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Obstetrics and Gynecology · Obstetrics

Obstetric analgesia

Modern obstetrics offers a range of pain relief methods in labor, including psychoprophylaxis, hydrotherapy, opioid analgesics, and regional anesthesia. The choice of tactics depends on the phase of the labor process and the parturient's condition.

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Main methodEpidural anesthesia is the most effective and common method
Pain scale (VAS)The target level for adequate analgesia is 0–30 mm
Motor blockFor labor, the target Bromage scale level is 0–1
Opioid analgesicsAdministered strictly intravenously 2–3 hours before delivery
3 min readFor medical studentsUpdated Sep 20, 2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Non-pharmacological methods and hydrotherapy

Non-pharmacological approaches help reduce pain and relax the nervous system:

  • Psychoprophylaxis: conducted during pregnancy at the antenatal clinic. The acquired knowledge helps the woman behave correctly in labor, which reduces the need for medications.
  • Acupuncture: requires a dedicated specialist, therefore it is not widely used.
  • Hydrotherapy: used in the first stage of labor if special tubs are available. Warm water reduces adrenaline release, relaxes muscles, promotes L-waves in the brain, and accelerates cervical dilation.

Use of opioid analgesics

Pharmacological pain relief with opioid medications has strict regulations:

  1. Time of administration: active phase of labor when contractions become painful.
  2. Route of administration: exclusively intravenous.
  3. Duration of action: from one to one and a half hours.
  4. Important limitation: due to the potential depressant effect on the fetal respiratory center, injections are stopped 2–3 hours before the baby's birth.
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Regional (epidural) anesthesia

Regional block is recognized as the leader in efficacy and safety for the mother and fetus. It is performed only if conditions for cardiopulmonary resuscitation are available.

  • Timing of initiation: optimally in the active phase with established labor activity. In case of severe pain, starting in the latent phase at 2–3 cm dilation is permissible.
  • Technique: puncture is performed in the interspinous spaces L₂–L₃ or L₃–L₄, with the patient in the lateral or sitting position.
  • Extent of the block: covers segments from S₅ to T₁₀.
  • Methods of administration: boluses, continuous infusion, or patient-controlled epidural analgesia.

Evaluation of efficacy and impact on labor stages

The Visual Analogue Scale (100 mm ruler) is used for pain control, where a range of 0–30 mm is considered successful. The motor level is assessed using the Bromage scale (target is 0–1).

Impact on labor stages:

  • First stage: duration may be shortened.
  • Second stage: prolongation is possible due to weakened pushing efforts and blockade of the Ferguson reflex; the risk of occiput posterior position increases. The permissible duration increases: up to 3 hours for nulliparous women, up to 2 hours for multiparous women.
How to memorize

Epidural block for labor: puncture level L2-L4, coverage of segments S5-T10, and keep the motor block to a minimum (Bromage 0-1) so as not to inhibit pushing efforts.

Class and exam questions

What are the indications and timing for initiating epidural anesthesia?

It is optimal to perform the procedure in the active phase of labor with established labor activity. In case of pronounced pain, it is permitted to start in the latent phase when the cervix is dilated to 2–3 cm.

What are the rules for administering opioid analgesics in labor?

Drugs are administered strictly intravenously in the active phase of labor. Their action lasts 1–1.5 hours, and administration must be completely stopped 2–3 hours before the expected birth of the child.

How is the efficacy of pain relief assessed by the patient?

Assessment is carried out using a 100 mm Visual Analogue Scale (VAS). The criterion for adequate analgesia is an indicator in the range of 0–30 mm.

Why may the second stage of labor be prolonged during epidural anesthesia?

This occurs due to a decrease in skeletal muscle tone, blocking of the Ferguson reflex and weakening of pushing efforts, as well as potential difficulty in the internal rotation of the fetal head.

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What else to study on this topic

  • Causes of the onset of labor
  • Stages of labor and uterine changes (dilation, expulsion, placental stage)
  • Management of labor in the dilation and expulsion stages
  • Placental stage of labor
  • Fetal monitoring during labor and Apgar scoring of the newborn

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Other topics in the "Obstetrics" section

Causes of labor onsetStages of laborFirst stage of laborContractionsPosition and relation of the fetus to the maternal pelvisBiomechanism of labor in occiput presentationSecond stage of laborBiomechanism of labor in the expulsion stageThird stage of laborPlacental separation
Entire "Obstetrics" section

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