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Anesthesia in Labor

Almost every pregnant woman wonders and worries about the discomfort and pain she is likely to have during labor and delivery. Since doctors now have several ways of reducing or eliminating most of the discomforts, you will want to find out ahead of time what is available.

Not all women will need relief from the pain of labor. Many times this is helped by support from the baby’s father or another family member. This may be all the “anesthesia” they need.

Other women may need a combination of support and medications. Fear is one cause of pain, and it has been found that women who have attended childbirth classes and are given enough information about the whole process need less medication.

Every woman is different. Every woman's labor and delivery is different. It is difficult to decide in advance what pain relief will be needed. Therefore, it is best to know about different choices, and then wait and see how the labor progresses. Your doctor and you can then decide what medications, if any, will be needed.

There are several types of drugs that may be used during the birth of your child. They are: pain killers (narcotics), general anesthesia, and regional anesthetics. Pain killers or analgesics reduce the feeling of pain. General anesthesia allows the mother to sleep during delivery. Regional anesthetics make certain areas of the body numb while the woman remains fully awake.

How do pain medications (narcotics) work?

There is not one specific pain medication used during labor. These drugs reduce pain and help cut down on fear and anxiety. These medicines are usually given by injections into an IV that goes directly into your blood stream, or as an injection into your muscle. You and your doctor may decide together what is necessary and best for you and the baby.

What are some side effects of narcotics?
Side effects are rare and usually only happen if higher doses are used. These may include getting sick to your stomach and throwing up. You may get very sleepy or stop taking deep breaths, cutting down on the amount of oxygen you’re taking in. The doctors and nurses watching you can easily help if you are having some of these side effects.
What anesthesias are available?
General anesthesia, regional anesthesia, and local anesthesia are available. They work by causing you not to feel any sensation in all or part of your body. You and your doctor will discuss which of these anesthesias are appropriate.
What is a general anesthesia?

General anesthesia is one where the woman sleeps during delivery. Sleep is caused by a special medication given to her through a needle that has been placed in one of her arm veins. Soon afterward, certain gases are given to her to breathe, which circulate throughout her body, to keep her asleep. She then wakes up when the delivery is all over.

This type of anesthesia is usually only given if there is an emergency and not a moment to waste. Because it takes only a short time to give and is effective almost immediately, it may be your doctor’s choice should a problem occur. In that case, you should be prepared to accept this decision.

What are regional anesthetics?

Regional anesthetics cause a specific area of the body to become numb. The types most often used are spinal, epidural, caudal, saddle block, and pudendal anesthesia.

What is spinal anesthesia?
This anesthetic provides numbness of the body from the waist to the toes, while the woman remains awake. This type is most frequently used for cesarean sections.
How is it given?

A numbing medication, something similar to novocaine, is injected into the lower portion of the back which gradually causes the mother’s lower part of her body to feel tingly, heavy, and numb. She is then unable to move her legs. She feels no pain during delivery, but in an hour or so the feeling gradually returns.

Other types of special spinal anesthetics are epidural, caudal, and saddle block anesthesia.

What is an epidural anesthetic?

An epidural anesthetic is given in the same area of the back as the spinal, but the medication is injected into the space just short of the spinal canal, called the epidural space. For pain relief during labor, a small plastic tube is then inserted into the space and taped to the mother’s back. This allows more numbing medication to be added as needed without any other needle sticks. This tube is usually not uncomfortable for the woman. As one dose wears off, another can be given. It usually takes effect in five to 10 minutes and continues until after delivery. She will feel numbness and tingling in the lower portion of her body, but she still is able to move.
The advantage of this method is that it can be used not only for delivery but during labor as well. Therefore, very little discomfort is experienced during both labor and delivery.

For injection of a spinal, epidural, or caudal, the mother will be asked to lie on her left side in a curled up position or possibly sitting and curled over. For a saddle block, she will be asked to sit up. This position may be uncomfortable at her stage of labor but is in no way harmful to her or the baby.

What is caudal anesthesia?

Caudal anesthesia is an epidural anesthesia in which the medication is injected into the lower part of the spinal canal near the tailbone. This causes the lower part of the belly and legs to become numb. The woman may still feel some pressure but not pain. She will still be able to help push the baby out during delivery.

This anesthesia can also be started during labor and continued throughout delivery.

What is saddle block anesthesia?

A saddle block or low spinal is given just before the baby is about to be delivered. The medication is injected in the lower spine. This type of anesthesia causes numbness only in the area of the body that ordinarily would come in contact with a saddle while riding horseback. The medication produces a numbing sensation usually long enough only for delivery and to repair an episiotomy.

What is pudendal anesthesia?
This anesthesia provides for numbing of specific nerves (called pudendal nerves) in the lower part of the body near the birth canal. A needle is carefully inserted into the vagina and is injected along both sides of the vagina. This makes the area between the mother’s legs feel numb. This feeling usually lasts for as long as it takes for delivery and repair of the episiotomy.
What is a local anesthesia?

Local anesthesia is made possible by injecting the medication directly into the skin that needs to be made numb (much like what a dentist does).

For delivery, the medication is injected into the perineum (the space between the vagina and anus) just before the baby is born. This allows the area to be pain-free when the episiotomy is performed and later repaired.

Local anesthesia does not help with contraction pains.

Will the baby be affected by the anesthetics?

If the woman gets a general anesthetic, the baby may be made sleepy also. Because of this, the mother is usually not given any of the anesthetic until just before the baby is to be born. That way, the baby is less likely to be affected.

A small amount of the medications used in the regional anesthesias may get to the baby but usually, there is little effect. Overall, their use is considered safe.

Are there any risks to the mother?

All of the anesthetics are considered quite safe for the woman, but there is always a small risk. When a general anesthetic is given, the woman may vomit and breath some of the stomach contents into her lungs. This is usually prevented by not allowing the mother to eat or drink anything after labor begins. If she needs liquids, an IV (needle into a vein) will be used so fluids may be given.

When a spinal or epidural anesthetic is given, there is a chance that low blood pressure may occur. This is best treated by extra fluids and special medications.

There is also a chance that a headache may occur after a spinal or epidural anesthetic. This headache is worse when you sit or stand up and gets better when you lay down. It is treated with plenty of fluids and pain medicine until it disappears. Sometimes your anesthesiologist will treat this with a simple spinal injection.

Women given epidurals run a higher chance of having low level fever during labor. This can lead to your baby needing to have tests and antibiotics to cover the possibility of infection. Generally, the babies of mothers with this fever do not have an infection, but the babies sometimes need special tests and medicines to check for the possibility that they might have an infection.

Remember, no anesthesia is perfect. Each one has its advantages and disadvantages, as well as possible risks and side effects. But with well-trained doctors, the chances of a safe and pleasant delivery are likely.

You may want to discuss your feelings regarding pain relief and anesthesia with your doctor before the time of delivery. That way, the two of you may plan together the best way for you to have the type of childbirth experience you desire.

Will I be able to choose any one of the anesthetics when I go into labor?

Not every type of anesthetic method is available at every hospital. The variety depends on the medical staff available and their experience and training. You should discuss these things with your doctor to find out what is available at your hospital. Your doctor and staff can help you make the best decisions in selecting an anesthetic.

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