Labor and Delivery

There are multiple options for pain control during labor. The labor epidural is very safe and efficient technique. It is indicated upon request in women who are in established labor and do not have contraindications like coagulation disorders, infection, CNS space-occupying diseases or inability to cooperate. The complications of labor epidural include uneven block, multiple attempts, and failed epidural necessitating replacement, accidental intrathecal or intravascular placement, extensive or prolonged block, neurological injury, epidural abscess, and epidural hematoma. Common side effects of the labor epidural are: pruritus, nausea and vomiting, urinary retention, maternal hypotension and fever. In addition to epidural, other techniques for neuraxial anesthesia include combined spinal epidural (CSE), dural puncture epidural (DPE), and continuous spinal analgesia. The alternatives to epidural include pharmacologic medications like opioids, ketamine, dexmedetomidine and nitrous oxide, and non-pharmacologic methods like emotional support by spouse or friend, massage, hypnotherapy, hydrotherapy, and doulas. The obstetric anesthesiologist needs to have various skills not only in epidural placement and troubleshooting, but also knowledge about the fetal heart monitoring and experience in teamwork.