Obstetrical Anesthesia Frequently Asked Questions
Q. What methods of analgesia are available for pain relief when I am in labor?
A. Your obstetrician may provide intravenous medications to help relax you and provide pain relief. If you wish for a more complete method, anesthesiologists may be called in to provide regional anesthetics in the form of an epidural, a spinal or both.
Q. What is a labor epidural?
A. It is a local anesthetic delivered through a small catheter placed in the small of the back near the spinal canal. It is generally considered one of the most effective methods for patients wishing for significant pain relief but wanting to be awake and able to participate in the birth.
Q. What is a spinal?
A. It is similar to an epidural but, because anesthetic is injected directly into the spinal canal, the effects are felt faster. It is more difficult to move and push via this method, however, due to greater numbness. For this reason, the epidural is the more popular method.
Q. Who should not consider these methods of pain relief?
A. People on blood thinners or with a history of bleeding disorders, those with nervous system disorders, with an infection in the back or those with a history of back surgery and/or spinal abnormality may not be good candidates for these methods of pain relief. If you have specific questions about whether you are a candidate, it is possible for you to discuss this with an anesthesiologist at one of our monthly seminars (see below).
Q. What happens with an epidural?
A. The epidural will not be placed until you are in active labor (usually at least 4-5cm dilated). You will have already been administered several liters of intravenous fluid, such that at least 1-2 liters have been given. You will be asked to position yourself on your left side or in a sitting, fetal-like position. The skin of your back will be wiped with an antiseptic solution to reduce the chance of infection. Following injection of a local anesthetic, a needle will be placed through the numbed area and into the epidural space of your spine. A catheter is then inserted through the needle and left in place after the needle is removed in order that an anesthetic may be administered continuously. The catheter is removed after the baby is born. The effects generally last 1-2 hours after that.
Q. What are the risks of epidural analgesia for childbirth?
A. Risks include severe headaches, inadequate pain relief, and/or allergic reaction to the medication. Epidurals may inhibit the ability to push in some patients, which may increase the chances of a forceps delivery (a procedure which carries its own set of risks). Additionally a sudden, and possibly dangerous, drop in the blood pressure of the mother and/or baby can occur. This can usually be easily treated but, for this reason, periodic blood pressure monitoring is required. Finally, although rare, additional unexpected but severe complications may also occur. Accidental injection into blood vessels resulting in seizures, inadvertent injection into spinal canal causing temporary but total paralysis, a broken needle or catheter which may require surgical removal, post delivery back pain, weakness or paralysis of the lower part of the body, bleeding and/or infection are all unusual but distinct possibilities.