Pregnancy, labor, and delivery are associated with major physiologic changes that can decrease maternal reserves. Consequently, various techniques of analgesia and anesthesia can have profound effects on maternal physiology. Furthermore, obstetric pain management and operative obstetric anesthesia are recognized as secondary causes of neonatal respiratory depression. Improper management of labor is the common claim in obstetrical malpractice cases. Malpresentation and/or dystocia are some of the most fertile areas for medical negligence lawsuits. The clinician must be fully aware of the general predisposing factors to complications in the third stage of labor. Common postpartum complications include urinary tract problems, such as infections, urine retention, or incontinence. Obstetricians have long recognized the excessive perinatal morbidity and mortality associated with the breech-presenting fetus. Multiple gestations often pose intrapartum management problems. Emphasizing the shoulder dystocia was a true obstetric emergency, and greater emphasis was placed on team approach, including neonatal resuscitation.

This chapter begins with a discussion on the pharmacology of both new and accepted drugs in obstetric anesthesia management. Drugs administered to the parturient to provide analgesia or anesthesia for childbirth can affect not only maternal physiology but also fetal condition and neonatal well-being. Therapeutic strategies must be formulated with consideration for these effects, as well as the compounding influences of obstetric agents and illicitly consumed substances. Operative anesthesia must be appropriately adapted to the special requirements of surgery during pregnancy but is rarely a legitimate alternative for analgesic management. An obstetric anesthesia service requires a director with interest and skill in management; clinical, educational, or research success is not a substitute. Challenges include provision for appropriate staffing and equipment and fostering effective communication among professional staff from multiple disciplines whose timely, coordinated input is essential to safe, high-quality outcomes.