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Obstetrical Anesthesia

Pain Relief During Labor

Obstetrical Anesthesia Anesthesiologists are pain management specialists and serve as consultants in the Labor and Delivery Suite. We work with your Obstetrician and/or Nurse Midwife to help you through the birthing process. If you desire pain relief for your labor, and your obstetrician agrees, we will be happy to assist you. The following is a brief overview of your options or pain relief provided by the obstetric anesthesiologists. We encourage you to consider your options for labor pain relief before your labor begins.

Knowing ahead of time what pain relief techniques are available to you during childbirth will help ease any fears you may have about your delivery. It is your decision on how you would like your labor pain managed or if you prefer not to have us assist you at all—the choice is yours. Consider all of the facts in a non-pressured setting.

There are two basic approaches for using medication to manage labor pain, systemic medications and epidural and spinal:

  • Systemic medications are intravenous medications, such as NUBAIN. The term systemic refers to the fact that the medication acts in your whole "system," or body. They act in your brain and produce drowsiness and sedation in addition to pain relief.
  • Epidural or spinal medication acts locally on the nerves that transmit pain from the uterus and vagina. The result is that you will be comfortable and alert, so that you can fully participate in the birthing process. Another advantage of the epidural and spinal techniques is that a relatively small dose of medication is required to relieve the pain. Therefore, less medication will be transferred to your baby than if you were to receive systemic narcotics.

A common question is: "What is the difference between an epidural and a spinal?" Both techniques are similar, as they involve blocking transmission of pain signals close to their point of origin. Each technique (epidural, spinal, or the combined spinal-epidural) has particular advantages and disadvantages. One of the advantages of the epidural technique is that medication can be administered continuously through an epidural catheter (a thin plastic tube) by connecting it to an Epidural pump. Pain relief may be administered continuously throughout labor and delivery and utilized if a cesarean becomes necessary.

Spinal techniques and combined spinal-epidural techniques have their own distinct advantages. For example, spinals take effect more quickly than epidurals. The type of pain relief technique you will receive will be tailored to suit your needs. In some circumstances, an epidural may be the best choice and other times the spinal or combined spinal-epidural technique may be most appropriate.

The challenge of obstetric anesthesia is to render you comfortable without compromising your ability to effectively push during contractions. If you are unable to feel any sensation of pressure during the second stage of labor, and/or if the epidural or spinal pain relief technique weakens your muscles, you may not be able to push effectively during the second stage.

We will individualize your pain relief to make you as comfortable as possible during the labor and delivery process however; some discomfort is usually experienced just prior to delivery.

If you already have an epidural in place for labor, and you require a cesarean, you may be given a stronger dose of local anesthetic through your epidural catheter or your anesthesiologist may elect to administer a spinal to keep you comfortable during the surgery. In many instances patients may feel some brief periods of discomfort during a cesarean section. If a cesarean delivery is elective or becomes necessary before an epidural is placed, you will likely be offered a spinal anesthetic. If you need an emergency cesarean section, you may have to undergo general anesthesia. General anesthesia is usually reserved for those emergency situations in which there is insufficient time to perform regional anesthesia. General anesthesia may also be used if there are reasons that prevent you from having a spinal-epidural anesthetic.

Most often, a small amount of narcotics is added to your spinal prior to your cesarean. This medication allows for prolonged pain relief after the procedure (about 24 hours). Supplementations to this method of pain relief are often given to keep you as comfortable as possible.

I am having an epidural for the delivery of my baby, will I feel my contractions?

Most patients experience numbness after the initial dose of medication. Our goal is to provide pain relief but to retain motion of the legs to assist with pushing. The mother is often aware of the contractions, but pain is significantly reduced. As labor progresses the mother often experiences intense pressure close to delivery.

What is PCEA?

PCEA is patient controlled epidural anesthesia. After the epidural is placed, the catheter is connected to a programmable pump that delivers a continuous infusion of pain-relieving medication and also allows the patient to self-administer extra medication (a "bolus").

What is a bolus?

A bolus is the administration of additional medication(s) to alleviate pain.