Pain Relief in Labor

Only in some very rare individuals is labor not associated with considerable pain. The pain that most women experience during childbirth has been written and talked about for centuries. It makes quite an impression on almost all women. Most women remember their labor and birth experiences with exquisite detail. This is not to say that the experience is beyond the internal resources of every woman. On the contrary, the very continuance of the species is evidence of the fortitude of women. Since the beginning, most women have endured the pain of childbirth without any significant pain relief.

Forceps and Vacuum Extractors

Occasionally, during the pushing stage of labor (second stage), a baby will be close to being born, but “not quite there yet”. This is often the most stressful time for a mother or baby. A mother may be exhausted or nearly so, and a baby may show signs of head and cord compression (which usually do not permanently affect the baby [but may]). A doctor may decide to use forceps or a vacuum extractor to help with delivery in these situations.


Throughout history, blood loss after delivery and its associated complications have accounted for more maternal deaths than any other reason except infection. This is no longer the case when a woman is cared for by a competent clinician supported by a reasonably modern health care system. Overall, approximately 6% of women will have an estimated blood loss of 500 cc or more (that’s about a pint) associated with childbirth.

Shoulder Dystocia

In a small percentage of births, the baby’s shoulder will become locked under the mother’s pubic bone immediately after delivery of the head. The doctor or midwife may be unable to deliver the baby with the usual hand skills. Every doctor and midwife is trained in the handling of this emergency, and there are several different approaches.

Fetal Distress

Fetal distress is the term applied to the condition of the fetus who is exhibiting heart rate signs of poor oxygenation. Another synonymous phrase is “fetal intolerance to labor”. Both of these terms emerged with the advent of the electronic fetal monitor (EFM).

Cephalo-Pelvic Disproportion

“Cephalo-” means head, and refers to the fetus’s head. CPD refers to a fetal head which is too big to fit through the mother’s pelvic bones. Cases of true CPD will not result in vaginal birth. Borderline cases of CPD may allow the head to emerge (after “molding”) only to have the shoulders become stuck above the mother’s pubic bone (a condition called “shoulder dystocia”).

Failure to Progress

This term, failure to progress, is simply that. Dilatation of the cervix and descent of the fetus fail to occur despite efforts to correct it. In the recent past, this diagnosis has taken some criticism due its use (or overuse) to justify high c-section rates.