Operational Obstetrics & Gynecology
Labor and Delivery
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:
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:
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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