Guidelines for childbirth anesthesia revised

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The American Society of Anesthesiologists (ASA) has issued revised guidelines for anesthesia administration to women during labor and delivery—whether natural or surgical—and for pain control after delivery.

The guidelines, published in the medical journal Anesthesiology, update guidelines issued in 1998 and include “recommendations on a wider range of techniques than was previously addressed.”

The guidelines also provide information for women to consider before receiving anesthetics during childbirth.

“Not all women require anesthetic care during labor and delivery,” Dr. Joy L. Hawkins, from the University of Colorado, Denver, and chairperson of the ASA task force that produced the guidelines, said in a statement.

If a woman does request pain relief during labor and delivery, there are many options available, Hawkins said, depending on her medical status, progress of labor and the resources available at the healthcare facility.

“The revised practice guidelines do not guarantee specific outcomes, but provide basic recommendations based on a synthesis of expert research and recommendations,” Hawkins added.

The recommendations say women in early labor should be offered the option of spinal or epidural analgesia, and women should be reassured that this approach does not increase the likelihood of needing a cesarean section.

The guidelines state that the use of spinals or epidurals is preferred over general anesthesia for most cesarean sections.

Another point covered is that drinking clear liquids in limited quantities has been found to bring comfort to women in labor and does not increase labor complications. Women with uncomplicated labor may drink small amounts of clear liquid, while those scheduled for nonemergency cesarean section may drink small amounts of clear liquids up to 2 hours before anesthesia administration.

However, the guidelines advise, solid foods should be avoided by women during labor. Women scheduled for elective cesarean section or tubal ligation should not eat for 6 to 8 hours prior to anesthesia administration.

SOURCE: Anesthesiology, April 2007.

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