PAAMG Frequently Asked Questions: Obstetrical Care
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.
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.
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.
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.