OBSTETRIC ANALGESIA AND ANESTHESIA

Uterine contractions and  cervical dilation  result in visceral pain (T10-L1).
Descent of  the  fetal  head and pressure on  the  vagina and perineum  result in somatic pain (pudendal nerve, S2-S4).
In the  absence  of a  medical  contraindication,  maternal  request  is  a  sufficient medical indication for pain relief  during labor.

Absolute  contraindications  to  regional  anesthesia  (epidural,  spinal,  or 
combination) include the following: 

• Refractory maternal hypotension 
• Maternal coagulopathy 
• Maternal  use  of  a  once-daily  close  of  low-molecular-weight heparin within  12  hours 
• Untreated  maternal bacteremia 
• Skin infection over the site  of  needle placement 
• Increase in  ICP caused by a mass lesion