Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++Table Graphic Jump Location|Download (.pdf)|PrintStages of LaborStagesDermatomesDefinitionFirstT10–L1Uterine contractions with dilation of cervix until fully dilatedSecondS2–S4Full dilation of cervix until delivery of infantThirdS2–S4Expulsion of placenta++Table Graphic Jump Location|Download (.pdf)|PrintNonpharmacologic Methods of Pain ReliefMethodTechniqueHypnosisModify perception of pain through self-hypnosis and posthypnotic suggestionPsychoanalgesiaReduction in maternal anxiety through controlled breathing and relaxation techniques (Dick-Read method)PsychoprophylaxisReduction in pain perceptions through controlled relaxation and breathing (Lamaze)Leboyer technique“Birth without violence” or avoidance of birth trauma for neonate through decreasing environmental stimuliAcupunctureInsertion of fine needles at meridians to correct energy paths disrupted by laborTENSTranscutaneous electrical nerve stimulation at T10–L1 bilaterallyWater birthingMaternal stress relief through immersion in warm bathAromatherapyStress relief in labor through inhalation of aerosolized essential oilsTouch and massageEmotional and pain relief through therapeutic touch ++ See following table. ++Table Graphic Jump Location|Download (.pdf)|PrintSystemic Medications and Inhalational Agents for Labor Pain ReliefMedicationUse and/or dosageCommentsOpioidsPopular in first stage of laborMaternal and fetal respiratory depression possibleDecrease fetal heart rate variabilityMorphine5–10 mg IM (peak effect 1–2 h)2–3 mg IV (peak effect 20 min)Often used as PCA or continuous infusionMeperidine50–100 mg IM (peak effect 40–50 min)25–50 mg IV (peak effect 5–10 min)Fentanyl50–100 μg IM (peak effect 7–8 min)25–50 μg IV (peak effect 3–5 min)Short durationUse for PCA in labor analgesia has decreased since the introduction of remifentanilRemifentanilPCA: initial infusion 0.03 μg/kg/min; titrate to 0.1 μg/kg/minShort half-life in plasmaUse supplemental oxygenMinimizes neonatal respiratory depressionAgonist–antagonistsLimited potential for respiratory depressionButorphanol (Stadol)1–2 mg IMTransient sinusoidal fetal heart rate patternNalbuphine (Nubain)5–10 mg IVNeonatal respiratory depressionSedatives/tranquilizersPhenothiazinesAnxiolytic and antiemeticHydroxizine (Vistaril)25–50 mg IMDecreases fetal heart rate variabilityPromethazine (Phenergan)25–50 mg IMInhalational analgesiaEntonox: 50% N2O/50% O2 (mixture not available in the United States)Patient controlledMay be difficult to obtain precise concentrationAvailability of proper scavenging is often lacking ++ Epidural analgesia: ++ Analgesia provided by analgesics delivered via epidural catheterMost effective form of intrapartum analgesiaRequires preanesthetic evaluation, presence of anesthesiologist, resuscitation equipment ++ Indications: ++ Maternal request for pain relief represents sufficient condition for epidural administration (ACOG/ASA joint guidelines) ++ Contraindications: ++ Patient refusal/inability to cooperateElevated intracranial pressure/mass effectSoft tissue infection at epidural siteSepsisCoagulopathyHypovolemia ++ Technique: ++ Patient positioned, monitors in placeEpidural space accessed using epidural needleCatheter passed through the needle, aspirated, and secured as usualEpidural catheter tested:Every dose is a test dose and should be given in a ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth