Pain Management During Labor Part 1: Pathophysiology of Labor Pain and Maternal Evaluation for Labor Analgesia

Labor pain is an intense, unpleasant experience with significant physiologic consequences on the mother and the fetus. Delivery was called poena magna by the Romans, which means “great pain” or “great punishment.”1 Labor pain is subjective, with great interpersonal variability. It may also vary from pregnancy to pregnancy. Understanding the neurophysiology of labor pain and the maternal and fetal effects of pain is essential for all practitioners involved in the care of laboring patients. A thorough and focused assessment of the laboring patient before selecting and administering analgesic modality is essential to maximize efficacy and maternal satisfaction, without sacrificing maternal and fetal safety. In this article, we review the neurophysiology of labor pain, maternal and fetal effects of pain, and assessment of the parturient for labor analgesia.