Normal Pregnancy, Labor, and Delivery––Without Epidural Analgesia

Abstract

A 20-year-old woman, G1P0, presents to Labor & Delivery (L&D) in active labor at 40 weeks estimated gestational age (L-1). She has painful uterine contractions, and her cervix is 4 cm dilated on admission. The nurses easily start an IV in one of the prominent superficial veins of her forearm, and they position the patient in bed tilted toward her left side. The obstetric anesthesiologist visits the patient as a matter of routine—to introduce herself to the patient, to find out basic information about her medical history, and to answer any questions she may have about the options for pain relief during labor. The patient thanks the anesthesiologist for the visit, but says she is going to try to “go natural” (L-2). The first stage of labor is very painful, and the patient accepts a small dose of intravenous nalbuphine for analgesia, but continues to decline an epidural (L-3). Soon, her cervix becomes fully dilated, and she pushes or “bears down” with each contraction, performing a Valsalva maneuver to push the baby head first down the birth canal. After a painful and exhausting second stage of labor, she delivers a healthy baby girl and is joyful to be a new mother! The tired but happy mother receives her vigorous baby from the nurses and gets skin-to-skin contact with the baby immediately. The baby makes sucking movements with her mouth, and the mother puts the baby to her breast (L-4). The nurses check the uterine fundus and it is firm. Oxytocin is added to the mother’s intravenous fluid and infused at a low rate (L-5).