Ambulatory labor analgesia: what does an obstetrician need to know?

Abstract

A simple statement that describes the degree of the patient's satisfaction with the pain relief from her labor epidural analgesia has often assessed the quality of labor analgesia as perceived by the patient. Many laboring parturients, midwives, obstetricians and anesthesiologists are increasingly concerned by the limitations of traditional epidural labor analgesia. In general, women dislike the inability to void, the often-dense motor block, the feeling of numbness of the lower body, the total lack of the urge to bear down, and the complete perineal anesthesia. Continuous search for balanced labor analgesia that provides relief from pain, while preserving motor function, has led to the development of an ambulatory labor analgesia technique. This article assesses the validity of various strongly advocated opinions as to whether parturients benefit from ambulation in labor and also reviews the current trends in ambulatory labor analgesia.

Dexmedetomidine versus sufentanil with high‐ or low‐concentration ropivacaine for labor epidural analgesia: A randomized trial

“…A higher score indicates greater pain intensity. A score of 0 is defined as no pain; below 3, mild pain; 4–6, moderate pain, which was tolerable but disrupted sleep; and 7–10, severe pain which was unbearable . A modified Bromage scale was used for grading motor block associated with intravertebral anesthesia in parturient women.…”

“…According to the study, epidural anesthesia is currently the best method of anesthesia, for it is effective in 95% of the cases by adjusting the dosage of anesthetics according to the conditions of the parturient women . Effective pain relief during labor can not only reduce pain, but also play an important role in reducing the use of cesarean section and ensuring the safety of the mother and child . Therefore, it has been the focus of obstetrics and anesthesiology to discover effective and safe methods for analgesia during labor.…”

Timing of induction of labour analgesia: what does an obstetrician need to know?

“…combined spinal‐epidural labour analgesia, ambulatory labour analgesia etc.) have been invented and successfully introduced into the clinical practice of obstetric anesthesia over time (2–4). Therefore, the impact (if any, as this issue remains controversial) of labour analgesia on a number of obstetrical outcome parameters, such as progress of labour, need for labour augmentation, and frequency of instrumental (e.g.…”

Doctors and doulas in the labor and delivery suite

“…Maternal stress during labor and delivery is a complex psychological response, which can be influenced by many factors, including the parturient’s expectations, her level of education (while many pregnant women present with a significant amount of prior knowledge regarding childbirth, others may have little or no understanding of the labor and delivery), intensity and severity of uterine contractions (labor pain), the labor suite environment and presence (or absence) of a lay support person (1).…”