women s health issues
Labor
Pain relief
With the advice of her doctor or midwife, a woman usually plans an approach to pain relief long before labor starts. She may choose one of the following: Natural childbirth, which relies on relaxation and breathing techniques to deal with pain Analgesics (given intravenously) A particular type of anesthetic (local or regional) if needed After labor starts, these plans may be modified, depending on how labor progresses, how the woman feels, and what the doctor or midwife recommends. A woman’s need for pain relief during labor varies considerably, depending to some extent on her level of anxiety. Attending childbirth preparation classes helps prepare the woman for labor and delivery. Such preparation and emotional support from the people attending the labor tend to lessen anxiety. (pain relievers) may be used. If a woman requests analgesics during labor, they are usually given to her. However, because some of these drugs can slow (depress) breathing and other functions of the newborn, the amount given is as small as possible. Most commonly, an Opioid Pain Relievers such as Local anesthesianumbs the vagina and the tissues around its opening. This area can be numbed by injecting a local anesthetic through the wall of the vagina into the area around the nerve that supplies sensation to the lower genital area (pudendal nerve). This procedure, called a pudendal block, is used only late in the second stage of labor, when the baby’s head is about to emerge from the vagina. It has been largely replaced by epidural injections. A more common but less effective procedure involves injecting a local anesthetic at the opening of the vagina. With both procedures, the woman can remain awake and push, and the fetus’s functions are unaffected. These procedures are useful for deliveries that have no complications. Regional anesthesianumbs a larger area. It may be used for women who want more complete pain relief. The following procedures can be used: Lumbar epidural injectionis almost always used when pain relief is needed. An anesthetic is injected in the lower back—into the space between the spine and the outer layer of tissue covering the spinal cord (epidural space). Alternatively, a catheter is placed in the epidural space, and a local anesthetic (such asbupivacaine) is continuously and slowly given through the catheter. An opioid (such asfentanylorsufentanil) is often also injected. An epidural injection for labor and delivery does not prevent the woman from pushing and does not make women more likely to need a cesarean delivery. An epidural injection can also be used in cesarean deliveries. Spinal injectioninvolves injecting an anesthetic into the space between the middle and inner layers of tissue covering the spinal cord (subarachnoid space). A spinal injection is typically used for cesarean delivery when there are no complications. Occasionally, use of either an epidural or a spinal injection causes a fall in blood pressure in the woman. Consequently, if one of these procedures is used, the woman’s blood pressure is measured frequently. General anesthesiamakes a woman temporarily unconscious. It is rarely necessary and infrequently used because it may slow the function of the fetus’s heart, lungs, and brain. Although this effect is usually temporary, it can interfere with the newborn’s adjustment to life outside the uterus. General anesthesia is typically used for emergency cesarean delivery because it is the quickest way to anesthetize the woman. 