Women's Health and Education Center (WHEC)

Pain Management During Labor and Delivery

List of Articles

  • Obstetric Anesthesia: Complications and Management
    During pregnancy, there are major alterations in nearly every maternal organ system. These changes are initiated by hormones secreted by the corpus luteum and placenta. The mechanical effects of the enlarging uterus and compression of surrounding structures play an increasing role in the second and third trimesters. This altered physiologic state had relevant implications for the anesthesiologist caring for the pregnant patient. Any drug that reaches the fetus undergoes metabolism and excretion. Well-conducted obstetric analgesia and anesthesia, in addition to relieving pain and anxiety, may benefit the mother. Placental drug uptake is limited, and there is no evidence to suggest that this organ metabolizes any of the agents commonly used in obstetric anesthesia. The idea that surgical anesthesia, although deemed necessary for the patient, might have detrimental effects on the growth and development of the human fetus has led to a great deal of investigation, both in-vitro and in experimental animals. Because a single exposure to anesthetic agents seems unlikely to result in fetal abnormalities, the selection of agent should be based on specific surgical requirements.

  • Obesity and Anesthesia
    The worldwide prevalence of obesity has increased substantially over the past few decades. Economic, technologic, and life style changes have created an abundance of cheap, high-calorie food coupled with decreased required physical activity. The purpose of this document is to review pathophysiology of obesity and challenges it poses for obstetrical anesthesia. The incidence of maternal obesity and its attendant comorbid conditions (diabetes, cardiovascular disease) continues to increase at an alarming rate, with major public health implications. Obese patients should be counseled before labor, advising them what intrapartum complications to anticipate. This also includes an anesthesia consult, especially to evaluate the airway.

  • Overview of Obstetric Anesthesia Professional Liability
    Nearly in two decades, a review of liability associated with obstetric anesthesia using the American Society of Anesthesiologists (ASA) Closed Claim database found that, although awards to plaintiffs were higher in obstetric claims from the 1970s and 1980s, there were more claims for minor complications in obstetric compared to non-obstetric claims. The most common complications in obstetric claims were newborn death or brain damage (29%) and maternal death (22%). Over the past three decades, there have been numerous changes in the practice of anesthesiology in general and in the practice of obstetric anesthesia specifically. Specifically explored are the contribution of newborn death and brain damage compared to maternal death and brain damage to obstetric anesthesia liability in 1990 or later claims. This review should spur us to examine and change our practices to minimize both patient harm and our liability when we are not at fault. Only closed claim analyses can help us understand the conditions under which fatal and non-fatal injuries lead to litigation.

  • Effects of Regional Analgesia on Labor
    Most women experience significant pain during their first labor that is why obstetricians spend a considerable amount of time counseling women about their pain control options. Epidural analgesia is attractive to both patients and clinicians because it is the most effective pain control method available, are relatively safe, and have only moderate effects on the course of labor. Despite its popularity and safety, epidural analgesia is not without side effects. The most common of which are maternal fever, effects on uterine basal tone and fetal heart rate (FHR) abnormalities. Of the various pharmacologic methods of pain relief during labor and delivery, regional analgesia techniques -- spinal, epidural, and combined spinal epidural -- are the most flexible, effective, and least depressing to the central nervous system, allowing an alert, participating woman and an alert neonate.

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