ACOG issues guidelines for obstetrics analgesia and anesthesia.

ACOG has issued clinical guidance for obstetricians and other healthcare professional for management of pain during labor and giving anesthesia for any surgical procedure required during labor.

The reviewed guidelines were published in Journal of Obstetrics & Gynecology, April issue.

Non-pharmacological options were not covered in this bulletin. Many such options are used in healthcare and home settings like massage, acupuncture, relaxation techniques and water immersion in first stage. Recently physicians are also using virtual reality  during labor to distract patients and limit the use of analgesic.

The recommendation includes:

1. Analgesia and anesthesia services should be available to provide labor analgesia and surgical anesthesia in all hospitals that offer maternal care (levels I–IV).
2. American Society of Anesthesiologists (ASA) and ACOG believe that trained labor nurses, under supervision from a physician  should not be restricted from participating in the management of pain relief during labor.t
3. Neuraxial analgesia does not increase the rates of cesarean delivery and according to ACOG and (ASA) maternal request in absence of any contraindication is a sufficient medical indication for pain relief during labor.
4. Thrombocytopenia is a relative contraindication for neuraxial analgesia, in absence of current guidance on safe lower limit for platelet count.
5.  A platelet count ≥80,000/microliter, with no history of any congenital or acquired coagulopathy, or current antiplatelet or anticoagulant therapy, with normal platelet function is currently accepted okay for receiving Epidural and Spinal.
6. Narcotics or opioids like fentanyl, morphine, and nalbuphine are associated with adverse effects for newborn and mother, specifically respiratory depression. So, a close watch of respiratory status is warranted.
7. Epidural, combined spinal–epidural (CSE) or general anesthesia are suitable for emergency C-section if no Epidural is in place.