JOG ININ| CLINICAL ISSUES Analgesia and Anesthesia During Labor and Birth: Implications for Mother and Fetus Judith H. Poole IEE Labor and birth, although vie ed as a normal physiological process, can produce significant pain, requiring appropriate pain management. Systemic analgesia and regional analgesia/ anesthesia have become less common, hereas the use of ne er new- raxial techniques, ith minimal motor blockade, have become more popular. to - and ultra-lo -dose epidural anakesia, spinal analgesia, and combina- tion spinaLepidural analgesia have replaced the once traditional epidural for labor. The shift from regional anesthesia during labor, in bich the oman became 4@ passive participant during the labor and birth, to a collaborative approach for pain management, in hich the oman becomes an active participant, has resulted in a ne philosophy of labor analgesia. This article provides a revie of the curent systemic anal- gesics and regional and neuraxial analgesia! anes- thesia techniques for pain management in labor and birth. Also addressed are implications for perinatal muses ho participate in pain management choices during labor and birth. JOGNN. 32 8 93 2 3. DOF 7 882 328 98 ey ords: Analgesia Anesthesia lntrapar- tun Pain Accepted: May 2 Labor and birth, although a normal physiological process, can produce significant pain. All providers involved in the care of omen during childbirth must ork collaboratively to develop a plan of care that includes appropriate pain management (Ameri- can Academy of Pediatrics AAP American Col- lege of Obstetricians and Gynecologists ACOG , 2 2 ACOG, 2, 2 2 American Society of Anesthesiologists ASA,2 a2 b). Pain man- 8 JOGNN agement options for the oman in labor have changed dramatically over the past decade (Bim- bach, 2 Gogarten Aken, 2). Systemic analgesia and regional analgesialanesthesia are no used less, hereas ne er neuraxial techniques, ith minimal motor blockade, have become more popular Use of lo and ultra-lo -dose epidural analgesia, spinal analgesia, and combination spinal-epidural analgesia have replaced the once traditional epidur- al for labor. The shift from regional anesthesia, in hich the ‘oman became a passive participant during the labor and birth, to a collaborative approach for pain ‘management, ith the oman an active participant, reflects a ne philosophy of labor analgesia. This article ill provide a revie of the current systemic analgesics and regional and neuraxial analgesial anesthesia techniques used for pain management in labor and birth. Also addressed are implications for the perinatal nurse hen participating in pain man- agement choices during labor and birth. Definitions Pharmacologic pain management involves the use of different agents administered by several tech- niques. For the purposes of this article, the follo ing definitions apply to the techniques described: Analgesia: Use of medication to decrease or alter the normal sensation of pain. Anesthesia: Use of medication to provide partial or complete loss of sensation ith or ithout loss of consciousness. Local Anesthetic Block: Techniques that provide analgesia by blocking pain impulse transmis- olume 32, Number 6