Labour pain, severe

O62.9 +(Z51.2)

GENERAL MEASURES

Antenatal counselling.
Psychological support from family member, friend or volunteer ‘doula’.
The need for analgesics may be reduced by keeping the woman informed about the progress of labour, providing reassurance and carefully explaining the procedures performed.
Anticipate the need for analgesia rather than waiting for severe distress.

MEDICINE TREATMENT

  • Pethidine, IM, 1 mg/kg 4 hourly as needed, to a maximum of 100 mg.

OR

  • Morphine, IM, 0.1 mg/kg 4 hourly as needed, to a maximum of 10 mg.

LoEIII [36]

Titrate dose and dose frequency according to pain.
Supplement with premixed nitrous oxide 50%/ oxygen 50% in late first stage.

Epidural anaesthesia

Offer this service only at hospitals with anaesthetic expertise, monitoring, capacity and equipment for epidural. (See chapter: Anaesthesiology, pain and intensive care).

Perineal analgesia:

  • Lidocaine, 1 or 2%, infiltration, locally or by a pudendal block.

Postpartum and post-episiotomy pain O90.9 + (R10.2 + Z51.2)

  • Paracetamol, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum daily dose: 4g in 24 hours.

OR

  • NSAID, e.g.:
    • Ibuprofen, oral, 400 mg 8 hourly with meals.

OR

  • Pethidine, IM, 1 mg/kg 4 hourly as needed, to a maximum of 100 mg.

OR

  • Morphine, IM, 0.1 mg/kg 4 hourly as needed, to a maximum of 10 mg.

LoEIII[37]