Pain Management During Labor and Birth

The intensity of pain during labour varies depending on the individual and the pregnancy. Labour pain is caused by uterine muscle contractions. The pressure exerted by the head of the fetus is the other etiological factor of labour pain. Exertion of pressure on the bladder, vagina, and pelvis generates pain. Spontaneous uterine contractions can worsen the pain during labour. This necessitates the need for pain management.

Expected Outcomes

Pain management helps control visceral pain caused by spontaneous uterine contractions. It also helps to control the somatic pain that emanates from pressure exertion by the fetus’ head. Pain relief is achieved through the blockade of the transmission of nerve impulses. The blockage can either be complete or partial. Pian relief enables the labouring woman to have sufficient rest in case of prolonged labour. By helping to avert discomfort, pain relief creates a positive labour and birth experience for pregnant women.

Medications Used During Labor and Birth

Medication	Onset of Action	Dosage	Side Effects	Patient Education	Contraindications
Meperidine	3 to 6 minutes	25 to 50 mg intravenously (IV) every 2 hours or 50 to 100 mg Intramuscularly (IM) every 2 to four hours (Nanji & Carvalho, 2020).	Agitation, bradycardia, constipation, dry mouth, dysphoria, palpitations, QT-interval prolongation, sedation, sweating, flushing, and syncope (Sarah & Roshan, 2016).	Educated on the risk of addiction and abuse. Misuse and abuse can cause death. Patients should monitor and report any incidence of respiratory depression. Prolonged use can lead to fetal withdrawal symptoms. Patients should report to their healthcare providers the duration of medication use. Patients should not operate machinery.	Known hypersensitivity. Severe bronchial asthma. Respiratory depression. Paralytic ileus within two weeks of taking Monoamine oxidase inhibitors (Nanji & Carvalho, 2020).
Fentanyl	IV administration offers immediate action. Onset is 7 to 15 minutes after IM administration (Nanji & Carvalho, 2020).	50 to100 micrograms (mcg) intravenously hourly	Asthenia, constipation, somnolence, abdominal pain, confusion, apnea, hallucination, nervousness, bradycardia, Q-T interval prolongation, sedation, seizures, visual disturbances, paresthesia, and bronchitis (Sarah & Roshan, 2016).	Risk of addiction and abuse. Risk of life-threatening respiratory depression The patient should report all cases of respiratory depression for close monitoring. Prolonged use can lead to neonatal opioid withdrawal syndrome. Severe respiratory depression can occur with concomitant use of CNS depressants. Severe hypotension can occur after administration (Nanji & Carvalho, 2020).	Known hypersensitivity Severe respiratory depression. Bronchial asthma. Gastrointestinal obstruction. Within fourteen days of using monoamine oxidase inhibitors.
Butorphanol	Less than 10 minutes after IV administration, 5 to 10 minutes after IM, within 15 minutes after Intranasal (IN) administration (Nanji & Carvalho, 2020).	1 to 2 mg IV or IM. Repeat when needed after every four hours.	Sedation, nasal congestion, insomnia, vomiting, nausea, dizziness, blurred vision, constipation, anorexia, epistaxis, dyspnea, cough, lethargy, palpitations, apnea, and respiratory depression (Sarah & Roshan, 2016).	Patients should avoid other CNS depressants such as alcohol. Risk of withdrawal symptoms in cases of opioid dependency. Prolonged use can lead to neonatal withdrawal symptoms. Patients having underlying conditions such as hypothyroidism and head injuries should report for close monitoring (Nanji & Carvalho, 2020).	Opioid dependence. Respiratory failure, Respiratory depression. Coronary insufficiency Myocardial infarction. Cardiac arrhythmias (Nanji & Carvalho, 2020).
Morphine	15 to 30 minutes after oral administration. Less than 5 minutes after IV administration (Nanji & Carvalho, 2020).	2 to 5 mg intravenously or 10 mg intramuscularly after every four hours.	Pruritus, constipation, urinary retention, vomiting, headache, somnolence, asthenia, abdominal pain, depression, diarrhoea, insomnia, fever, paresthesia, xerostomia, respiratory depression, oedema, anorexia, dizziness (Nanji & Carvalho, 2020).	Educate the patient on the risk of addiction, abuse, and overdose. If tablets or capsules are taken, they should be swallowed whole without chewing. Respiratory depression is likely to occur. Patients should report all incidences of respiratory depression for close monitoring. Prolonged use during pregnancy can cause neonatal opioid withdrawal syndrome (Nanji & Carvalho, 2020).	Known hypersensitivity Paralytic ileus Gastrointestinal obstruction. Within fourteen days of administering MAOIs, respiratory depression, heart failure, and cardiac arrhythmias (Sarah & Roshan, 2016).
Bupivacaine	Within 1 minute after epidural administration. Maximum blockade after 15 minutes (Kim et al., 2019).	0.25% increased up to 175 mg (70 millilitres)	Nausea, bruising, vomiting, constipation, bradycardia, headache, dizziness, pruritus, dysgeusia, anaemia, tinnitus, dysuria, pyrexia, diarrhoea, hypertension, contusion, flatulence (Kim et al., 2019).	Patients should report any underlying conditions such as glucose-6-phosphate dehydrogenase deficiency and methemoglobinemia, shock, and heart block (Kim et al., 2019).	Known hypersensitivity to amide local anaesthetics. Severe haemorrhage, cardiac arrhythmias, septicemia, presence of local infection at the site of administration, and obstetrical paracervical block anaesthesia (Kim et al., 2019).
Ropivacaine	3 to 15 minutes	20 to 40 mg initially for 0.2% solution, then 12 to 28 mg per hour or 20 to 30 mg per hour continuous infusion of 0.2% solution (Fang et al., 2016).	Bradycardia, cardiac arrhythmia, tachycardia, angina, hypertension, and cardiac arrest. Apprehension, headache, disorientation, drowsiness, nausea, vomiting, blurred vision, unconsciousness, CNS depression, shivering, seizures, and tinnitus (Fang et al., 2016).	Patient to report any history of malignant hyperthermia. Patients to report any underlying conditions such as glucose 6-phosphate deficiency and methemoglobinemia, cardiac disease, or pulmonary disease (Fang et al., 2016).	Known hypersensitivity to Ropivacaine and other amide-type local anesthetics. Known hypersensitivity to parabens
Lidocaine	Less than two minutes.	For analgesia 25 to 30 ml of a 1% solution. For anesthesia 15 to 20 ml of 1,5 % solution (Fang et al., 2016). (Both are delivered in the lumbar region.)	Hypotension, edema, confusion, dizziness, headache, constipation, vomiting, cardiac arrest, methemoglobinemia, seizures, malignant hyperthermia, petechia, dysrhythmias (Fang et al., 2016).	Patients to report underlying conditions such as Wolff-Parkinson-White Syndrome. Patients to report any incidences of respiratory depression (Fang et al., 2016).	Known hypersensitivity to lidocaine. Hypersensitivity to other amide-type local anesthetics. Adams-Stokes syndrome. Cardiogenic shock, congestive heart failure (Fang et al., 2016).

Pain management is important because it helps to create positive labor and birth experiences for pregnant mothers. Both narcotic analgesics and local anesthetics are used to provide pain relief during labor and childbirth. The patient should receive sufficient education on the use of each medication. Furthermore, caution should be taken in instances where the medication is contraindicated.

References

Fang, G., Ding, Z., & Song, Z. (2016). Comparison of The Effects of Epidural Anesthesia and Local Anesthesia in Lumbar Transforaminal Endoscopic Surgery. Pain Physician, 19(7), E1001–E1004. https://doi.org/10.36076/ppj/2016.19.e1001

Kim, W. H., Hur, M., Park, S. K., Yoo, S., Lim, T., Yoon, H. K., Kim, J. T., & Bahk, J. H. (2019). Comparison Between General, Spinal, Epidural, and Combined Spinal-Epidural Anesthesia for Cesarean Delivery: A Network Meta-Analysis. International Journal of Obstetric Anesthesia, 37, 5–15. https://doi.org/10.1016/j.ijoa.2018.09.012

Nanji, J. A., & Carvalho, B. (2020). Pain Management During Labor and Vaginal Birth. Best Practice and Research: Clinical Obstetrics and Gynaecology, 67, 100–112. https://doi.org/10.1016/j.bpobgyn.2020.03.002

Sarah, A. & Roshan, F. (2016). Side Effects and Efficacy of Neuraxial Opioids in Pregnant Patients at Delivery: A Comprehensive Review

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