📘 MATERNAL ANALGESIA

(Important for Midwifery, Obstetrics & Gynecology, NHM, AIIMS, NORCET, GPSC & Staff Nurse Exams)

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✅ 1. Introduction / Definition

Maternal analgesia refers to the use of pain-relieving medications during labor and delivery to alleviate maternal discomfort while ensuring safety for both the mother and fetus.

It may include systemic, regional, or inhalational agents used depending on the stage of labor, maternal preference, and fetal condition.

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✅ 2. Objectives of Maternal Analgesia

• To provide pain relief during labor without impairing uterine contractions
• To reduce anxiety and stress during delivery
• To maintain maternal consciousness and cooperation
• To ensure fetal well-being and minimize neonatal depression

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✅ 3. Types of Maternal Analgesia

🔹 A. Non-Pharmacological Methods (Supportive Measures)

• Breathing exercises
• Massage and warm compress
• Relaxation techniques
• Hydrotherapy
• TENS (Transcutaneous Electrical Nerve Stimulation)

🔹 B. Pharmacological Analgesia

Type	Examples	Use in Labor
Opioid Analgesics	Pethidine, Morphine, Fentanyl	Early labor
Non-opioid Analgesics	Paracetamol	Mild pain relief
Inhalational Agents	Entonox (N₂O + O₂)	During contractions
Regional Analgesia	Epidural, Spinal analgesia	Active/advanced labor
Sedatives/Tranquilizers	Diazepam, Promethazine	Relieve anxiety, rest

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✅ 4. Common Drugs Used in Maternal Analgesia

🔹 Pethidine (Meperidine)

• Dose: 50–100 mg IM/slow IV
• Use: Systemic analgesia in early labor
• Side Effects: Neonatal respiratory depression, sedation

🔹 Fentanyl

• Use: Short-acting opioid, fewer side effects
• Preferred in: Epidural or IV infusion

🔹 Epidural Analgesia

• Drugs: Bupivacaine + Fentanyl
• Use: Continuous labor analgesia without affecting consciousness
• Side Effects: Hypotension, urinary retention, delayed pushing

🔹 Nitrous Oxide (Entonox)

• Composition: 50% N₂O + 50% O₂
• Use: Inhaled during contractions
• Advantage: Rapid onset, quick elimination

🔹 Paracetamol

• Use: Safe in pregnancy, mild pain
• Preferred when: Opioids are contraindicated

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✅ 5. Nurse’s Responsibilities in Maternal Analgesia

• Obtain informed consent
• Monitor maternal vital signs, pain level, and fetal heart rate
• Watch for signs of respiratory depression or hypotension
• Assist anesthetist during epidural/spinal procedures
• Educate the mother about options and side effects
• Ensure resuscitation equipment is ready when opioids are used

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✅ 6. Precautions and Contraindications

Analgesia Type	Contraindications / Cautions
Opioids	Close to delivery → neonatal depression
Epidural	Coagulopathy, spinal deformity, infection
Entonox	Respiratory diseases, uncooperative patient

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✅ 7. Golden One-Liners for Revision

• Epidural analgesia is the most effective and commonly used regional analgesia in labor
• Pethidine may cause neonatal respiratory depression if given late in labor
• Entonox provides rapid and short-acting pain relief during contractions
• Bupivacaine + Fentanyl is the common combination in epidural analgesia
• Always monitor for hypotension and fetal bradycardia in regional blocks

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✅ 8. Top 5 MCQs for Practice

1. Which of the following is most commonly used for epidural analgesia during labor?
a) Lignocaine
b) Fentanyl
c) Bupivacaine
d) Pethidine
Correct Answer: c) Bupivacaine
Rationale: Bupivacaine is preferred for regional blocks due to its long duration and effectiveness.

2. Which drug may cause neonatal respiratory depression if given close to delivery?
a) Diazepam
b) Paracetamol
c) Pethidine
d) Oxytocin
Correct Answer: c) Pethidine
Rationale: Opioid crosses the placenta and can suppress the neonate’s breathing.

3. Which inhalational agent is used for pain relief during labor?
a) Oxygen
b) Halothane
c) Entonox
d) Nitroglycerin
Correct Answer: c) Entonox
Rationale: Entonox is a 50:50 mixture of N₂O and O₂ used during labor pain.

4. What is the most serious complication of epidural analgesia?
a) Tachycardia
b) Headache
c) Hypotension
d) Hypertension
Correct Answer: c) Hypotension
Rationale: Epidural blocks sympathetic nerves causing vasodilation and low BP.

5. The nurse must observe for which sign after administration of opioids during labor?
a) Polyuria
b) Bradycardia
c) Respiratory depression
d) Fever
Correct Answer: c) Respiratory depression
Rationale: Opioids like Pethidine can depress the respiratory center.