ANESTHESIA PAIN RELIEF OPTIONS

FOR LABOR AND DELIVERY:

Information for the expectant mother

Each woman’s childbirth experience is different. The amount of pain you feel during labor depends on your level of pain tolerance, the size and position of the baby, the strength of uterine contractions, and your other birth experiences. Sometimes labor goes quickly and easily; sometimes it is painful and exhausting. Many women are able to use breathing exercises and relaxation methods to reduce labor discomfort.  The emotional support provided by labor and delivery nurses is also comforting to many.  Others want pain relief at the second or third stage of labor and delivery. 

Labor can be unpredictable, so you need to know about your pain management choices before labor begins.  You can ask the clinic doctor or nurse questions during your prenatal visits.  You can also ask the specially trained nurses during Childbirth Preparation classes.

An important point to remember is that everyone experiences pain differently.  Only you will know the level of pain you’re experiencing, so you should never feel guilty about asking for pain relief.

General thoughts on Anesthesia and Pain Medications  

When it comes to using anesthesia or pain medications in childbirth, most women fall into one of three categories:

1)      Those who would prefer to give birth without any medications/anesthetics

2)      Those who are unsure of pain relief options, and how medications might affect their labor and delivery

3)      Those who are certain they will want medication for pain relief

You have to think about two people when you make choices about pain medication or anesthesia – you and your baby.  Ideally, you want to have enough pain relief so that you can deliver your baby with minimal pain, anxiety and side-effects.  You want to be able to fully participate in the birth experience and be able to push when it is time to do so.

Options

One of the most common methods of treating labor pain is Intravenous (IV) medications injected into a vein.  They help reduce the pain of labor and may reduce anxiety.  IV medications will probably not relieve the pain completely, but may be enough to make the delivery a tolerable experience.  These medications are usually given in the early and active stages of labor to help you rest and relax.

Local anesthesia is a series of shots or injections that numb a small area of your body.  They can make you feel more comfortable during the second stage of labor or can be given if you need stitches after the birth.

Regional anesthesia (pudendal block) is given as a shot of local anesthetic to numb your vaginal area in preparation for delivery.  This type of anesthesia is usually given during the second stage of labor or when the doctor needs to use forceps to help deliver the baby.

An epidural is a combination of local anesthetic and narcotic.  It is given through a tiny tube placed into your back, near the spinal canal.  The epidural is usually started when you are dilated to 4 to 5 centimeters, but sometimes it is placed earlier. When the epidural is in place you may experience some numbness or weakness in your legs, and you will usually be restricted to bed until the medication has worn off.  “Continuous epidural” can last as long as your labor.

An intrathecal injection is similar to an epidural. It is usually given when you are dilated 4 to 5 centimeters. Intrathecal injections can be made of different combinations of medications, depending on the situation. You can usually feel the effect of an intrathecal much faster than an epidural.  With an intrathecal you can remain active in the labor and delivery process and have good pain relief. The pain relief can last from 1 to 7 hours, depending on what mixture of medication is used, but the average is 3 hours. 

A spinal block numbs the lower half of your body, and works very quickly.  It is a good option for pain relief during delivery, but not during labor.  A spinal block is often used when the doctor needs to use forceps or vacuum extraction (suction) to help the baby be born, or during a Cesarean section.

General anesthesia is used only for complicated deliveries or emergency cesarean sections.  The patient is given medication through an IV and breathes anesthetic gases.  General anesthetic can be administered quickly and is the best choice when there is an emergency situation.

You make the choice about pain management during labor and delivery.  Remember, no one experiences childbirth the same way. Your pain management options depend on many things, including your progress in labor, your health history, and any conditions that come up during your labor.  You can feel safe in knowing the doctor and nurses will carefully evaluate your condition, make medical judgments, take appropriate safety precautions and present your options to you so that you can make an informed decision about your care.