| Learning Objective #1: Describe the factors that impact on women's perceptions and experiences of pain in labour | |||
| Learning Objective #2: Discuss the advantages and disadvantages of patient-controlled versus intramuscular administration of diamorphine for the control of pain in labour |
Design: Randomised controlled trial
Setting: The South Glasgow University Hospitals NHS Trust.
Sample: Primigravidae and multigravidae in labour at term (37-42 weeks).
Methods: Women (n=356) were randomised in labour to the study (PCA) or control group (IM). Randomisation was achieved through a random permuted block design stratified by parity. Study group women were given a loading dose of 1.2mg diamorphine intravenously and then attached to the pump. Control group women received IM diamorphine as per hospital protocol. Participants were also given 3mg of buccal Stemetil. Data were collected throughout labour and at six postnatal weeks.
Main outcome measures: Analgesia requirements during labour and women's satisfaction with the method of pain relief.
Results: Women in the study group (PCA) used significantly less diamorphine than women in the control group (IM) but were significantly more likely to state that they were very dissatisfied with their use of diamorphine and were significantly more likely to opt out of the trial before the birth of the baby. The majority of women in both groups used other analgesia concurrent with diamorphine such as Entonox, aromatherapy or TENS.
Conclusion: PCA administration of diamorphine for the relief of pain in labour offers no significant advantages over IM administration. The results also suggest that diamorphine is a poor analgesic for labour pain irrespective of the mode of administration.