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Blefari and E. Gollo Labour pain is described as a complex, subjective and multidimensional experience characterized by severe pain. Usually, labour is divided into three stages. The first stage is defined as the beginning of regular uterine contractions until cervical dilatation is completed. The second stage is from the end of the first stage until the delivery of the fetus, and the third stage continues until the placenta and membranes have been discharged. During the first stage the pain is mainly visceral and mediated by the T10–L1 segments of the spine, while during the second stage, an additional somatic component is present, mediated by the S1–S4 segments of the spine.

A meta-analysis by the Cochrane Library did not reveal any effects of epidural analgesia on fetal heart rate, meconium abnormalities or the number of newborns with an Apgar score lower than 7 at 5 min. 2 in the umbilical artery (Table 1). Combined spinal-epidural (CSE) analgesia consists in a single intrathecal injection of opioids with or without local anaesthetics plus epidural analgesia. It gives rapid pain relief, minimal motor blockade and faster cervical dilatation, and is associated with more spontaneous deliveries and fewer instrumental deliveries than epidural analgesia.

65. Linton EA, Perkins AV, Woods RJ et al (1993) Corticotropin releasing hormone-binding protein (CRH-BP): plasma levels decrease during the third trimester of normal human pregnancy. J Clin Endocrinol Metab 76:260–262 66. Goland RS, Wardlaw SL, Stark RI et al (1986) High levels of corticotropin-releasing hormone immunoactivity in maternal and fetal plasma during pregnancy. J Clin Endocrinol Metab 63:1199–1203 67. Petraglia F, Giardino L, Coukos G et al (1990) Corticotropin-releasing factor and parturition: plasma and amniotic fluid levels and placental binding sites.

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