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Towards the humanisation of birth : a study of epidural analgesia and hospital birth culture
This book examines the future of birthing practices, particularly by focusing on epidural analgesia in childbirth. It describes historical and cultural trajectories that have shaped the way in which birth is understood in Western, developed nations. In setting out the nature of epidural history, knowledge and practice, the book delves into related birth practices within the hospital setting. By critically examining these practices, which are embedded in a scientific discourse that rationalises and relies upon technology use, the authors argue that epidural analgesia has been positioned as a safe technology in contemporary maternity culture, despite it carrying particular risks. In examining alternative research the book proposes that increasing epidural rates are not only due to greater pain relief requirements or access but are influenced by technocratic values and a fragmented maternity system. The authors outline the way in which this epidural discourse influences how information is presented to women and how this affects their choices around the use of pain relief in labour.
Book
Deliver Me from Pain
Despite today's historically low maternal and infant mortality rates in the United States, labor continues to evoke fear among American women. Rather than embrace the natural childbirth methods promoted in the 1970s, most women welcome epidural anesthesia and even Cesarean deliveries. In Deliver Me from Pain, Jacqueline H. Wolf asks how a treatment such as obstetric anesthesia, even when it historically posed serious risk to mothers and newborns, paradoxically came to assuage women's anxiety about birth.
Each chapter begins with the story of a birth, dramatically illustrating the unique practices of the era being examined. Deliver Me from Pain covers the development and use of anesthesia from ether and chloroform in the mid-nineteenth century; to amnesiacs, barbiturates, narcotics, opioids, tranquilizers, saddle blocks, spinals, and gas during the mid-twentieth century; to epidural anesthesia today.
Labor pain is not merely a physiological response, but a phenomenon that mothers and physicians perceive through a historical, social, and cultural lens. Wolf examines these influences and argues that medical and lay views of labor pain and the concomitant acceptance of obstetric anesthesia have had a ripple effect, creating the conditions for acceptance of other, often unnecessary, and sometimes risky obstetric treatments: forceps, the chemical induction and augmentation of labor, episiotomy, electronic fetal monitoring, and Cesarean section.
As American women make decisions about anesthesia today, Deliver Me from Pain offers them insight into how women made this choice in the past and why each generation of mothers has made dramatically different decisions.
eBook
Preventing spinal anesthesia headache in cesarean section: Randomized clinical trial
Objectives: Post-dural puncture headache (PDPH) is a common complication following neuraxlai block In cesarean sections, typically occurring 12-72 hours postoperatively and leading to considerable challenges and financial costs. We aimed to compare dexamethasone and paracetamol for preventing spinal anesthesia headaches in cesarean sections. Methods: A double-blind randomized clinical trial was conducted from December 2019 to April 2020. This study included 215 singleton pregnant women scheduled for elective cesarean section. To prevent PDPH, the patients were allocated to intravenous dexamethasone (n=70), paracetamol (n=75), and normal saline (n=70) groups. The primary outcomes were the incidence and severity of PDPH and VAS score evaluations. Secondary outcomes included recovery time, frequency of painkiller use, newborn Apgar scores, and patient satisfaction. Results: Significant time (p<0.001) and group (p=0.020) effects were observed on PDPH. At 48 hours postoperatively, patients receiving dexamethasone or paracetamol reported significantly lower PDPH severity compared to the normal saline group (p=0.009). The incidence of PDPH was also higher in the control group at 48 hours (p=0.033). No significant differences were observed among the groups in recovery time, analgesic use, Apgar scores at 1 and 5 minutes, or patient satisfaction (p>0.05). Conclusion: Both paracetamol and dexamethasone had a positive impact on reducing the incidence and severity of PDPH compared to the normal saline group in cesarean sections (with dexamethasone showing a stronger effect). Recovery time, painkiller use, newborn Apgar scores, and patient satisfaction did not differ significantly between the groups. Further research is needed to validate these findings and ensure reproducibility. Keywords: Cesarean section; dexamethasone; paracetamol; post-dural puncture headache; spinal anesthesia.
Journal Article
Comparison of the effects of norepinephrine and phenylephrine on shivering and hypothermia in patients undergoing caesarean section under spinal anaesthesia at a tertiary hospital in China：a randomised, double-blind, controlled trial protocol
IntroductionPeripheral vasodilation causes a redistribution of body temperature from the core to the periphery, resulting in shivering and hypothermia. These are normal pathological and physiological processes during spinal anaesthesia. Two drugs, norepinephrine and phenylephrine, have peripheral vasoconstrictive effects. It is unclear the effects of norepinephrine and phenylephrine on shivering and hypothermia in patients undergoing caesarean section under spinal anaesthesia.Methods analysis240 eligible parturients will be recruited for this randomised, double-blind, controlled trial and randomly assigned to either the norepinephrine or phenylephrine groups. The primary outcome will be the incidence of shivering while secondary outcomes will include the severity of shivering, rectal temperature, incidence of hypothermia and umbilical artery blood pH value.Ethics and disseminationThe Institutional Ethics Committee of The Second People’s Hospital of Hefei approved the trial protocol (ID: 2023-093). The results will be published in a compliant journal. The original data will be released in December 2029 on the ResMan original data-sharing platform of the China Clinical Trial Registry (http://www.medresman.org.cn).Trial registration numberChiCTR2300077164.
Journal Article
Labor Analgesia in a Patient with Severe Dystrophic Calcinosis Cutis
Abstract
Introduction
Calcinosis cutis is a condition characterized by pathologic calcium deposition into superficial dermal skin layers. It is often associated with an autoimmune disease. However, it may also occur after minor localized trauma and infection.
Description of Problem
We report a case of lumbar epidural placement of labor analgesia in a parturient with severe dystrophic calcinosis cutis without apparent complications.
Clinical Solution
We recommend fastidious optimization of epidural placement conditions for all patients who may be at high risk for neuraxial anesthesia, including consideration of ultrasound use, use of an experienced anesthesia provider for neuraxial placement, and placement in early labor. Additionally, judicious discussion of risks, benefits, and alternatives when obtaining informed consent is critical, ideally with the patient identified for a comprehensive visit in a preoperative obstetric anesthesia clinic before delivery.
Journal Article
Comparison of the Effect of Spinal Anesthesia Applied in Elective Cesarean Cases on Frontal QRS Angle in Anemic and Non-Anemic Patients
Background/Objectives: Pregnancy is associated with profound physiological alterations that, together with anemia and spinal anesthesia, may influence myocardial repolarization. The frontal QRS-T [f(QRS-T)] angle has emerged as a reliable electrocardiographic parameter for evaluating repolarization heterogeneity. Materials and Methods: This observational prospective study included 100 term pregnant women [18–45 years, American Society of Anaesthesiologists (ASA) II] undergoing elective cesarean delivery under spinal anesthesia at Sanliurfa Training and Research Hospital between May and August 2025. Participants were divided into two groups: anemic (Hb < 10.5 g/dL, n = 50) and non-anemic (Hb ≥ 10.5 g/dL, n = 50). Standard monitoring and 12-lead ECGs were performed preoperatively and postoperatively. The f(QRS-T) angle was calculated as the absolute difference between QRS and T axes; values > 180° were adjusted by subtracting from 360°. Results: Demographic variables were comparable between groups. No significant differences were observed in mean arterial pressure or heart rate. Preoperative QTc and f(QRS-T) angle values did not differ significantly. However, postoperative QTc was prolonged in the anemic group compared with non-anemic women (426.3 ± 19.2 ms vs. 417.2 ± 20.7 ms, p = 0.026). Likewise, the postoperative f(QRS-T) angle was significantly higher in anemic patients (29.5 [16.0–45.3] vs. 20.5 [9.8–34.5], p = 0.017). Within-group analysis revealed significant postoperative increases in both QTc (p < 0.001) and f(QRS-T) angle (p < 0.001) in the anemic group, but not in controls. Hemoglobin levels correlated negatively with postoperative QTc (r = −0.267, p = 0.008) and f(QRS-T) angle (r = −0.264, p = 0.008). Conclusions: In anemic patients undergoing cesarean delivery under spinal anesthesia, the postoperative QTc interval and f(QRS-T) angle increased significantly compared with both baseline values and non-anemic counterparts. Assessment of the f(QRS-T) angle, a simple and inexpensive ECG-derived parameter, may aid in perioperative risk stratification and enhance patient safety.
Journal Article
Anesthetic Management for Delivery in Parturients with Heart Disease: A Narrative Review
Cardiac disease remains a leading cause of maternal morbidity and mortality, particularly in developed countries where improved survival has increased the number of pregnant patients with congenital heart disease. The physiological changes of pregnancy, such as increased blood volume, cardiac output, and hypercoagulability, can exacerbate preexisting cardiac conditions, posing significant anesthetic challenges during cesarean delivery. This review outlines anesthetic strategies for parturients with structural or functional cardiac disease, emphasizing individualized, multidisciplinary care. We examine general and regional anesthesia approaches, intraoperative monitoring, and hemodynamic goals, including fluid balance, venous return optimization, and myocardial oxygen demand reduction. Preoperative risk stratification and coordination with cardiology and obstetric teams are essential. Future efforts should aim to standardize protocols and improve maternal–fetal outcomes through evidence-based anesthetic planning.
Journal Article
Obstetric anesthesia services in Israel snapshot (OASIS) study: a 72 hour cross-sectional observational study of workforce supply and demand
Background
We planned an observational study to assess obstetric anesthesia services nationwide. We aimed to assess the effect of the anesthesia workload/workforce ratio on quality and safety outcomes of obstetric anesthesia care.
Methods
Observers prospectively collected data from labor units over 72 h (Wednesday, Thursday and Friday). Independent variables were workload (WL) and workforce (WF). WL was assessed by the Obstetric Anesthesia Activity Index (OAAI), which is the estimated time in a 24-h period spent on epidurals and all cesarean deliveries. Workforce (WF) was assessed by the number of anesthesiologists dedicated to the labor ward per week. Dependent variables were the time until anesthesiologist arrival for epidural (quality measure) and the occurrence of general anesthesia for urgent Cesarean section, CS, (safety measure). This census included vaginal deliveries and unscheduled (but not elective) CS.
Results
Data on 575 deliveries are from 12 maternity units only, primarily because a major hospital chain chose not to participate; eight other hospitals lacked institutional review board approval. The epidural response rate was 94.4%; 321 of 340 parturients who requested epidural analgesia (EA) received it. Of the 19 women who requested EA but gave birth without it, 14 (77%) were due to late arrival of the anesthesiologist. Median waiting times for anesthesiologist arrival ranged from 5 to 28 min. The OAAI varied from 4.6 to 25.1 and WF ranged from 0 to 2 per shift. Request rates for EA in hospitals serving predominantly orthodox Jewish communities and in peripheral hospitals were similar to those of the entire sample. More than a fifth (13/62; 21%) of the unscheduled CS received general anesthesia, and of these almost a quarter (3/13; 23%) were attributed to delayed anesthesiologist arrival.
Conclusions
Inadequate WF allocations may impair quality and safety outcomes in obstetric anesthesia services. OAAI is a better predictor of WL than delivery numbers alone, especially concerning WF shortage. To assess the quality and safety of anesthetic services to labor units nationally, observational data on workforce, workload, and clinical outcomes should be collected prospectively in all labor units in Israel.
Journal Article
Shnider and Levinson's anesthesia for obstetrics
Now in a fully updated Fifth Edition, Shnider and Levinson's Anesthesia for Obstetrics, continues to provide the comprehensive coverage that has made it the leading reference in the field. The rising number of Cesarean births and the more advanced age of first-time mothers in the United States have brought with them an increased risk for complications, making the role of the obstetric anesthesiologist increasingly important. This comprehensive reference addresses maternal and fetal physiology; fetal assessment; anesthesia and analgesia in both vaginal and Ceserean delivery; neonatal well-being; management of fetal, maternal, and anesthetic complications; and management of coexisting disorders in the mother. The Fifth Edition includes a new editorial team, a new full-color format, and new sections on Assessment of the Fetus, Anesthesia for Cesarean Delivery; Neonatal Well-Being: Old and New Concepts; Ethical, Medical, and Social Challenges and Issues; Maternal Safety, Difficult and Failed Intubation, Morbidity, and Mortality; and Anesthetic Considerations for Reproductive, In-Utero, and Non-Obstetric Procedures
eBook