labor%20pain
LABOR PAIN
Labor pain experience is highly individualized and will depend on a woman's emotional, motivational, cognitive, cultural and social circumstances.
There is no other circumstance where it is considered acceptable for a patient to experience severe pain that is amenable to safe intervention while under a physician's care.
The pain felt during the 1st stage of labor originates from the rhythmic contractions of the lower uterine segment and progressive cervical dilation mediated via T10-L1 spinal nerves.
The pain in the 2nd stage of labor is more intense due to stretching of the vagina, vulva and perineum as the fetus descends in the birth canal superimposed by the pain of uterine contractions, and is transmitted through the S2-S4 spinal segments.

Maternal and Fetal Monitoring

  • Clinical monitoring of both the mother and the fetus should be done
    • Monitor maternal hypotension and fetal heart rate (HR) changes after initiation of analgesia
  • Extent of analgesia and neural blockade should be regularly assessed
    • Assess motor function and balance
    • Parturient should not walk alone because proprioception may interfere with balance in some patients despite lack of motor blockade
  • Dose titration of the medications administered and determination of the need for further agents should be done as necessary
  • Adverse effects should be promptly detected and appropriately managed
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