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Operational Obstetrics & Gynecology

Labor and Delivery

Watch a PowerPoint Lecture

Watch a Video Showing a Normal Delivery or Cesarean Section

Labor

Contractions

Electronic Fetal Monitors

Latent Phase Labor

Fetal Heart Rate

Pain Relief

Active Phase Labor

Urine

Second Stage Labor

Progress of Labor

Estimated Fetal Weight

Preparing for Delivery

Delivery of the Baby

Dilatation and Effacement

Managing the Delivery

Delivery of the Placenta

Fetal Orientation

Episiotomy

Managing Labor and Delivery

Leopold's Maneuvers

Anesthesia

Initial Evaluation

Fetal Membranes

Clamp the Cord

History

Blood Count

The Placenta

Risk Factors

Early Labor

Uterine Massage

Vital Signs

Monitor the Fetal Heart

Post Partum Care

Pain Relief

Various cultures approach the pain of labor differently and individuals vary in their responses to labor pains. Some women will need little or no help with pain relief, while others will benefit from it. While no analgesic is 100% safe 100% of the time, pain relief is generally very safe and provides for a much happier experience for the woman and her family.

The following principles may be helpful:

  • A small number of women in labor will have virtually no pain and they do not need any analgesia.

  • The majority of women will have moderate discomfort, particularly toward the end of labor and they will generally appreciate some analgesia.

  • Some women will experience severe pain during labor and they will benefit from your most intensive efforts.

  • Giving analgesics prior to the onset of active labor (before 4 cm dilatation) will usually slow the labor process, although for some (those with a prolonged latent phase), it may actually speed up labor.

Focused breathing (Lamaze techniques) during contractions can be very helpful in reducing or eliminating the need for pharmacologic analgesia. Hypnotherapy can provide similar relief, as can massage therapy.

Narcotic analgesics can be highly effective at treating the pain of labor. They are generally safe for the baby, although it is better to avoid large doses toward the end of labor in order to avoid respiratory depression in the newborn. The greatest safety with narcotics is achieved when an antagonist (naloxone or Narcan) is available to treat the baby should depression appear. Good dosages for this purpose include:

  • Dilaudid (butorphanol) 1-2 mg IM Q 3-4 hours

  • Dilaudid (butorphanol) 1 mg IM and 1 mg IV every 3-4 hours

  • Demerol (meperidine) 12-25 mg IV every 60-90 minutes

  • Demerol (meperidine) 50-100 mg IM every 3-4 hours

  • Demerol (meperidine) 50 mg plus Vistaril (promethazine) 50 mg IM every 3-4 hours

  • Morphine 2.5-5 mg IV every 60-90 minutes

  • Morphine 7.5 - 15 mg IM every 3-4 hours

More frequent, smaller doses are better than larger, less-frequent doses. Smaller doses given IV are immediately effective, but wear off quickly. Whether that is an advantage or disadvantage depends on how close the woman is to delivery and her need for immediate pain relief.

Paracervical blocks (up to 20 cc of 1% Lidocaine in divided doses) can stop the pain of contractions for up to an hour and a half. Care must be taken to prevent excessive fetal uptake of the Lidocaine, which can lead to fetal bradycardia.

Continuous lumbar epidural anesthetic is effective and versatile, but requires skilled providers. In some settings, this can be very appropriate, but in other operational settings, these resources may not be available.

Inhalation of 50% nitrous oxide with 50% oxygen, can give very effective pain relief during labor and is safe for the mother and baby. It is safest when self-administered by the mother, under the guidance of her birth attendant. If she feels dizzy or starts to achieve anesthetic levels of the nitrous, she will naturally release the mask, reversing the effects of the nitrous oxide.

Less commonly used is a self-administered volatilized gas of methoxyflurane. It is capable of achieving anesthetic levels and so must be very closely monitored.


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Operational Obstetrics & Gynecology - 2nd Edition
The Health Care of Women in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMEDPUB 6300-2C
January 1, 2000

This web version of Operational Obstetrics & Gynecology is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy NAVMEDPUB 6300-2C, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified.

This formatting 2006 Medical Education Division, Brookside Associates, Ltd.
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