[Labor analgesia by one anesthesiologist in a small obstetric clinic]

In Japan, about 40% of all the parturients give birth in small obstetrician's clinics. There is no anesthesiologist in most clinics. The labor analgesia is not performed or is performed by the obstetrician in many facilities. In this paper the author reports labor analgesia by one anesthetist in a small obstetric clinic in Japan. The management of labor analgesia of this hospital is as follows; 1) The anesthesiologist explains the method and risks of labor analgesia to the patient in the outpatient clinic. The induced labor is recommended to the parturients who request labor analgesia. 2) The combined spinal-epidural analgesia (CSEA) is provided for labor analgesia with a local anesthetic of low concentration and fentanyl. 3) CSEA is usually administered upon the request of a parturient and continued till the end of the delivery. Adequate pain relief and high satisfaction were ascertained by the questionnaire to the parturients who had received labor analgesia in this hospital. The number of parturients who request labor analgesia is increasing. However, it is difficult or almost impossible to provide labor analgesia by one anesthetist for 24 hours and 365 days.