presents the comparative assessment of efficiency and safety of neuraxial pain relief in labor.Subjects and methods. Four groups of 40 women in each group participated in the study: In Group 1, epidural analgesia was used for pain relief in labor, in Group 2, ultra-low-dose spinal analgesia was used, and paravertebral analgesia was used for pain relief in Group 3. And Control Group included 40 women with no pain relief in labor. The efficiency of analgesia in labor was monitored (scores by N.N. Rasstrigin and B.V. Shneider), as hemodynamic rates: heart rate, arterial tension, and median arterial tension (ATmed). Bromage scores were used for assessment of motor block. The changes in cervical dilatation and duration of the first and second period of the labor were assessed. All complications and negative effects of pain relief and impact of analgesia on the fetus were registered.Results. All methods of pain relief demonstrated statistically significant reduction of sensitivity to pain. Dilating pains were evaluated as 7.15 scores in Group 1; 6.88 scores in Group 2, and 7.43 in Group 3. In Control Group it made 3.87 scores (p &lt; 0.001). During the second period of labor epidural and paravertebral analgesia was the most effective: 6.78 scores in Group 1 and 6.20 scores in Group 3 (p &lt; 0.05). After pain relief in Groups 1, 2 and 3 there was a statistically significant reduction of specific peripheral vascular resistance, ATmed, reduction of cardiac index due to normalization of heart rate. In the groups with pain relief, the time from the development of analgesic effect until full dilation was statistically significantly shorter. The best result was achieved through paravertebral analgesia (27.5 minutes faster versus Control Group, p &lt; 0.001). The statistically significant increase of active pushing phase was observed in Group 2, on the average for 6.1 minutes longer versus Control Group (p &lt; 0.005).Conclusions. Neuraxial methods provide sufficient level of analgesia and are capable to manage labor abnormalities with no negative impact on the fetus. All represented methods of pain relief can be used for obstetric anesthesiology. In each specific obstetric situation, there is an option to choose the most appropriate method of pain relief.

BackgroundFear of childbirth may reduce the womens’ pain tolerance during labour and may have impact on the mother-infant interaction. We aimed to assess (1) the association between fear of childbirth antepartum and subsequent request for pharmacological pain relief, and (2) the association between the used method of pain relief and experienced fear of childbirth as reported postpartum in low risk labouring women.MethodsSecondary analysis of the RAVEL study, a randomised controlled trial comparing remifentanil patient controlled analgesia (PCA) and epidural analgesia to relieve labour pain. The RAVEL study included 409 pregnant women at low risk for obstetric complications at 18 midwifery practices and six hospitals in The Netherlands (NTR 3687). We measured fear of childbirth antepartum and experienced fear of childbirth reported postpartum, using the Wijma Delivery Expectancy/Experience Questionnaire.ResultsWomen with fear of childbirth antepartum more frequently requested pain relief compared to women without fear of childbirth antepartum, but this association did not reach statistical significance (adjusted odds ratio (aOR2.0; 95% confidence interval (CI) 0.8–4.6). Women who received epidural analgesia more frequently reported fear of childbirth postpartum compared to women who did not receive epidural analgesia (aOR3.5; CI 1.5–8.2), while the association between remifentanil-PCA and fear of childbirth postpartum was not statistically significant (aOR1.7; CI 0.7–4.3).ConclusionsWomen with fear of childbirth antepartum more frequently requested pain relief compared to women without fear of childbirth antepartum, but this association was not statistically significant. Women who received pharmacological pain relief more frequently reported that they had experienced fear of childbirth during labour compared to women who did not receive pain relief. Based on our data epidural analgesia with continuous infusion does not seem to be preferable over remifentanil-PCA as method of pain relief when considering fear of childbirth postpartum.Trial registrationNetherlands Trial Register 3687; Register date: 5 Nov 2012.

Intracutaneous or subcutaneous injection of sterile water is rapidly gaining popularity as a method of pain relief in labour and it is therefore essential that it is properly evaluated. Adequate analgesia in labour is important to women worldwide. Sterile water injection is inexpensive, requires basic equipment, and appears to have few side effects. It is purported to work for labour pain. To determine the efficacy of sterile water injections for relief of pain (both typical contraction pain and intractable back pain) during labour compared to placebo (isotonic saline injections) or non-pharmacological interventions, and to identify any relevant effects on mode and timing of delivery, or safety of both mother and baby. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 May 2011), MEDLINE, and EMBASE (January 2010 to 30 May 2011), together with reference lists in retrieved studies and review articles. We included randomised, double blind, controlled studies using intracutaneous or subcutaneous sterile water injections for pain relief during labour. There were no restrictions on birth place, parity, risk, age, weight, gestation, or stage of labour. Potential comparators were placebo (saline) and non-pharmacological interventions (e.g. hypnosis or biofeedback). Two review authors independently assessed eligibility and quality of trials, and extracted data. We resolved any disagreements or uncertainties by discussion with a third review author. Primary outcome measures were at least 50% pain relief, or at least 30%, pain relief, patient global impression of change of at least 'good', mode of delivery, perinatal morbidity and mortality, maternal complications and adverse events. Secondary outcomes were women with any pain relief, use of rescue analgesia, and treatment group average pain relief. We made explicit judgements about potential biases in the studies. We included seven studies, with 766 participants: four used intracutaneous injections, two subcutaneous, and one both. All reported on low back pain in labour only. Methodological quality was good, but four studies were at high risk of bias due to small size of treatment groups, incomplete outcome data, and performance bias.All studies reported treatment group mean or median scores, finding greater reduction in pain for sterile water. However, failure to demonstrate a normal distribution for pain intensity or relief, and use of different scales, meant meta-analysis was inappropriate. No study reported primary dichotomous efficacy outcomes. One reported the number self-scoring 4/10 cm or more reduction in pain; significantly more had this outcome with sterile water (50% to 60%) than with placebo (20% to 25%).There was no significant difference between sterile water and saline for rates of caesarean section (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.33 to 1.02), instrumental delivery (RR 1.31, 95% CI 0.79 to 2.18), rescue analgesia (RR 0.86, 95% CI 0.44 to 1.69), timing of delivery, or Apgar scores. Two studies reported that more women treated with sterile water would request the same analgesia in future.No study reported on women's satisfaction with pain relief, women's sense of control in labour, women's satisfaction with the childbirth experience, mother/baby interaction, rates of breastfeeding, maternal morbidity, infant long-term outcomes, or cost. No adverse events were reported other than transient pain with injection, which was worse with sterile water. The outcomes reported severely limit conclusions for clinical practice. We found little robust evidence that sterile water is effective for low back or any other labour pain. Neither did we find any difference in delivery or other maternal or fetal outcomes. Further large, methodologically rigorous studies are required to determine the efficacy of sterile water to relieve pain in labour.

BackgroundMany women use pharmacological or non-pharmacological pain relief during childbirth. Evidence from Cochrane reviews shows that effective pain relief is not always associated with high maternal satisfaction scores. However, understanding women’s views is important for good quality maternity care provision. We undertook a qualitative evidence synthesis of women’s views and experiences of pharmacological (epidural, opioid analgesia) and non-pharmacological (relaxation, massage techniques) pain relief options, to understand what affects women’s decisions and choices and to inform guidelines, policy, and practice.MethodsWe searched seven electronic databases (MEDLINE, CINAHL, PsycINFO, AMED, EMBASE, Global Index Medicus, AJOL), tracked citations and checked references. We used thematic and meta-ethnographic techniques for analysis purposes, and GRADE-CERQual tool to assess confidence in review findings. We developed review findings for each method. We then re-analysed the review findings thematically to highlight similarities and differences in women’s accounts of different pain relief methods.ResultsFrom 11,782 hits, we screened full 58 papers. Twenty-four studies provided findings for the synthesis: epidural (n = 12), opioids (n = 3), relaxation (n = 8) and massage (n = 4) – all conducted in upper-middle and high-income countries (HMICs). Re-analysis of the review findings produced five key themes. ‘Desires for pain relief’ illuminates different reasons for using pharmacological or non-pharmacological pain relief. ‘Impact on pain’ describes varying levels of effectiveness of the methods used. ‘Influence and experience of support’ highlights women’s positive or negative experiences of support from professionals and/or birth companions. ‘Influence on focus and capabilities’ illustrates that all pain relief methods can facilitate maternal control, but some found non-pharmacological techniques less effective than anticipated, and others reported complications associated with medication use. Finally, ‘impact on wellbeing and health’ reports that whilst some women were satisfied with their pain relief method, medication was associated with negative self-reprisals, whereas women taught relaxation techniques often continued to use these methods with beneficial outcomes.ConclusionWomen report mixed experiences of different pain relief methods. Pharmacological methods can reduce pain but have negative side-effects. Non-pharmacological methods may not reduce labour pain but can facilitate bonding with professionals and birth supporters. Women need information on risks and benefits of all available pain relief methods.

Labor pain and how to deal with it have been investigated and debated for decades. It is a topic where maternity and anesthesiology professionals are often on opposite sides of the fence. Thus, the invitational meeting jointly sponsored by two venerable and prestigious organizations, the Maternity Center Association and the New York Academy of Medicine, and held in New York City on May 4 and 5, anticipated some understandable tension and disagreement as well as agreement among the meeting participants. Without a doubt, those maternity health practitioners, anesthesiologists, researchers, health workers, and educators who were fortunate enough to attend “The Nature and Management of Labor Pain: An Evidence-Based Symposium,” received a rare learning experience. Not only did they hear ten presentations of outstanding quality, but they also shared in a multidisciplinary endeavor that opened fresh dialog and presented up-to-the-minute evidence with the potential to influence future practice and research. The Symposium, planned by a multidisciplinary steering committee, endeavored to use the evidence-based framework to seek the truth about labor pain and its management by presenting papers from health professionals in obstetrics, anesthesiology, epidemiology, midwifery, nursing, childbirth education, and health policy. Specifically, the Symposium objectives were to identify actions that could be taken now, based on the best current available information, to do the following: • Make accurate information about labor pain and methods to relieve it available and easily accessible to the relevant clinical and other health professionals. • Make accurate, meaningful information on these subjects available and easily accessible to child-bearing women and the general public. • Improve women's access to a choice of reasonably safe and effective pharmacological and non-pharmacological methods for pain relief during labor. • Assure that women receive full information on all methods of labor pain relief that are available in their place of birth and have the freedom to choose which of these methods they will use. • Identify important gaps in the knowledge base, and develop and address research priorities. Of the ten papers, seven were systematic reviews, and all underwent a rigorous referee process before the meeting. The first paper, “The Nature of Labor Pain,” by Nancy Lowe, CNM, PhD, was followed by four papers on various aspects of epidural analgesia, including mode of action, efficacy, safety, and effects, which were presented by Donald Caton, MD, with co-authors Michael Froelich, MD, and Tammy Y. Euliano, MD; Ellice Lieberman, MD, DrPH, with co-author Carol O'Donoghue, MPH, MSN: Barbara Leighton, MD, with co-author Stephen Halpern, MD; and Linda Mayberry, PhD, RN, with co-authors Donna Clemmens, PhD, RN, and Anindya De, PhD. The second group of papers included presentations on parenteral opioids by Leanne Bricker, MB BCh, MRCOG, with co-author Tina Lavender, PhD, MSc, PGDip, RN, RM; nitrous oxide by Mark Rosen, MD; selected nonpharmacological methods (intradermal water blocks, touch and massage, immersion in water, maternal movement and positioning, continuous labor support) for labor pain relief by Penny Simkin, PT, with co-author MaryAnn O'Hara, MD, MPH; pain and women's satisfaction by Ellen Hodnett, RN, PhD; and patterns and choice issues in labor pain management by Theodore Marmor, PhD, with co-author David Krol, MD. Critique panels of invited experts from various health disciplines provided additional insights and explored the presentations, the first panel on the unintended effects of epidurals and the second on implications for core practice-oriented disciplines. The sessions for audience discussion were, not surprisingly, extremely vigorous and provided lots of strong opinions, lively interaction, and additional valuable information on new research in pain management. The ten symposium papers, with additional and updated information and data, are expected to be published together as a supplement of the American Journal of Obstetrics and Gynecology early in 2002. Thus, the latest knowledge and evidence on labor pain and its management will be made available as quickly as possible to a wide audience. As noted earlier, labor pain management is an area that engenders disagreement and diverse and strong feelings among health professionals, and it did so at this meeting, especially on the topic of epidural analgesia. Disagreement occurs in other countries also, as can be noted from the column by Sheila Kitzinger, in her Letter from Europe in this issue of Birth. She reports that the Royal College of Anaesthetists in Great Britain recently conducted a debate about pain in childbirth, and asked her to represent women who declined medication for pain relief (as did Cherie Blair, wife of the Prime Minister, for the recent birth of her baby). Ms. Kitzinger was asked to speak against the motion, “That natural childbirth is inappropriate in a modern world,” and to present “the Cherie Blair point of view.” Nevertheless, at the same time during the New York Symposium, agreement could be found on many issues, both in interpreting the evidence and in recommending some constructive clinical steps forward. Although all sides did not agree on the best, safest, and most efficacious methods of pain relief, and some anesthesiologists remained unconvinced by the presentation on nonpharmacological techniques, by the end of the two-day meeting, participants agreed in a general way that women should be allowed to make informed choices for their pain relief based on the evidence and after being advised of risks and benefits. Some discussants pointed out that a major shortcoming of this otherwise highly successful and comprehensive Symposium was the absence of a focus on, and paper devoted to, the effects of pain and pain management on the fetus and newborn. Although the evidence in the literature is sparse, attention was drawn to two Swedish papers that were recently published in Birth (1, 2). Participants showed particular interest in the paper by Dr. Marc Rosen on “Nitrous Oxide for Relief of Labor Pain: A Systematic Review.” Although commonly used combined with 50 percent oxygen under the trade name Entonox in England and other countries, nitrous oxide is seldom used in the United States, yet the evidence shows that it is an effective and safe inhalation analgesia in labor, with a low incidence of side effects. Its “advantages are that the mother can remain awake and in control of the analgesia; that neither uterine activity nor ‘bearing down' during the second stage is affected” (3, p 328). The Symposium sponsors, the Maternity Center Association and the New York Academy of Medicine, and Symposium Project Director Judith Rooks deserve the highest praise for their vision in organizing such a timely, important, and potentially far-reaching project. Maternity health professionals and anesthesiology professionals were brought together in an environment to listen and learn, and to examine and explore the available evidence about pain relief in labor. It was also extremely fitting that a highlight of the meeting was the presentation of the Carola Warburg Rothschild Award to Sir Iain Chalmers, Professor Emeritus Murray Enkin, and Professor Marc Keirse in celebration of their humanitarian and scientific endeavors in advancing research and care in pregnancy and childbirth. Indeed, no one mentions evidence-based care in this field without thinking of these three scholars and their pioneering work on the systematic reviews of randomized controlled trials of care (3, 4). That this Symposium in New York was “evidence-based” was all the more important because, as I noted in my introduction of Chalmers, Enkin, and Keirse at the Symposium award ceremony, “knowledge about, and indeed application of, the systematic reviews, the Cochrane Library, and evidence-based care, although recognized and accepted in Canada and on the other side of the Atlantic, has been slow to enter mainstream obstetrics in the United States.” Reactions after the Symposium were rapid. Several participants told me that they were going back to their communities with new enthusiasm and ideas for research and practice. Some participants from Lamaze International who attended remained for two more days to hold a strategic planning session. Coming away from the Symposium, they were struck by the reality that whereas most women will be readily given an epidural on request and have that choice reinforced, those who prefer and ask for physiological pain-relief measures, on the other hand, often receive different and less positive feedback from caregivers and institutions. These women's voices are too often not heard, their choice not supported, and the nonpharmacological measures not available. Lamaze International plans to give its organization a renewed focus and emphasis on women's choices for nonpharmacological pain-relief methods, reflected in their new motto, “Voices and Choices in Birth.” Other participants also felt a sense of discouragement after the meeting. One family physician noted that too many practitioners accept the epidural “as a substitute for care.” He went on to say that “Birth has become an anesthetic event. Epidurals are used as second best when proper support is unavailable. We accept second best!” The papers from this Symposium, researched and written under such a rigorous scientific and evidence-based framework, will surely provide a solid basis on which maternity health professionals and institutions can explore and launch new ways to support women in labor and birth. The Maternity Center Association and New York Academy of Medicine have opened the door to the next initiatives for women's labor pain management and care.

Objectives:To evaluate the attitudes of pregnant women towards different forms of labor pain relief, preferred methods of pain relief, and the effects of social media on their awareness and knowledge.Methods:This was a cross-sectional study conducted between April and August 2017 in the Maternity and Children’s Hospital, Najran, Saudi Arabia. A total of 416 pregnant women were interviewed and analyzed using IBM Statistical Package for Social Sciences version 20 (IBM Corp, Armonk, NY, USA).Results:A total of 62.7% were aware of labor pain. However, 58.7% of the total sample group was unaware of labor pain relief, and 79.8% of the total sample group was unaware of the different forms of labor pain relief available. Educational level was significantly associated with awareness and knowledge of labor pain relief (p=0.001). The majority of pregnant women obtained information from friends (57.5%); and only 16.1% of women received information from their health care providers.Conclusion:Most of the pregnant women recruited into this study had insufficient awareness of labor pain and methods of pain relief. They acquired their information from their friends and families rather than from their health care providers.

BACKGROUND AND OBJECTIVES: The pain is an inherent phenomenon in labor and may interfere directly with its physiology. The objective of this study was to correlate the effectiveness of the association of the shower aspersion and the swiss ball as a method of pain relief in active labor stage. CONTENTS: This is an integrative review. The sample was taken from the LILACS, Scielo, BDENF and Medline databases. Fourteen articles were used, published between 2010 and 2016, in the Portuguese and English language. The results indicate a significant reduction of the pain score when associated with both therapies, in addition to acting effectively in the labor progression. CONCLUSION: The present review allowed the perception that the association of shower aspersion and swiss ball therapies is more effective than its isolated use, enhancing pain relief when applied in the active phase of labor, improving its progression, reducing the duration and stimulating natural childbirth.

The reasons why primigravidas choose a particular method of pain relief during labour and the quality of pain relief with epidural and non-epidural methods of pain relief — Views from the shop floor

Ketamine for pain relief in acute pancreatitis

To investigate the pain relief used in association with vacuum extraction assisted deliveries and to identify risk factors for not receiving pain relief during the procedure. Retrospective birth register study. Nationwide study in Sweden. The study population consisted of all women (n=62568) with a singleton pregnancy who gave birth in gestational weeks 37(+0) to 41(+6) between 1999 and 2008 and were delivered by vacuum extraction. Register study with data from the Swedish Medical Birth Register. Epidural blockade, spinal blockade, pudendal nerve blockade, infiltration of the perineum, no pain relief. In all, 32.4% primiparas and 51.4% multiparas who had a vacuum-assisted delivery had this without potent pain relief such as epidural blockade, spinal blockade or pudendal nerve block. When infiltration was added as a method for pain relief, 18% were still delivered without pain relief. Multiparas were more likely than primiparas to be delivered without potent pain relief, odds ratio (OR) 2.29 95% confidence interval (CI) (2.20-2.38). Compared with women delivered by vacuum extraction due to prolonged labor, those with signs of fetal distress were more likely to be delivered without potent pain relief (OR) 1.74, 95% (CI) (1.68-1.81). A considerable number of women are delivered by vacuum extraction without pain relief. The high proportion might reflect that clinical staff do not always consider pain relief to be of high priority in vacuum extraction deliveries or that they fear impaired pushing forces.