PAAMG Frequently Asked Questions: Obstetrical Care

Please note that the information provided on this website is not appropriate to all patients having surgery and should not be relied upon in making medical decisions. The following questions and answers are provided solely for informational purposes, do not constitute medical advice or guidance, and are subject to the disclaimers contained in this website’s Terms of Use. This information should be used only in consultation with an appropriate physician or anesthesiologist. Please contact your surgeon’s office or the anesthesia office if you have questions concerning you and your conditions.

Yes. Most women find labor painful at some point in the process. Some women do not find that they need pain relief during this process and others need anesthesia care.
Yes. It takes time to insure that a patient desiring a labor epidural has an IV with fluids administered and a blood test to be sure that the procedure can be performed safely. Making this decision before one arrives in labor reduces the possibility of delays in this pain relief. One may take a “wait and see” approach to this care but should expect to experience labor pain while these steps to insure ones safety are taken. Making pain relief decisions while experiencing labor pain is not optimal for anyone.
Natural Childbirth or Lamaze techniques

IV pain medications can provide some partial pain relief but may make the mother and infant sleepy. Thus, these are usually used only in the early stages of labor.

Regional Blocks. Spinal, epidural, or combined spinal / epidural anesthetics are used to minimize labor pain. These therapies partialy numb the lower body and provide pain relief but they do not eliminate all discomfort associated with childbirth. The therapies all have optimal times for administration prior to birth for pain relief. Last minute decisions for this therapy may not allow time for relief to achieve its full potential. Thus, we recommend that patients do their research on this therapy and make their decisions as early in this process as possible. Labor epidural anesthesia is the most common form of pain relief administered.

Spinal and epidural anesthetics are achieved by placing a needle and sometimes a small tube (catheter) in the patient’s back in the space surrounding the spinal cord or in the epidural space surrounding the spinal cord. Medicine is injected into the space to partialy numb the nerves in this area. The catheter may be used to allow for continuous administration of medicine into the spinal area for longer-term pain relief.

You will be monitored during the procedure, and you will have an IV placed before the procedure to insure that you are properly hydrated. Lab work will be performed to be sure that you can have this procedure safely. Sterile drapes and disinfectants will be placed on your lower back. A local anesthetic will be injected with a small needle to numb the area of the procedure. An epidural or spinal needle will be placed in your lower back and a catheter may be used to continuously administer medications for long-term pain relief. Placement of an epidural or spinal generally hurts less than placement of an IV catheter, and generally less than a contraction.

As the medications take effect, one normally feels a warm sensation followed by numbness in the lower body. Some loss of strength may be experienced in one’s legs but the ability to push should remain intact. Pain relief normally takes affect in 15 to 20 minutes with complete pain relief in 30 minutes. Most often you will still feel pressure in the birth canal, which will help you know when you need to push.

Epidural anesthesia has a well-established safety record for you and your baby. The effects on your baby are minimal since the medications are injected close to the nerves that control labor pain. The dose of medication is small, and the medication is greatly diluted by the time it crosses the placenta to your baby. The anesthesiologist will evaluate you and your medical condition to help you select the safest form of pain relief for you and your baby.
A “walking epidural” is a combination of a spinal and an epidural. An epidural needle is first placed, and then, a spinal needle is inserted through the epidural. A small amount of anesthetic is injected through the spinal needle and then the epidural needle is placed. This gives you a light amount of fast acting pain relief followed by the longer-term epidural pain relief. However, we want you monitored during your period of labor and do not want you to walk around. The walking part of this therapy is a misnomer. This therapy is not commonly used at this facility.
The risks are few and are rare, but they do exist. For a complete list of the risks, please discus them with your anesthesiologist. The most common risks are:

lower back tenderness and backache where the spinal or epidural was placed. This is of short duration and the post-delivery medications normally prescribed by your obstetrician should be adequate to accommodate this discomfort.

A headache (commonly called a “spinal headache”) can develop from a spinal or epidural, usually within 48 hours. This headache starts when you stand, and stops when you lie down. Spinal headaches sometimes go away without any treatment. If the headache is severe, we can do an epidural blood patch, which takes away about 80 – 90% of these headaches. Talk to your anesthesiologist if you have more questions about this.

The epidural space contains small veins and on occasion the epidural medication can be injected into them. This can have multiple effects, but it is usually avoided by a test procedure that the anesthesiologist performs on the epidural prior to its use.

No, a few patients in labor are not candidates for regional anesthesia, but most are. The reasons that you may not be a candidate for regional anesthesia can include bleeding disorders, certain infections, previous back surgery, or extreme obesity.
Epidural anesthesia if time allows. Spinal anesthesia. General anesthesia.

Regional anesthesia is safer for both mother and baby than general anesthesia. However, emergency circumstances may dictate the use of general anesthesia because of its speed and responsiveness to patient needs. The concern about general anesthesia is the risk of regurgitation (aspiration) of solids or liquids from the mother’s stomach into the lungs while the mother is unconscious. Pregnant women are at a greater risk of this because their stomachs empty more slowly during pregnancy. Please refrain from eating and drinking anything after labor starts.

We have an anesthesiologist dedicated to labor and delivery anesthesia services seven days per week, twenty-four hours per day. This physician does not perform services in the operating room or elsewhere in the medical center during this period of call. They are focused on labor and delivery patient care needs and must respond to pages in thirty minutes of being paged to the unit by the nursing staff. They have at least four other anesthesiologists on call that mutually back up each other at all times.
Please stop consuming herbal products unless they are prescribed by your physician two weeks prior to surgery. Please consult with your physician about your prescription medications prior to surgery.
Based on your age, sex, and physical condition, you will need lab work completed before surgery. Your surgeon’s office will order these diagnostic tests for you and direct you to the lab. The surgeon and the anesthesiologist use these results to assess your condition just prior to surgery and anesthesia.
These substances can affect the anesthesia agents we use to care for you. We need to know if you have consumed these substances to adjust your care. We may have to cancel your surgery if the level of these substances in your body exceeds our safety thresholds for your care.