Labor and Delivery Pain Management:
The birth of your child is one of the most important events in your life. This handout has been created by the
Department of Anesthesiology at West Jefferson Medical Center to help you understand your options for pain management
during labor and to assist you in understanding the right choice for you and your baby.
Each Woman’s Labor is Unique
Every woman has a unique labor experience. Some women use breathing and relaxation techniques to help cope with the
sensations of childbirth. West Jefferson offers prepared childbirth classes to help you learn these comfort techniques.
Should you need or desire assistance beyond this, the anesthesiologists and nurse anesthetists at West Jefferson Medical
Center are available 24 hours a day.
Please review the following options and talk with your doctors about what is best for you.
Labor pain may be lessened by medications given through your IV. They usually will not relieve pain completely. IV pain
medication can have side effects. Most are minor, such as nausea or drowsiness. These medications are usually only given
early in labor, because they may slow your baby’s breathing.
Local anesthesia can be used to provide numbness of small areas. This technique is commonly used to numb the vaginal area prior
to an episiotomy or when any vaginal tears that happened during birth are repaired. This technique does not lessen pain from contractions.
Epidural blocks are usually the most effective method of pain relief during labor. An epidural block numbs the lower part of your body.
Epidurals can be safely administered without causing sedation to you or your baby.
Epidurals are placed with you sitting or lying on your side, with your back curved outward. It is important to remain still
during the placement of an epidural. After a sterile cleansing of your lower back, a small injection of local anesthetic will be given
to numb the area where the epidural needle is inserted. With careful advancement of the needle the epidural space is reached and a flexible
plastic catheter will be placed. The needle is then removed. The plastic catheter will be secured with tape. All further medications will
be given through this catheter, similar to the way IV medications are given through an IV catheter. Your blood pressure will be watched
closely as epidural medications are given, since it will occasionally decrease as the labor pain is treated.
Labor pain will significantly decrease, but you should still expect to feel pressure with contractions. The lower half of your
body may feel tingly or warm. You can move after the epidural is placed, but you will not be allowed to walk around, as the medications used
to relieve pain may also cause some weakness in your legs. A continuous infusion of medication will be given through the epidural catheter.
Sometimes, additional medications given through the catheter with a syringe are also needed.
Exceptions to Epidural Pain Relief
Women with medical conditions that increase the risks of epidural placement may not be offered an epidural for pain relief. Women who have
bleeding disorders often cannot have an epidural, because the procedure can cause bleeding into the epidural space, which may cause nerve injury.
Women with severe infection can also develop nerve injury after epidural placement if bacteria enters the epidural space. Back surgeries such as
Harrington rods or spinal fusion can present unique challenges for the anesthesiologist and should be discussed in advance if possible. The
anesthesiologist may request surgical notes or X-rays. If you have a concern regarding one of these issues please discuss it with your doctors.
Risks of Epidural Placement
Although uncommon, there can be complications associated with epidural placement. The occurrence of a headache after epidural is approximately 1
percent. These headaches can be severe, but are treatable and have no long-term consequences. Nerve injuries from catheter placement are
exceedingly rare. Rarely, a misplaced catheter may go undetected, which may have serious effects on the mother’s heart rate or respirations.
This unlikely event is avoided by careful observation. Shivering and backache may occur, but also occur in patients without epidurals.
Anesthesia for Cesarean Birth
An epidural or spinal can be used for cesarean delivery. The procedure for administering a spinal block is similar to that described for an
epidural. A thinner needle is used, and the medication is injected into the spinal fluid instead of into the epidural space. If a labor
epidural has already been placed, the same catheter may be injected with additional medication for cesarean delivery. The resultant anesthesia
with a spinal or an epidural is almost identical, and the risks and exceptions are similar for both. The decision to use an epidural
or a spinal for cesarean delivery depends on the medical conditions of the mother and baby. Spinal and epidural blocks allow you to be awake
for the delivery of your baby. One visitor is usually allowed in the operating room during a cesarean delivery, to act as a support person
during this exciting time.
Since pregnancy increases the risk of general anesthesia, it is usually only used when a spinal or epidural cannot be used for
medical reasons, or when the baby needs to be delivered in an emergency. With a general anesthesia, the mother will be asleep during the
delivery and a support person for the mother will not be able to enter the operating room.
Please visit Registration on the first floor of WJMC to speak with someone regarding your anesthesia options. Our goal is to answer your
questions, ease your fears and make your labor and the baby’s birth as safe as possible. We are always available to answer questions,
whether they come up before, during or even after delivery. Please contact us at (504) 349-1237 if you have any questions. As you approach
this wonderful time in your life, know that you have the support of an experienced anesthesia practice.
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