The information posted on this website is for informational/educational purposes only. It should not be considered medical advice and is not intended to replace consultation with a qualified medical professional. You are advised to consult with a qualified physician for additional information and actual medical advice before making any decisions regarding anesthesia or other health care matters. 

Labor and Delivery Pain

What are my possible options for pain relief during labor and delivery?


1.Some women prefer natural methods such as Lamaze. These techniques are usually taught outside the hospital prior to labor.

2.Your obstetrician may prescribe intravenous (IV) or intramuscular medication for pain. These usually relieve pain for a few hours, but may make both you and your baby sleepy.

3.Your obstetrician may request an anesthesia consult for spinal or epidural pain medication (more information below).

4.You may also combine techniques. For instance, you may start out in labor using natural relaxation techniques, but later choose intravenous medication. If the IV pain medication wears off before delivery, you may decide to request an epidural orspinal anesthetic.




Who performs spinal and epidural anesthesia?


Spinal and epidural anesthetics are performed by anesthesiologists or certified registered nurse anesthetists (CRNA’s) as part of an anesthesia care team. Your anesthesia care team is present in labor and delivery area of the hospital to provide pain relief, anesthesia for C-sections, and to assist the obstetrician with complex medical problems that may present during labor and delivery.




What is an epidural anesthetic?


Epidural anesthesia is a type of regional anesthesia (i.e. it affects the lower region of your body). This is accomplished by the placement of a very small plastic tube into the lower back. One end of the tube rests just outside the sack that holds spinal fluid. A dilute solution of numbing medicine and narcotic is placed through the tube and gradually bathes the nerves going to your lower body to relieve pain. Medication can be given through the tube continuously and either increased or decreased as needed to keep you comfortable during labor. These medications stay in this area of your back and do not enter your blood stream in significant amounts. Because of this, you and your baby are not sedated. However, the epidural anesthetic may be started at a time in labor when you are very tired and you may naturally fall asleep when the pain goes away. Epidural anesthesia works quite well and about three-quarters of women delivering in hospitals request this type of pain relief.




How is an epidural catheter placed?


If you choose to have an epidural anesthetic, the anesthesiologist or CRNA will ask you to curl up on your side or sit up with your knees bent and head down. These positions curve your lower back and separate the bones in your spine. The anesthesiologist or CRNA will wash your back off with antiseptic and then inject a local anesthetic to numb the small area where the epidural will be placed. The anesthesiologist or CRNA will ask you to do your best not to move at this point. A needle is placed in your lower back (between the bones) and the catheter is inserted through the needle. You may feel a brief tingling sensation down one leg during this process. The needle is then removed and the epidural catheter is taped to your back. After delivery, the epidural catheter is removed and the numbness wears off over a few hours.




Will an epidural slow my labor?


There has been much debate and research on this topic. Generally, epidural anesthesia does not dramatically effect the progress of labor and delivery. Sometimes there is a brief slowing of contractions thought to be due to the extra IV fluids given around the time of epidural placement. Occasionally, labor progresses more rapidly after the epidural anesthetic is working and you are more relaxed. One factor important for a good labor pattern is the placement of the epidural only after labor is regular and your cervix is dilating.




What kind of pain relief can I expect from an epidural anesthetic?


The goal of a labor epidural anesthetic is to significantly reduce the pain while leaving enough sensation to feel pressure and push during delivery. The epidural medication generally begins to work within 5 minutes, but can take up to 15 minutes to achieve its full effect. Sometimes your pain relief may not be complete, or it may be one sided. In most cases, changing your position, changing the dose of medication, and/or repositioning the catheter in your back resolves this. On occasion, the catheter may need to be replaced. Be sure to talk to your nurse or anesthesiologist if you have concerns about the amount of pain you feel.




Will an epidural increase my chances of needing a C-section?


Statistically, there is a higher rate of C-sections in laboring women with epidural anesthesia. However, this is due to the fact that women who have more difficult labor (due to multiple factors including the size and position of the baby) and intolerable pain are more likely to ask for epidural anesthesia. This same group of women are more likely to require C-section for delivery because of factors unrelated to the anesthetic.




What is a spinal anesthetic?


A spinal anesthetic is a single injection of medication in the lower back. The medication is injected by a very small needle directly into the spinal fluid where it spreads out to affect the nerves that go to your lower body. A spinal anesthetic is often used as a complete anesthetic for C-sections. However, the dose and type of medication can be changed to act as a pain reliever during labor. Labor spinal anesthesia provides almost immediate pain relief, but only last about two hours. A spinal anesthetic may be a good choice for you if you are almost ready to deliver and need urgent pain relief. A combined spinal/epidural anesthetic is another option. The initial dose of medication is given through the spinal needle for fast pain relief and then an epidural catheter is inserted for extended pain management.




What are the most common side-effects of epidural and spinal anesthesia?


The most common side effects from epidural and spinal anesthesia are:

1. Itching — this is not an allergy, but a common side effect of some of the medication.

2.A decrease in blood pressure — this is due to the medications and relief of pain. This is usually counteracted with increased IV fluids and occasionally, medication. For this reason, an IV is placed prior to the epidural. Vital signs of you and your baby will be followed during the epidural anesthetic.

3.Shaking — this is a side effect of the epidural medication, rapid infusion of relatively cold IV fluid, and labor itself.




What are the possible complications of epidural and spinal anesthesia?


1.Infrequently, once the anesthetic takes effect, the mother’s uterus contracts very hard. This may cause the baby’s heart rate to decline briefly, but does not harm the baby.

2.Approximately one in every four hundred patients receiving spinal or epidural anesthesia gets a spinal headache. Spinal headaches usually start the day after the anesthetic. These headaches can be painful, but are not life threatening and can be treated.

3.On rare occasions, the epidural medication may go into a blood vessel. A very large dose could cause a loss of consciousness or a seizure. Small doses are normally used for labor.

4.Occasionally, the anesthetic can be too strong and breathing assistance may be required.

5.Very rarely, back or nerve damage can occur.
6.While extremely rare, blindness, major organ damage or death may result from any anesthetic.





Labor and Delivery Pain

What are my possible options for pain relief during labor and delivery?


1.Some women prefer natural methods such as Lamaze. These techniques are usually taught outside the hospital prior to labor.

2.Your obstetrician may prescribe intravenous (IV) or intramuscular medication for pain. These usually relieve pain for a few hours, but may make both you and your baby sleepy.

3.Your obstetrician may request an anesthesia consult for spinal or epidural pain medication (more information below).

4.You may also combine techniques. For instance, you may start out in labor using natural relaxation techniques, but later choose intravenous medication. If the IV pain medication wears off before delivery, you may decide to request an epidural orspinal anesthetic.




Who performs spinal and epidural anesthesia?


Spinal and epidural anesthetics are performed by anesthesiologists or certified registered nurse anesthetists (CRNA’s) as part of an anesthesia care team. Your anesthesia care team is present in labor and delivery area of the hospital to provide pain relief, anesthesia for C-sections, and to assist the obstetrician with complex medical problems that may present during labor and delivery.




What is an epidural anesthetic?


Epidural anesthesia is a type of regional anesthesia (i.e. it affects the lower region of your body). This is accomplished by the placement of a very small plastic tube into the lower back. One end of the tube rests just outside the sack that holds spinal fluid. A dilute solution of numbing medicine and narcotic is placed through the tube and gradually bathes the nerves going to your lower body to relieve pain. Medication can be given through the tube continuously and either increased or decreased as needed to keep you comfortable during labor. These medications stay in this area of your back and do not enter your blood stream in significant amounts. Because of this, you and your baby are not sedated. However, the epidural anesthetic may be started at a time in labor when you are very tired and you may naturally fall asleep when the pain goes away. Epidural anesthesia works quite well and about three-quarters of women delivering in hospitals request this type of pain relief.




How is an epidural catheter placed?


If you choose to have an epidural anesthetic, the anesthesiologist or CRNA will ask you to curl up on your side or sit up with your knees bent and head down. These positions curve your lower back and separate the bones in your spine. The anesthesiologist or CRNA will wash your back off with antiseptic and then inject a local anesthetic to numb the small area where the epidural will be placed. The anesthesiologist or CRNA will ask you to do your best not to move at this point. A needle is placed in your lower back (between the bones) and the catheter is inserted through the needle. You may feel a brief tingling sensation down one leg during this process. The needle is then removed and the epidural catheter is taped to your back. After delivery, the epidural catheter is removed and the numbness wears off over a few hours.




Will an epidural slow my labor?


There has been much debate and research on this topic. Generally, epidural anesthesia does not dramatically effect the progress of labor and delivery. Sometimes there is a brief slowing of contractions thought to be due to the extra IV fluids given around the time of epidural placement. Occasionally, labor progresses more rapidly after the epidural anesthetic is working and you are more relaxed. One factor important for a good labor pattern is the placement of the epidural only after labor is regular and your cervix is dilating.




What kind of pain relief can I expect from an epidural anesthetic?


The goal of a labor epidural anesthetic is to significantly reduce the pain while leaving enough sensation to feel pressure and push during delivery. The epidural medication generally begins to work within 5 minutes, but can take up to 15 minutes to achieve its full effect. Sometimes your pain relief may not be complete, or it may be one sided. In most cases, changing your position, changing the dose of medication, and/or repositioning the catheter in your back resolves this. On occasion, the catheter may need to be replaced. Be sure to talk to your nurse or anesthesiologist if you have concerns about the amount of pain you feel.




Will an epidural increase my chances of needing a C-section?


Statistically, there is a higher rate of C-sections in laboring women with epidural anesthesia. However, this is due to the fact that women who have more difficult labor (due to multiple factors including the size and position of the baby) and intolerable pain are more likely to ask for epidural anesthesia. This same group of women are more likely to require C-section for delivery because of factors unrelated to the anesthetic.




What is a spinal anesthetic?


A spinal anesthetic is a single injection of medication in the lower back. The medication is injected by a very small needle directly into the spinal fluid where it spreads out to affect the nerves that go to your lower body. A spinal anesthetic is often used as a complete anesthetic for C-sections. However, the dose and type of medication can be changed to act as a pain reliever during labor. Labor spinal anesthesia provides almost immediate pain relief, but only last about two hours. A spinal anesthetic may be a good choice for you if you are almost ready to deliver and need urgent pain relief. A combined spinal/epidural anesthetic is another option. The initial dose of medication is given through the spinal needle for fast pain relief and then an epidural catheter is inserted for extended pain management.




What are the most common side-effects of epidural and spinal anesthesia?


The most common side effects from epidural and spinal anesthesia are:

1. Itching — this is not an allergy, but a common side effect of some of the medication.

2.A decrease in blood pressure — this is due to the medications and relief of pain. This is usually counteracted with increased IV fluids and occasionally, medication. For this reason, an IV is placed prior to the epidural. Vital signs of you and your baby will be followed during the epidural anesthetic.

3.Shaking — this is a side effect of the epidural medication, rapid infusion of relatively cold IV fluid, and labor itself.




What are the possible complications of epidural and spinal anesthesia?


1.Infrequently, once the anesthetic takes effect, the mother’s uterus contracts very hard. This may cause the baby’s heart rate to decline briefly, but does not harm the baby.

2.Approximately one in every four hundred patients receiving spinal or epidural anesthesia gets a spinal headache. Spinal headaches usually start the day after the anesthetic. These headaches can be painful, but are not life threatening and can be treated.

3.On rare occasions, the epidural medication may go into a blood vessel. A very large dose could cause a loss of consciousness or a seizure. Small doses are normally used for labor.

4.Occasionally, the anesthetic can be too strong and breathing assistance may be required.

5.Very rarely, back or nerve damage can occur.
6.While extremely rare, blindness, major organ damage or death may result from any anesthetic.





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