Pain Control for Childbirth
No, you do not need to make a decision about your pain control before you come to the hospital in labor. However, reviewing the following information may be helpful in explaining your pain control choices, answering questions, and relieving any anxiety that you may have about the process.
Please take a chance to talk with your obstetrician or midwife about your desires for pain control before your expected due date. Every woman’s labor and childbirth experience is unique. You may anticipate having a pain management treatment, but decide during your labor that you don’t need one. Other women may not plan on using any pain medications, but then change their mind once in labor. It is very helpful to have relevant information ahead of time to help you make an informed decision.
What pain relief options are available to me while I am in labor?
There are several pain relief options available to you while you are in the process of labor. If you find that you would like pain relief, one option is intravenous pain medication given by your obstetrician. Often times, your obstetrician will consult with an anesthesiologist to provide other pain control choices to you. These choices commonly are:
1. Epidural analgesia
2. Intrathecal analgesia
3. Combined spinal-epidural analgesia (CSE)
Epidural Analgesia
An epidural is a type of regional anesthesia used for the process of labor that can provide longer-lasting pain control. After numbing the skin, a tiny plastic catheter (slightly larger than fishing line) is inserted through a needle in the lower back. The needle is removed and only the small plastic catheter is left in place. Local anesthetic (numbing medication) is given through the catheter and numbs the nerves after they leave the vertebral column.
The numbing medication usually begins to work within 15 minutes. Numbing medication can continually be given through the epidural catheter and last as long as the labor process does. When a patient has an epidural, a bladder catheter is also placed. Because your leg muscles may be partially numb while the epidural is in place, you would remain in bed for the duration of your labor and delivery. The catheter is usually removed just after your baby is born.
Intrathecal Analgesia
An intrathecal is a type of spinal anesthetic. A single dose of local anesthetic (numbing medication) is given through a needle placed into the lower back. Unlike an epidural, an intrathecal is a single dose of medication and isn’t repeated. One dose usually provides around 1-2 hours of comfort.
Combined Spinal-Epidural (CSE)
A combined spinal-epidural is a type of regional anesthetic that uses one needle to deliver a single dose intrathecal as well as to place a plastic epidural catheter outside of the vertebral column for later use. A combined spinal-epidural is used to provide more immediate relief with the spinal portion, as well as to have an epidural catheter in place in case the labor process is prolonged and pain control is needed later.
Will I still feel contractions with an epidural or an intrathecal and will I still be able to push?
The goal of pain control for the labor process is to decrease the pain of your contractions while still allowing you to be aware that they are taking place. Most patients still feel a sensation of pressure during a contraction. You should still be able to push when the active portion of your labor begins.
Can I walk after I have an epidural or an intrathecal placed?
There is often some degree of numbing of your legs after either an epidural or an intrathecal is placed. Because of this numbness, after an epidural or an intrathecal is placed, the remaining portion of your labor and delivery will take place in your hospital bed.
What are the risks associated with an epidural or an intrathecal?
Pain control options for labor and delivery are extremely safe. Anytime a needle is used, there is a very small risk of bleeding or infection. The most common complication seen with a spinal or an epidural is what is called a spinal headache. Less than 1 percent of women who have a spinal (intrathecal) or an epidural develop a spinal headache (also called a post-dural puncture headache). If you develop a spinal headache, there is specific treatment called an epidural blood patch that relieves the symptoms.
Some women have heard that there is a risk of permanent nerve injury with a spinal or an epidural. The risk of nerve injury with a spinal or epidural is extremely small and very rarely documented. The biggest risk for most patients is that the epidural does not work as effectively as desired. If this is the case, your anesthesiologist can make adjustments to provide better pain relief.
Contrary to some myths, there is no evidence that an intrathecal or an epidural slows down the process of labor or harms your baby in any way.
What are my anesthesia choices if I have a Cesarean section?
The type of anesthesia that you receive for a Cesarean section depends on the particular circumstances of your delivery. If you and your obstetrician have previously discussed having a Cesarean section and you enter the hospital for a planned operation, you will most often receive a spinal anesthetic for the surgery. The spinal medication that numbs the lower part of your body will be placed into your back after you enter the operating room. You will remain comfortably awake for the operation and be able to meet your baby immediately after he or she is born.
If your Cesarean section was unplanned, the type of anesthesia depends on the circumstances of your labor. If you have an epidural in place already, the anesthesiologist may place additional numbing medication through that epidural catheter to keep you comfortable for the operation. If there is concern for your baby’s health, and the Cesarean section is being performed more urgently, you may be placed under general anesthesia for the operation. If this is the case, you will not be awake in the operating room and will meet your baby soon after you awaken. We make every effort to keep you and your baby together during and after a Cesarean section.