James C. Eisenach, M.D., Editor
Pain Relief in Labour. Edited by Felicity Reynolds. London, BMJ Publishing Group, 1997. Pages: 256. Price: 27.00 [pound sign].
Pain Relief in Labour is one of a growing number of textbooks in the area of management of labor pain. This textbook by Russell, Scrutton, and Porter has some influences characteristic of practice in the United Kingdom. The textbook is intended for the nonanesthesia care provider, such as midwives, obstetricians, and general practitioners. The emphasis is, not unexpectedly, on nonregional labor analgesic techniques, including “natural childbirth,” transcutaneous electrical nerve stimulation, acupuncture, hypnosis, herbal remedies (including aromatherapy), homeopathy, and inhalational analgesia for labor.
This textbook begins with a description of US and UK surveys of labor analgesia practices. A Table depictsthat in the United States in 1990. 0% of cases were performed with inhalational analgesia for labor analgesia, and 33% of cases were performed with epidural analgesia for labor. In contrast, in the United Kingdom in 1992, 60% of cases were performed with inhalational analgesia for labor analgesia, and 20% of cases were performed with epidural analgesia for labor. The authors state that inhalational analgesia with nitrous oxide is an option despite their statement that “nausea and vomiting is very common with nitrous oxide.” The data presented may incorrectly convey to the reader a sense that inhalational analgesia is without complications or without loss of maternal protective airway reflexes and loss of maternal consciousness. The authors state that “failure to provide epidural analgesia was the single most frequent cause of anxiety and disappointment among laboring women. There are insufficient anaesthetists in the UK and many countries to provide an efficient epidural service universally.”
Who should inform the mother about pain relief and methods of analgesia? The authors suggest “midwives not anaesthetists” provide information to the patient but recommend development of a liaison between midwives, obstetricians, general practitioners, and anesthetists. This comment raises concerns regarding which individual can effectively and accurately disseminate information regarding regional analgesic techniques for labor. Should the nonanesthesia care provider carry this responsibility?
The psychological methods of pain relief, including “natural” childbirth, psychoprophylaxis, hypnosis, and biofeedback are discussed with emphasis on the benefits of antenatal training for these psychological methods and suggestion that these methods should be “strongly encouraged” by the midwives, obstetricians, and general practitioners. The physical methods of pain relief, including transcutaneous electrical nerve stimulation, massage, water bath, aromatherapy, homeopathy, and herbalism, suggest effective analgesia for the first stage of labor only. Reports on efficacy are anecdotal and without clear scientific evidence. The authors state, “Though many nonpharmacological approaches to pain relief have been put forward, few have been widely used and fewer still subjected to randomized trials.”
The authors briefly review the anatomy and physiology of regional analgesia for labor with nice diagrams and illustrations of spinal-epidural anatomy. There is also a brief review of the indications and contraindications of regional analgesia for labor and reference to the effects and complications of regional analgesia for labor (i.e., potential association of epidural analgesia for labor with obstetric outcome).
The final part of the textbook illustrates “practical procedures” for regional analgesia for labor with sample infusion regimens. A guide is also provided for the nonanesthesia care provider on how to administer an epidural top-up dose.
Is this book worth buying? This textbook is more suited for the nonanesthesia care provider, such as the midwife, obstetrician, or general practitioner. For anesthesiology trainees and practitioners, this book is of peripheral interest only.
Sumedha Panchal, M.D.
Associate Director; Division of Obstetric Anesthesiology; Department of Anesthesiology Critical Care Medicine; Johns Hopkins University; Baltimore, Maryland
(Accepted for publication September 23, 1998.)