ANALGESIA & ANESTHESIA IN LABOR Goal of Pharmacologic Pain Relief Goal is to provide maximum pain relief with minimum

nimum risk to mother and fetus Goal is impacted by following factors All systemic drugs used in labor for pain relief cross placental barrier by simple diffusion Drug action in body depends on rate at which substance is metabolized by liver Fetus has inadequate ability to metabolize analgesic agent

Timing of Medication After complete assessment, analgesia agent generally administered when cervical change has occurred - pain medication given too early may prolong labor and depress fetus Nursing Management Drugs may cause fetal respiratory depression at birth if given too late in labor Maternal and fetal vital signs must be stable before systemic drugs may be administered Assess mother and fetus and evaluate contraction pattern before administering prescribed medications Epidural Injection Injection of anesthetic agent into epidural space Produces little or no feeling to area from uterus downward Pushing during second stage of labor may be impaired due to lack of sensation Hypotension is most common side effect Woman may need urinary catheterization due to loss of bladder sensation Continuous Epidural Analgesia Provides good analgesia Produces less nausea and provides greater ability to cough May produce breakthrough pain, sedation, respiratory depression Itching and hypotension are side effects Spinal Block Local anesthetic agent injected directly into spinal canal Level of anesthesia dependent upon level of administration May be administered higher for cesarean birth or lower for vaginal birth Onset of anesthesia is immediate

Side effects include Maternal hypotension, which can lead to fetal hypoxia requiring frequent blood pressure monitoring health changes Indwelling urinary catheter usually needed due to decreased bladder sensation and tone Woman's legs must be protected from injury for 8 to 12 hours after birth of baby due to decreased movements and sensation Pudendal Block Local anesthesia injected directly into pudendal nerve, which produces anesthesia to lower vagina, vulva, perineum Only produces pain relief at end of labor Has no effect on fetus or progress of labor May cause hematoma, perforation of rectum, trauma to sciatic nerve Local Infiltration Local anesthesia injected into perineum prior to episiotomy Provides pain relief only for episiotomy incision There is no effect on maternal or fetal vital signs Requires large amounts of local anesthetic agents Complications Regional anesthesia administered per spinal or epidural route has similar possible complications Maternal hypotension Bladder distension Inability to push during second stage of labor Severe headache with spinal anesthesia Elevated temperature with epidural anesthesia Possible neurologic damage Nursing Care Related to General Anesthesia Nurse should Assess when mother ate or drank last Place wedge under mother's right hip to displace uterus and prevent vena cava compression Provide oxygen prior to start of surgery Ensure IV access is established Assist anesthesiologist Major Complications Fetal depression If mother receives general anesthesia, infant may have respiratory depression Method not advocated when infant is considered high risk Uterine relaxation: Most general anesthetic agents cause some uterine relaxation