Labor analgesia for the parturient with herbal medicines use: what does an obstetrician need to know?

The use of herbal medicines in the developed world is widespread, and increasing. Herbal medicines, which include a wide spectrum of substances ranging from home-made teas to the national regulatory bodies-approved medicinal substances, are defined as plant-derived products that are used for medicinal and/or nutritional purposes. The use of herbal self-therapy is common in pregnancy, with many parturients consuming more than one agent at a time. Despite widespread use there has been surprisingly little research into the outcomes or the potential risks of using herbal therapies during pregnancy. As epidural analgesia is the most popular form of pain relief in labor, the potential for herbal remedies-related alterations in maternal hemodynamics (e.g., hypertension, tachycardia), and increased bleeding tendencies (e.g., spinal-epidural hematoma) remain a significant concern. Obstetricians and obstetric anesthesiologists must be familiar with the effects of herbal medicines and should specifically inquire about the use of herbal medicines during prenatal/preanesthetic assessment. This review article attempts to summarize current data on special considerations for labor analgesia in parturients with herbal medicines use.