• Pain relief during labor may be enhanced by childbirth preparation methods and by the administration of analgesics and/or regional anesthesia blocks.
• The goal of pharmacologic pain relief during labor is to provide maximum pain relief with minimal risk for the mother and fetus.
• The best time for administering analgesia is determined after a complete assessment. An analgesic agent is generally administered to nulliparas when the cervix has dilated 4 to 5 cm and to multiparas when the cervix has dilated 3 to 4 cm.
• Analgesic agents include a variety of drugs, such as butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain).
• Narcotic antagonists (such as naloxone) counteract the respiratory depressant effect of the opiate narcotics by acting at specific receptor sites in the central nervous system.
• Regional analgesia and anesthesia are achieved by injecting
• local anesthetic agents into an area that will bring the agent into direct contact with nerve tissue. Methods most commonly used in childbearing include epidural block, spinal block, pudendal block, and
• local infiltration.
• Adverse reactions of the woman to local anesthetic agents range from mild symptoms such as palpitations to cardiovascular collapse.
• Complications of general anesthesia include fetal depression, uterine relaxation, vomiting, and aspiration.
• The choice of analgesia and anesthesia for the high-risk woman and fetus requires careful evaluation.

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