Anesthetic care of the pregnant mother focuses on the safety and comfort of the parturient. Using epidural analgesia for labor has grown significantly and most women now request anesthesia services for the management of pain during labor. There are numerous anesthetic and analgesic techniques to assist the birthing process, like intravenous analgesia, peripheral nerve blocks, neuraxial anesthesia, and general anesthesia.

Normal labor is defined as uterine contractions that result in progressive dilation and effacement of the cervix. Failure to meet these conditions defines abnormal labor, which suggests an increased risk for an unfavorable outcome. Abnormal labor alerts the obstetrician to consider alternative methods for a successful delivery that minimize risks to both the mother and the infant. Dystocia of labor is defined as difficult labor or abnormally slow progress of labor. Other terms that are often used are dysfunctional labor, failure to progress (lack of progressive cervical dilatation or lack of descent), and cephalopelvic disproportion (CPD).

Forceps are instruments designed to aid in the delivery of the fetus by applying traction to the fetal head. There are many different types of forceps that have been described and developed. Generally, forceps consist of two mirror image metal instruments that are maneuvered to cradle the fetal head and are articulated, after which traction is applied to effect delivery.

Fetal malpresentation occurs in about 4% of all term pregnancies. Breech presentation is the most common malpresentation, where the fetal longitudinal lie is oriented parallel to the long axis of the uterus and the buttocks are near the cervix. There are 3 types of breech presentation,

• Frank (hips are flexed and the legs are extended)
• Complete (hips and legs are flexed)
• Footling or incomplete (incomplete flexion of one or both hips)

A transverse lie occurs when the fetal longitudinal axis is perpendicular to the long axis of the uterus. The location of the spine determines if the fetus is "back up" (the curvature of the spine is in the upper part of the uterus) or "back down" (the curvature of the spine is in the lower part of the uterus)

The uterine cervix serves 2 major functions in a pregnancy. One, it retains its physical integrity by remaining firm during pregnancy as the uterus dramatically enlarges. This physical integrity is critical so that the developing fetus can remain in the uterus until the appropriate time for delivery. Second, in preparation for labor and delivery, the cervix softens and becomes more distensible, a process called cervical ripening. These chemical and physical changes are required for cervical dilation, labor and delivery of a fetus.

The third stage of labor refers to the period following the completed delivery of the newborn until the completed delivery of the placenta. Relatively little thought or teaching seems to be devoted to the third stage of labor compared with that given to the first and second stages. Another interesting aspect of the third stage is the marked discrepancy in what is believed to be its appropriate and optimal conduct. A clear division exists between authorities who advocate the physiological approach and those who advocate the active approach to management.

Compound presentations are rare obstetric events which are usually unjustified, but considering the unlikely possibility of a problem delivery is valuable. Although in an average delivery service of 2500 births annually such an event might be expected to occur only about once a year, providers should know strategies for managing this situation if intervention becomes necessary. Compound presentations may be observed more commonly after premature rupture of membranes, with preterm labor, with pelvic masses displacing the main fetal pole, or after inductions of labor involving floating presenting parts. These more likely with obstetric interventions than with spontaneous events.

Assessment of the fetal presentation with respect to the maternal birth canal is critical to the route of delivery. At term, most fetuses present in the vertex presentation, where the fetal head is flexed so that the chin is in contact with the fetal thorax. The fetal spine typically lies along the longitudinal axis of the uterus. Nonvertex presentations (including breech, transverse lie, face, brow, and compound presentations) occur in less than 4% of fetuses at term. Malpresentation of the vertex presentation occurs if there is an extension of the fetal head leading to brow or face presentation, respectively. In a face presentation, the fetal head and neck are hyperextended, causing the occiput to encounter the upper back of the fetus while lying in a longitudinal axis.