Labour Pain, Severe

General measures

Medicine treatment

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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

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

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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: Hospital Level STG, Adult NDoH: Anaesthesiology, pain and intensive care).

Perineal analgesia: R10.2

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

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

• Paracetamol, oral, 500 mg to 1 g, 4–6 hourly as required (to a maximum of 4 g in 24 hours).
  • Maximum dose: 15 mg/kg/dose.

OR

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

OR

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

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Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2025-9 Review_Version 2.0_26 March 2026

Chapter 6 Obstetrics_6.14 Labour Pain, Severe