Pain relief in labour: support, non-drug methods and the nursing checks for neuraxial analgesia
- Safe practice
Every woman has the right to effective pain relief in labour. The nurse offers support and non-drug methods, and watches closely after an epidural.
What it is
Res. 3280 de 2018 states that every woman has the right to safe and effective pain relief in labour, including neuraxial analgesia, and that her request is enough reason to provide it. WHO recommends, according to the woman's preferences, epidural analgesia, parenteral opioids, relaxation techniques and manual techniques such as massage or warm packs. The nurse assesses the pain, offers continuous support and non-drug options, prepares the woman for an epidural and monitors her and the baby afterwards. Drugs and their amounts follow the anaesthesia order and the institutional protocol.
What it requires
- A companion of her choice and continuous support from trained staff.
- A pain scale and her own goals, recorded before and after each measure.
- Free choice of position and movement in the first stage.
- Pain relief is not used to speed up labour, and oxytocin is not used to prevent delay in women with an epidural (WHO).
Components
- Support: presence, information, encouragement and a companion.
- Non-drug methods: breathing, relaxation, music, mindfulness, massage, warm packs, walking and upright positions.
- Drug methods: parenteral opioids and neuraxial (epidural or combined spinal–epidural) analgesia, given by the anaesthesia team according to protocol.
How it is applied (and why)
- Assess pain with a scale and ask what she expects and what her birth plan says — the plan is built around her preferences.
- Make sure a companion is present or offer one — continuous support improves the birth experience.
- Offer breathing, relaxation, massage, warm packs and changes of position — WHO recommends them and they combine with drugs.
- Encourage oral fluids if she is low risk and walking in the first stage — they add comfort.
- Before neuraxial analgesia, confirm request, consent, IV line and baseline vital signs and fetal heart — they are the starting point.
- Help her lie on her side or sit and round her back for the puncture — the right position makes placement safer.
- After the block, check blood pressure and the fetal heart as the protocol says — a fall in pressure can slow the fetal heart.
- If pressure falls, turn her on her side and call the anaesthesia team — this is the first measure while they decide treatment.
- Check the motor block before she gets up and help her change position — with low-dose analgesia she can still move.
- Reassess pain and record each measure — this shows whether the plan works.
In nursing practice
- Shivering after an epidural is common; headache is rare and is reported (MedlinePlus).
- Rarely the medicine reaches the spinal fluid: dizziness or trouble breathing call for urgent help.
- A strong block can make pushing harder; WHO suggests that, where the setting allows it, pushing may wait until the urge to bear down returns.
Common mistakes
- Telling a woman to wait for pain relief when she has already asked for it.
- Keeping her flat in bed after an epidural without checking whether she can move.
- Not checking blood pressure and the fetal heart after the block.
- Offering only drugs, or only non-drug methods, without asking her preferences.
Test yourself
Think of the answer, then tap the question to see it.
According to Res. 3280, what is enough reason to give a woman pain relief in labour?
Her request.
Which contraindications to neuraxial analgesia does Res. 3280 list?
The woman's refusal, a clotting disorder, local or systemic infection and uncorrected hypovolaemia.
What is the first nursing measure if blood pressure falls after an epidural?
Turn the woman on her side and call the anaesthesia team.
Which three non-drug methods of pain relief does WHO recommend?
For example breathing techniques, massage and warm packs (also relaxation, music and mindfulness).
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018); WHO Labour Care Guide: user's manual (Annex: WHO recommendations on intrapartum care) (World Health Organization, 2020); Epidural block - pregnancy (MedlinePlus, U.S. National Library of Medicine, 2025).
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