A balance between pain relief, bodily awareness, and control: a qualitative study on women's experiences with intravenous remifentanil patient-controlled analgesia (PCA) for labour analgesia

BACKGROUND: Remifentanil patient-controlled analgesia became a routinely available option for all labouring women at North Zealand Hospital in Denmark in March 2025. The aim of this study was to explore women's experiences of remifentanil during labour, including pain relief, side effects, and its role alongside other analgesia options.

METHODS: Qualitative single-centre study including women who had given birth using remifentanil PCA. Remifentanil was administered as 10-30 μg boluses with one-to-one midwife care. Semi-structured interviews were analysed using manifest content analysis.

RESULTS: Eighteen women were interviewed, median 6 days postpartum. Three themes emerged: "Balancing pain relief, bodily awareness and control during birth," "Practical experiences of remifentanil," and "Reflections on labour analgesia options." Women described remifentanil as enabling a balance between pain relief and feeling connected to their body, fostering a sense of control. Remifentanil was positioned between nitrous oxide and epidural analgesia among available options, often chosen to avoid epidural-related risks and side effects. Most reported high satisfaction and few side effects. Initial guidance from the midwife was necessary to time remifentanil administration, after which most women learned to time the doses themselves.

CONCLUSIONS: Remifentanil was described as a controllable and acceptable form of labour analgesia that enabled women to balance pain relief with bodily awareness, and active participation during labour. Women positioned RemiPCA between nitrous oxide and epidural analgesia and often described it as a less invasive option that still provided meaningful pain relief. These findings support remifentanil as a relevant additional option within individualised labour analgesia.