Treatment Guideline Chart
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.

Labor Pain References

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  2. Althaus J, Wax J. Analgesia and anesthesia in labor. Obstet Gynecol Clin North Am. 2005 Jun;32(2):231-244. PMID: 15899357
  3. Adams ED, Bianchi AL. A practical approach to labor support. J Obstet Gynecol Neonatal Nurs. 2008;37(1):106-115. doi: 10.1111/j.1552-6909.2007.00213.x. PMID: 18226164
  4. Australian and New Zealand College of Anaesthetists. Guidelines for the conduct of major regional analgesia in obstetrics. 1998:S14.
  5. Caton D, Corry MP, Frigoletto FD, et al. The nature and management of labor pain. Executive summary. Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S1-S15. PMID: 12011869
  6. Findley I, Chamberlain G. ABC of labour care-relief of pain. BMJ. 1999 Apr;318(7188):927-930. PMID: 10102864
  7. Fogarty V. Intradermal sterile water injections for the relief of low back pain in labour -- a systematic review of the literature. Women Birth. 2008 Dec;21(4):157-163. doi: 10.1016/j.wombi.2008.08.003. PMID: 18926789
  8. Hawkins JL. Epidural analgesia for labor and delivery. N Engl J Med. 2010 Apr;362(16):1503-1510. PMID: 20410515
  9. Gupta S, Kumar GS, Singhal H. Acute pain-labour analgesia. Indian J Anesth. 2006;50(5):363-369. Accessed 19 Aug 2010
  10. Schrock SD, Harraway-Smith C. Labor analgesia. Am Fam Physician. 2012 Mar;85(5):447-454. PMID: 22534222
  11. Simkin P. Comfort in labor: how you can help yourself to a normal satisfying childbirth. Childbirth Connection. 2007:1-14. Accessed 19 Aug 2010
  12. Leeman L, Fontaine P, King V, et al. The nature and management of labor pain: part II. Pharmacologic pain relief. Am Fam Physician. 2003 Sep;68(6):1115-1120. PMID: 14524398
  13. Leeman L, Fontaine P, King V, et al. The nature and management of labor pain: part I. Nonpharmacologic pain relief. Am Fam Physician. 2003 Sep;68(6):1109-1112. PMID: 14524397
  14. Simkin P, Bolding A. Update on nonpharmacologic approaches to relieve labor pain and prevent suffering. J Midwifery Women's Health. 2004;49(6):489-504. PMID: 15544978
  15. Tournaire M, Thea-Yonneau A. Complimentary and alternative approaches to pain relief during labor. Evid Based Complement Alternat Med. 2007 Dec;4(4):409-417. doi: 10.1093/ecam/nem012. PMID: 18227907
  16. Wong CA. Advances in labor analgesia. Int J Womens Health. 2010 Aug;1:139-154. PMID: 21072284
  17. Hofmeyr GJ. Prophylactic intravenous preloading for regional anesthesia in labour (Cochrane Review). The Cochcrane Library, Issue 2. Chichester, UK: John Wiley and Sons, Ltd; 2004
  18. Goldberg D, Zasloff E. Labor pain management. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia: Saunders, Elsevier; 2007
  19. Anesthesia for vaginal delivery. In: Miller R. Anesthesia. 5th: Churchill Livingstone, Inc; 2000:2304-2346.
  20. Cunningham F, Macdonald P, et al. Analgesia and anesthesia. William's Obstetrics. 20th. Stamford: Appleton and Lange; 1997:379-398.
  21. MedWorm
  22. National Collaborating Centre for Women’s and Children’s Health. Intrapartum care: care of healthy women and their babies during childbirth. Sep 2007. Accessed 19 Aug 2010.
  23. British Columbia Perinatal Health Program. Obstetric guideline 4: pain management options during labor. Oct 2007. Accessed 19 Aug 2010.
  24. American College of Obstetricians and Gynecologists (ACOG). Obstetric analgesia and anesthesia [summary in National Guideline Clearinghouse]. 2002
  25. Amedee Peret, FJA. Pain management for women in labour: an overview of systematic reviews: RHL commentary. The WHO Reproductive Health Library; Geneva: World Health Organization. 01 Mar 2013.
  26. Lee L, Dy J, Azzam H. Management of spontaneous labour at term in healthy women. J Obstet Gynaecol Can. 2016 Sep;38(9):843-865. PMID: 27670710
  27. National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies. NICE. Updated Feb 2017.
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