Every woman experiences childbirth in her own unique way. In preparing for labor and delivery, some women are quite certain they will want pain relief. Some are unsure of their pain relief options and how they will affect their labor and delivery. Others would prefer to give birth without any pain relief.
No matter which category you fall into, it is important for you to know how anesthesia and pain relief are used in labor and delivery. Even if you fall into the latter category, you should know your options. Every woman should be prepared for the possibility of needing an anesthetic should an emergency arise.
This information will attempt to answer many of the questions you may have about the use of anesthesia in labor and delivery and give you a general overview of the various types of anesthetics available today. After reading this material, you may also want to meet with your obstetrical provider (obstetrician, family practitioner, nurse midwife) or an anesthetist to discuss the best pain relief and anesthesia options for you and your baby.
General Thoughts on Anesthesia
Obstetrical anesthesia is different from any other type of anesthesia in that there are two patients involved — you and your baby. It is important that you take both individuals into account when considering your anesthesia choices.
Another factor to be considered is that labor is unpredictable. It can range anywhere from relatively quick and easy to painful and exhausting. 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.
Anesthesia Options for Labor and Delivery
The ideal anesthetic should:
- Provide enough pain relief to allow you to deliver your baby with minimal pain and anxiety, leaving you free to fully participate in the experience.
- Allow you to push when it is time to do so.
The ideal anesthetic should not:
- Stop contractions
- Make your baby sleepy
Commonly Used Obstetrical Anesthetics
There are several different forms of anesthesia administered for childbirth. They may be used independently or in conjunction with one another. Some of the most commonly administered anesthetics include:
Local infiltration – This series of local injections can make you more comfortable for delivery and for the placement of sutures if you need them.
Narcotics or tranquilizers – Administered as an injection or intravenously, narcotics or tranquilizers can help reduce the pain of labor but will not eliminate the pain entirely. They are also used to ease the anxiety that sometimes accompanies the delivery process.
Pudendal block – Administered as injections of local anesthetics to numb your vaginal area in preparation for delivery.
An epidural is a local anesthetic delivered through a tiny tube called a catheter placed in the small of the back, just outside the spinal canal. An advantage of the epidural is that it allows most women to fully participate in the birth experience (continue to feel touch and pressure) while relieving most, if not all, of the pains of labor. In most cases, the anesthetist will start the epidural when cervical dilation is 4 to 5 centimeters. Under certain circumstances, it may be desirable to place the epidural earlier.
This anesthetic is similar to an epidural, but because it is administered with a needle into the spinal canal, its effects are felt much faster. You may feel numb and need assistance in moving during the delivery. Spinal anesthetics are sometimes used for delivery by cesarean section or when forceps use is indicated.
Epidurals or spinals cannot be used if the patient:
- Uses blood thinners or has a bleeding tendency.
- Is hemorrhaging or in shock.
- Has an infection in the back or the blood.
- Has an unusual anatomic condition or spinal abnormality.
- Additionally, if time is of the essence.
General anesthesia is administered by giving anesthetic drugs intravenously and having the patient breathe anesthetic gases. A general anesthetic may be necessary if complications arise during delivery. Because general anesthetics can be administered quickly, they’re considered the best choice when time is of the essence. Also, general anesthesia enables the uterus to relax if your obstetrical provider finds it necessary.
What Your Anesthetist Should Know
In order for your anesthetist to determine which type of anesthesia is best for you and your baby, it is important that you inform your anesthetist about:
- Food and drink intake for the last several hours.
- History of difficulty breathing after anesthesia.
- History of lower back problems.
- Family history of high fevers.
- Any respiratory problems such as asthma, bronchitis, pneumonia, or if you have a cold, sore throat or flu.
- Special medical concerns such as cardiac disease, diabetes, asthma and other medical conditions.
If you are a woman with any of these conditions, it is especially important that you meet with an anesthetist prior to going into labor.
Common Questions about Anesthesia
Here are some of the questions frequently asked by pregnant women about the use of anesthesia in labor and delivery:
- “Will I remember everything?”
- “Will it affect my baby?”
- “Will I be able to breast feed?”
Because no two women experience pain or react to drugs in quite the same way, and because different anesthetic techniques have different effects, the answers to these questions will vary. There is no ideal anesthesia for everyone. This makes it very important for you to be informed — and discuss your options with your obstetrical provider and anesthetist. The purpose of anesthesia during labor and childbirth is to help you have the most positive birth experience possible. Anesthesia should not hinder you from enjoying your baby as soon as possible after delivery. You should be able to bond with and breast feed your baby, if you so desire. The better prepared you are before labor and delivery, the more rewarding the entire birth experience will be for you.
Acknowledgment: We gratefully acknowledge the assistance provided by Divina J. Santos, MD, and Carolyn J. Nicholson, CRNA, BSEd, Department of Obstetrical Anesthesiology, University of Cincinnati, Cincinnati, OH, and their videotape, “What Anesthesia Is Best for Me and My Baby?”