Background: While the standard lumbar epidural analgesia technique has often been described as the gold standard for pain relief during labor, its disadvantages of delayed onset and the presence of motor blockade to a certain degree pose several constraints to pain burdened mother who also may not want to be confined in the supine position during the entire labor process. An alternative which may address these issues is the combined spinal epidural or walking epidural technique. We embarked on this study to compare both techniques in terms of onset and degree of analgesia and the outcome of labor. Methods: Eighty (80) nulligravid ASA 1-2 term patients were randomly assigned to receive labor pain relief either using the standard continuous lumbar epidural analgesia (CLEA) using .125 percent bupivacaine with fentanyl or the combined spinal epidural analgesia (CSE) technique using intrathecal fentanyl and bupivacaine followed by bupivacaine boluses with fentanyl as needed. Outcome measures studied were Visual Analogue Pain Scores, onset degree and duration of pain relief and the progress and outcome of labor including neonatal outcome. Side effects were also noted. Results: Very significant was the rapid onset of action, denser, and longer duration of pain relief in the CSE group. Likewise a faster rate of cervical dilation resulting in a shorter first stage of labor was noted. Second stage duration and mode of delivery in both groups however did not differ significantly. Maternal satisfaction during the first stage was greater in the CSE group, although overall maternal satisfaction was comparable in both groups. Pruritus, although a significant occurrence in the CSE group did not need any intervention for treatment. No adverse effects on both the neonate and mother were noted. Conclusion: Based on the results of our study, the CSE or walking epidural is a encouraging alternative to laboring mothers, especially those in severe pain requiring rapid and profound relief. Our results show that compared the standard epidural technique, it hastens the rate of first stage labor - but whether ambulation plays a significant role in this aspect needs to be further investigations
Human ; LABOR PAIN ; OBSTETRIC LABOR ; ANALGESIA, EPIDURAL ; PAIN

Labor pain is one of the most challenging experiences encountered by females during their lives. Neuraxial analgesia is the mainstay analgesic for intrapartum pain relief. However, despite the increasing use and undeniable advantages of neuraxial analgesia for labor, there have been concerns regarding undesirable effects on the progression of labor and outcomes. Recent evidence indicates that neuraxial analgesia does not increase the rate of Cesarean sections, although it may be associated with a prolonged second stage of labor and an increased rate of instrumental vaginal delivery. Even when neuraxial analgesia is administered early in the course of labor, it is not associated with an increased rate of Cesarean section or instrumental vaginal delivery, nor does it prolong the labor duration. These data may help physicians correct misconceptions regarding the adverse effects of neuraxial analgesia on labor outcome, as well as encourage the administration of neuraxial analgesia in response to requests for pain relief.
Analgesia* ; Cesarean Section ; Female ; Humans ; Labor Pain ; Labor, Obstetric ; Pregnancy

No abstract available.
Analgesia* ; Bradycardia* ; Female ; Labor Pain* ; Pregnancy

No abstract available.
Analgesia* ; Bradycardia* ; Female ; Labor Pain* ; Pregnancy

Epidural analgesia provides effective pain control during labor. It however become the subject of controversy in recent years due to the perceived adverse effect on labor and delivery. There has been numerous debates concerning the effects of epidural analgesia on the progress of labor, use of oxytocin, instrumental delivery, cesarean section, neonatal and maternal effects.
ANALGESIA ; ANALGESIA, EPIDURAL ; LABOR PAIN ; CESAREAN SECTION

PURPOSE: This study intends to identify the relations among labor pain and labor agentry of puerperas giving birth in midwifery clinic and perception of delivery experience, and to establish factors influencing on their perception of delivery experience. METHODS: Descriptive survey research. Data were collected from puerperas giving birth through vaginal delivery in six midwifery clinics, and they were analyzed through t-test, ANOVA, pearson's correlation coefficients, and stepwise multiple regression. RESULTS: Figures of labor pain of puerperas giving birth in midwifery clinic by stage were 4.12, 6.80 and 8.11 in average in latent, active and transitional stage, respectively, while labor agentry and perception of delivery experience showed upper-middling figures, namely 3.70 and 3.94. It was revealed that labor agentry of puerperas giving birth in midwifery clinic had negative correlation with labor pain in latent stage (r=−0.176, p=0.021). Perception of delivery experience had the same with labor pain in latent stage (r=−0.177, p=0.020) and labor pain in active stage (r=−0.159, p=0.037), whereas perception of delivery experience had positive correlation with labor agentry (r=0.750, p < 0.001). In addition, factors influencing on perception of delivery experience of puerperas giving birth in midwifery clinic were labor agentry, educational background and marital satisfaction, accounting for 58.8%. CONCLUSION: The results suggest that developing and applying nursing intervention program that increases labor agentry so that puerperas giving birth in midwifery clinic may perceive childbirth experience positively.
Female ; Labor Pain ; Midwifery ; Nursing ; Parturition ; Pregnancy

The purpose of this study was to examine the effects on labor pain and duration of delivery time for primipara women treated by San-Yin-Jiao(SP-6) and Hob-Gog(LI-4) acupressure. The design of this study was a nonequivalent control group non-synchronizedpost test only design. It was done to identify the effects of SP-6 acupressure or LI-4 acupressure on labor pain in primipara women. The benefits of using SP-6 acupressure or LI-4 acupressure were evaluated by comparing three groups, a SP-6 acupressure group, a LI-4 acupressure group and a control group, not treated with acupressure. The participants included 192 primiparas who underwent vaginal delivery, 72 primiparas in the control group, 71 in the SP-6 acupressure group and 49 in the LI-4 acupressure group. Data were collected using a structured questionnaire consisting of general characteristics, a subjective labor pain scale (Johnson, 1974), and measurement of duration of delivery time. The results of this study are summarized as follows : 1. Differences in the acupressure effect for SP-6 and LI-4 were analyzed using Scheffe's test which showed that differences in the control group vs the SP-6 group and the control group vs the LI-4 group were statistically significant (t=21.767, p<0.05; t=23.923, p<0.05), but the SP-6 group vs the LI-4 group showed no significant differences. 2. The duration of delivery time in the group which had SP-6 acupressure or LI-4 acupressure was shorter (400.77+/-153.34; 379.10+/-127.60) than in the control group (528.68+/-239.08). Differences in the effects of acupressure with SP-6 and LI-4 were also analyzed by Scheffe's test. Control group vs SP-6 group and Control group vs LI-4 group were significantly different(t=127.91, p<0.05; t=149.58, p<0.05), but the SP-6 group vs the LI-4 group did not show any statistically significant difference (t=21.67). This study has shown that SP-6 and LI-4 acupressure were both effective in relation to labor pain and duration of delivery time for primiparas. But it is necessary to replicate the study with a larger number of participants to generalize of the results.
Acupressure* ; Female ; Humans ; Labor Pain* ; Pregnancy ; Surveys and Questionnaires

OBJECTIVE: The purpose of this study was to compare the efficacy of intravaginal misoprostol and that of intravenous sulprostone for termination of second-trimester pregnancy. METHODS: Fouty-six patients were randomly assigned to misoprostol and sulprostone group, and the misoprostol group was further divided into two groups according to gestational age. In the misoprostol group, the patients at or before 20 weeks of gestation received 400 microgram of intravaginal misoprostol every 4 hours until labor pain was established, 200 microgram every 6 hours after 20 weeks of gestation. In the sulprostone group, intravenous sulprostone was infused at the speed of 100 microgram/hr regardless of gestational age. RESULTS: At or before 20 weeks of gestation, the mean time from induction to completion of termination was shorter, and the success rate within 24 hours was higher in the misoprostol group than in the sulprostone group (9.0 vs. 20.2 hours; 86% vs 50%). After 20 weeks, the mean induction time was longer at misoprostol group than sulprostol group but, there was no significant difference in success rate within 24 hours (14.7 vs. 7.1 hours; 83% vs. 86%). There was no significant difference in the prevalence of complication between two groups. CONCLUSION: Misoprostol is superior to sulprostone for termination of pregnancy at or before 20 weeks of gestation, but both have almost equal effectiveness after 20 weeks of gestation. Considering less cost and complication, the efficacy of misoprostol should be further investigated for termination of second-trimester pregnancy.
Female ; Gestational Age ; Humans ; Labor Pain ; Misoprostol* ; Pregnancy* ; Prevalence

BACKGROUND: This study examined the efficacy of patient-controlled epidural analgesia (PCEA) during labor and compared the suitability of fentanyl and butorphanol mixed with bupivacaine. METHODS: After establishing effective epidural analgesia with 10 ml of 0.125% bupivacaine mixed with fentanyl 5 microgram/ml or butorphanol 1 mg/ml, 60 parturients in active labor were randomly assigned to one of two groups: PCEA using 0.0625% bupivacaine with fentanyl 2 microgram/ml (fentanyl group); PCEA using 0.0625% bupivacaine with butorphanol 20 microgram/ml (butorphanol group). PCEA pumps were programmed to deliver a 4 ml/hr basal infusion, 4 ml on-demand bolus, 10-min lockout intervals between doses, and a 20 ml hourly limit. Visual analogue pain scores, side effects, parturients' satisfaction scores, duration of labor and Apgar scores were recorded during and after labor. RESULTS: The quality of analgesia, side effects, duration of labor, overall satisfaction and Apgar scores didn't differ between the two groups. Average hourly infusion rates were 11.8 0.3 ml/hr (fentanyl group) and 13.9 0.4 ml/hr (butorphanol group). CONCLUSIONS: PCEA is a safe and effective method for labor analgesia and both solutions, the 0.0625% bupivacaine plus fentanyl 2 microgram/ml and the 0.0625% bupivacaine plus butorphanol 20 microgram/ml, appear suitable for PCEA use for labor pain. There is no difference in effectiveness between fentanyl and butorphanol.
Analgesia ; Analgesia, Epidural* ; Bupivacaine ; Butorphanol* ; Female ; Fentanyl* ; Labor Pain* ; Pregnancy

BACKGROUND: This study examined the efficacy of patient-controlled epidural analgesia (PCEA) during labor and compared the suitability of fentanyl and butorphanol mixed with bupivacaine. METHODS: After establishing effective epidural analgesia with 10 ml of 0.125% bupivacaine mixed with fentanyl 5 microgram/ml or butorphanol 1 mg/ml, 60 parturients in active labor were randomly assigned to one of two groups: PCEA using 0.0625% bupivacaine with fentanyl 2 microgram/ml (fentanyl group); PCEA using 0.0625% bupivacaine with butorphanol 20 microgram/ml (butorphanol group). PCEA pumps were programmed to deliver a 4 ml/hr basal infusion, 4 ml on-demand bolus, 10-min lockout intervals between doses, and a 20 ml hourly limit. Visual analogue pain scores, side effects, parturients' satisfaction scores, duration of labor and Apgar scores were recorded during and after labor. RESULTS: The quality of analgesia, side effects, duration of labor, overall satisfaction and Apgar scores didn't differ between the two groups. Average hourly infusion rates were 11.8 0.3 ml/hr (fentanyl group) and 13.9 0.4 ml/hr (butorphanol group). CONCLUSIONS: PCEA is a safe and effective method for labor analgesia and both solutions, the 0.0625% bupivacaine plus fentanyl 2 microgram/ml and the 0.0625% bupivacaine plus butorphanol 20 microgram/ml, appear suitable for PCEA use for labor pain. There is no difference in effectiveness between fentanyl and butorphanol.
Analgesia ; Analgesia, Epidural* ; Bupivacaine ; Butorphanol* ; Female ; Fentanyl* ; Labor Pain* ; Pregnancy