The document discusses the history and current practices of pain management during childbirth. It notes that historically, childbirth pain was seen as divine punishment. Non-pharmacological techniques like acupuncture and hypnosis were used. Queen Victoria popularized using chloroform for pain relief in the 1800s. Now, over 90% of women receive some form of analgesia, mainly neuraxial techniques like epidurals that are considered very safe when administered properly. The document provides details on various analgesic options and their risks and benefits.
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Childbirth - most painful experiences women
will experience in their lifetime
Childbirth pain was “divine retribution for Eve’s
disobedience in the Garden of Eden”
Many believed it was wrong to treat the pain
and escape God’s punishment
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<10% of laboring women in US in 2001
underwent childbirth without analgesia
Neuraxial analgesia is by far the most common
form of pain management
Development of increasingly safe techniques for
neuraxial analgesia
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Inhaled anesthetics were the first treatments
for labor analgesia used in modern times.
However, as volatile anesthetics became more
commonly used in childbirth, side effects were
more commonly encountered.
Neonatal depression
Maternal gastric aspiration
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Delivery was complicated by aspiration of
gastric contents in 66 women from 44,016
deliveries (0.15%) between 1932 and 1945.
The preventive fasting measures -
recommended by Mendelson
restricting intake
provision of non-particulate antacids
improvement of anesthetic-induction technique
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Assessment of all laboring women for risk
factors for neuraxial analgesia and general
anesthesia is recommended
Sufficient time should be available for adequate,
safe evaluation and discussion with the patient.
In otherwise healthy women, routine laboratory
testing is not required.
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Although any laboring woman has the potential
to require cesarean section, labor takes many
hours and requires adequate nutrition and
hydration.
ASA has recommended that moderate amounts
of clear liquids be allowed during the
administration of neuraxial analgesia and
throughout labor
A period of abstention from solids before the
placement of neuraxial analgesia is not
required.
28. Timing of placement
Current ASA guidelines note that maternal request
for labor pain relief is sufficient justification for
intervention and the decision should not depend
on an arbitrary cervical dilation.
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Pudendal nerve block
The pudendal nerve is derived from sacral nerve
roots and can be blocked with local anesthetic
using a transvaginal or transperineal approach to
treat pain during the second stage of labor and for
episiotomy repair.
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Low-dose epidural analgesia can be inadequate
for assisted vaginal delivery with forceps or
vacuum.
A higher concentration local anesthetic can be
administered through an indwelling epidural
catheter or a “second-stage spinal” can provide
excellent perineal analgesia.
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Supplementation of an indwelling epidural
catheter with 5 to 10 mL of 1% to 2% lidocaine
or 2% to 3% 2-chloroprocaine is usually
adequate, depending on whether vacuum or
forceps are being used.
Pudendal nerve block also can be considered for
operative delivery.
43. Individualize technique to patient’s goals
and stage of labor
Optimize management for spontaneous
delivery
Provide safe, cost-effective analgesia