Chapter 13 – Pain Management During Childbirth

Vocabulary flashcards covering key terms, drugs, techniques, and complications related to pain management during childbirth.

Tissue ischemia

Reduced uterine blood flow during contractions that causes hypoxic, MI-like pain in labor.

Cervical dilation

Stretching and opening of the cervix and lower uterus that produces significant labor pain.

Visceral pain

Deep, poorly localized pain from pressure on pelvic structures, often referred to back or legs during labor.

“Ring of fire”

Intense burning pain felt when the vaginal opening and perineum stretch as the fetal head crowns.

Labor intensity

Strength and speed of contractions; very rapid (<3 h) labors create severe pain and leave little time for analgesia.

Pitocin

Synthetic oxytocin used to induce/augment labor, producing stronger, quicker contractions and increased pain.

Cervical readiness

Degree of softness, effacement, and dilation; a favorable cervix facilitates easier, less painful labor.

Occiput posterior (OP) position

Fetal head facing mother’s back, causing prolonged labor and pronounced back pain.

Gate Control Theory

Idea that non-painful stimuli (massage, heat) can close nerve ‘gates’ and block transmission of pain signals.

Effleurage

Light, rhythmic stroking of the abdomen or thighs used to promote relaxation and reduce labor pain.

Sacral counterpressure

Firm pressure on the lower back applied to relieve pain from OP position or intense contractions.

Hydrotherapy

Immersion in warm water or use of shower to buoy body, relax muscles, and diminish labor pain.

Acupressure

Application of pressure to specific points to relieve pain or nausea during childbirth.

Butorphanol tartrate (Stadol)

Mixed opioid agonist-antagonist given parenterally for labor pain; has a ceiling effect on analgesia.

Nalbuphine (Nubain)

Mixed opioid agonist-antagonist analgesic for labor; contraindicated in opioid-dependent patients.

Meperidine (Demerol)

IV opioid sometimes used in labor; risk of neonatal respiratory depression requires careful timing.

Ceiling effect (opioids)

Characteristic of mixed agonist-antagonists where doses beyond a point do not increase pain relief.

Naloxone (Narcan)

Opioid antagonist that reverses opioid-induced respiratory depression in mother or newborn.

Diphenhydramine (Benadryl)

Antihistamine used during labor to treat itching or provide mild sedation adjunctive to analgesia.

Ondansetron (Zofran)

Serotonin-antagonist antiemetic administered to control nausea and vomiting in labor.

Promethazine (Phenergan)

Antiemetic/antihistamine used to reduce nausea or potentiate analgesics during childbirth.

Metoclopramide (Reglan)

Prokinetic antiemetic given pre-anesthesia to accelerate gastric emptying and lower aspiration risk.

Pudendal block

Local anesthetic injected near pudendal nerve to numb lower vagina and perineum for birth or episiotomy.

Epidural block

Continuous infusion of local anesthetic ± opioid into lumbar epidural space providing substantial labor analgesia.

Post-dural puncture headache

Severe positional headache from CSF leakage after accidental dural puncture; treated with a blood patch.

Autologous blood patch

Injection of patient’s blood into epidural space to seal dural leak and stop post-dural headache.

Hypotension (epidural)

Drop in maternal blood pressure due to sympathetic blockade; managed with IV fluids, repositioning, oxygen.

Neuraxial opioid analgesia

Placement of an opioid (e.g., morphine) into epidural or intrathecal space for extended postoperative pain relief.

Morphine (Duramorph)

Long-acting opioid used epidurally after cesarean, providing up to 24 h of analgesia; monitor for delayed respiratory depression.

Spinal/Subarachnoid block (SAB)

Single injection of anesthetic into CSF producing rapid, short-duration anesthesia, commonly for cesarean sections.

Combined spinal-epidural (CSE)

Technique combining immediate intrathecal relief with an epidural catheter for ongoing labor analgesia.

General anesthesia (obstetric)

Systemic anesthesia with loss of consciousness, reserved for urgent births when regional techniques are unsuitable.

Cricoid pressure (Sellick’s maneuver)

Firm pressure on cricoid cartilage during induction of general anesthesia to occlude esophagus and reduce aspiration risk.

Malignant hyperthermia

Rare, life-threatening hypermetabolic reaction to certain anesthetics; critical to recognize during general anesthesia.