Pregnancy: Epidurals & Pain Relief Options During Delivery
What will labor be like?
Each woman's labor is unique, and each woman experiences labor discomfort differently.
Pain during labor is caused by uterine muscle contractions and by pressure on the cervix. Pain might also be felt from the pressure of the baby on the bladder and bowels, and from the stretching of the birth canal and vagina when the baby is going through the birth canal.
The way a contraction feels is different for each woman and might feel different from one pregnancy to the next. Labor contractions cause discomfort or a dull ache in your back and lower abdomen, along with pressure in the pelvis. Some women might also feel pain in their sides and thighs. Some women describe contractions as strong menstrual cramps, while others describe them as strong waves that feel like diarrhea cramps.
The intensity of labor pain is not always why women seek pain relief. Often it's the repetitive nature and length of time the pain persists with each contraction.
What pain relief options are available during childbirth?
It is important for you to learn what pain relief options are available during childbirth. Please discuss your options with your health care provider well before your "birth day." Getting pain relief should not cause you to feel guilty. You are the only one who knows how you feel, so decisions regarding control of your labor pain must be made specifically by you.
Remember, however, that your pain relief choices might be governed by certain circumstances of your labor and delivery. Throughout your labor, your health care provider will assess your progress and comfort to help you choose a pain relief technique.
Your health care provider might ask an anesthesiologist (a doctor who specializes in pain relief) to talk with you about pain relief during labor. The anesthesiologist will be happy to answer your questions.
- Analgesic medicines can be injected into a vein or a muscle to dull labor discomfort. Analgesic medicines do not completely stop pain, but they do lessen it. Because analgesic medicines affect your entire body and might make both you and your baby sleepy, they are mainly used during early labor to help you rest and conserve your energy.
- General anesthesia is used for emergencies during the birthing process. General anesthesia induces sleep and must be given by an anesthesiologist. Although safe, general anesthesia prevents you from seeing your child immediately after birth.
- Local anesthesia might be used by your health care provider during delivery to numb a painful area or after delivery when stitches are necessary. Local anesthetic medicines do not reduce discomfort during labor.
- Regional anesthesia (also called epidural, spinal, or systemic anesthesia) is the most common and effective pain relief. Regional anesthesia greatly reduces or eliminates pain throughout the birthing process. It can also be used if a cesarean section becomes necessary. It is administered by an anesthesiologist during labor to reduce discomfort. There are 3 types of regional anesthesia: spinal, epidural and combined spinal/epidural. With each type, medicines are placed near the nerves in your lower back to “block” pain in a wide region of your body while you stay awake. It can also be used if a cesarean birth becomes necessary. Please note it is standard policy that your family member (s) will be asked to leave the room for regional anesthesia, for your and their safety.
Three types of regional anesthesia:
- Epidural – a thin plastic tube or catheter is placed in the back and medicine can be given through the tube when needed. The tube is left in place during the labor course. If a caesarean section is needed, a stronger dose of medicine can be given through the tube.
- Spinal – most commonly used in a planned cesarean section. Local anesthetic is placed using a very fine needle using a single injection. This method works fast, and only needs a small dose of anesthetic.
- Combined Spinal-Epidural or CSE – a combination of the above two. The spinal makes you numb quickly but can also be used to give more anesthetic if needed.
How is regional anesthesia given?
Your anesthesiologist will inject medicines near the nerves in your lower back to block the discomfort of contractions. The medicine will be injected while you are either sitting up or lying on your side.
After reviewing your medical history and asking you some questions, your anesthesiologist will numb an area on your lower back with a local anesthetic. A special needle is inserted into this numb area to find the exact location to inject the anesthetic medicine. After injecting the medicine, your anesthesiologist removes the needle. In most cases, a tiny plastic tube called an epidural catheter stays in place after the needle is removed to deliver medicines as needed throughout labor.
When is regional anesthesia given?
The best time to administer regional anesthesia varies depending on you and your baby’s response to labor. If you request regional anesthesia, your health care provider will contact your anesthesiologist and together they will discuss with you the risks, benefits, and timing of regional anesthesia.
If you request regional anesthesia, you might receive epidural or spinal anesthesia, or a combination of the two. Your health care provider will select the type of regional anesthesia based on your general health and the progress of your labor.
Will a regional block affect my baby?
Considerable research has shown that regional anesthesia is safe for you and your baby.
How soon does regional anesthesia take effect and how long does it last?
Epidural anesthesia starts working within 10 to 20 minutes after the medicine has been injected. Pain relief from epidural anesthesia lasts as long as your labor, since more medicine can always be given through the catheter.
Spinal anesthesia starts working immediately after the medicine has been injected. Pain relief lasts about two and one-half hours. If your labor is expected to last beyond this time, an epidural catheter will be inserted to deliver medicines to continue your pain relief as long as needed.
How numb will regional anesthesia make me feel?
Although you will feel significant pain relief, you might still be aware of mild pressure from your contractions. You might also feel pressure when your health care provider examines you.
Do I have to stay in bed after regional anesthesia?
Not necessarily. Your anesthesiologist can tailor the anesthesia to allow you to sit in a lounge chair or walk. Walking or sitting might even help your progress in labor. If you are interested, ask your anesthesiologist about a “walking epidural.”
Will a regional block slow my labor?
In some women, contractions might slow after regional anesthesia for a short period of time. Most women find that regional anesthesia helps them to relax and actually improves their contraction pattern while allowing them to rest.
If I have regional anesthesia, will I be able to push?
Yes. Regional anesthesia allows you to rest comfortably while your cervix dilates. When your cervix is completely dilated and it is time to push, you will have energy in reserve. Regional anesthesia should not affect your ability to push. It will make pushing more comfortable for you.
Are there any side effects of regional anesthesia?
Your anesthesiologist takes special precautions to prevent complications. Although complications are rare, some side effects might include:
- Decreased blood pressure — You will receive intravenous fluids, and your blood pressure will be carefully monitored and treated to prevent this from happening.
- Mild itching during labor — If itching becomes bothersome, your anesthesiologist can treat it.
- Headache — Drinking fluids and taking pain tablets can help relieve headaches after regional anesthesia. If the headache persists, tell your anesthesiologist and other medicines can be ordered for you.
- Local anesthetic reaction — While local anesthetic reactions are rare, they can be serious. Be sure to tell your anesthesiologist if you become dizzy or develop ringing in your ears so that he or she can quickly treat the problem.
For more information on pain relief, you may also ask your health care provider to order you access to EMMI, an online web based interactive patient education tool that can be accessed from any computer (www.viewemmi.com). You will find information under Anesthesia, "Pain Relief for Childbirth."
Further information, available in 40 different languages, can be found at the Obstetric Anaesthetists' Association. Go to information for mothers, pain relief in labor, and your anesthetic in cesarean section.