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Pain in labor and delivery

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of pain in labor and delivery are prepared by our editorial team based on guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC 2025), the American College of Obstetricians and Gynecologists (ACOG 2019), the Enhanced Recovery After Surgery Society (ERASS 2018), the Society of Obstetricians and Gynaecologists of Canada ...
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Diagnostic investigations

History and physical examination: as per ASA 2016 guidelines, conduct a focused history and physical examination (including, but not limited to, a maternal health and anesthetic history, a relevant obstetric history, a baseline BP measurement, and an airway, heart, and lung examination) before providing anesthesia care. Examine the patient's back ehen planning neuraxial anesthesia.
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  • Laboratory tests

Medical management

Opioids: as per ACOG 2019 guidelines, recognize that opioids are associated with adverse effects for the woman and the fetus or newborn, most significantly respiratory depression. Pay attention to respiratory status.
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Inpatient care

Fetal HR monitoring: as per ASA 2016 guidelines, monitor fetal HR patterns by a qualified individual before and after administering neuraxial analgesia for labor. Recognize that continuous electronic recording of fetal HR patterns may not be necessary in every clinical setting and may not be possible during the placement of a neuraxial catheter.
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  • Prevention of aspiration

Nonpharmacologic interventions

Labor support: as per SOGC 2018 guidelines, encourage parents and their support persons to prepare for birth by learning about birth physiology and acquiring skills in managing pain.
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Therapeutic procedures

Anesthetic care for labor and delivery, general principles: as per ACOG 2019 guidelines, offer pain relief during labor upon maternal request, provided there is no medical contraindication.
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  • Anesthetic care for labor and delivery (removal of retained placenta)

  • Anesthetic care for Cesarean delivery

  • Anesthetic care for postpartum tubal ligation

  • Technical considerations for analgesia

  • Management of failing epidural analgesia

  • Management of obstetric and anesthetic emergencies (hemorrhagic emergencies)

  • Management of obstetric and anesthetic emergencies (airway emergencies)

  • Management of obstetric and anesthetic emergencies (CPR)