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Obstetric Anesthesia

What is obstetric anesthesia?
Obstetric anesthesia is a subspecialty of anesthesia devoted to the time right before a baby is born, during delivery and post delivery pain management.

Every woman and labor experience is unique. Therefore, decisions regarding control of your labor pain must be designed specifically for you. Some women attain adequate pain control with non-medical techniques such as relaxation, breathing, visual imagery, massage and focusing. For some, these techniques work throughout labor, while for others, these techniques become inadequate as labor progresses. When this occurs, medications and other special procedures can be used to minimize pain.

What types of medications and procedures can be used to minimize pain during labor?

  • Intravenous or "IV" Medications - These are pain-relieving medications that are injected into a vein to decrease the sensation of pain during early labor and are prescribed by your obstetric caregiver. Because the medications are often narcotics, they may make you and the baby sleepy.
  • Local Anesthesia - This refers to the injection of medicines into the vaginal and rectal areas by the obstetric caregiver to relieve pain at the time of delivery. Local anesthesia does not remove the pain of contractions.
  • Regional Blocks - Regional blocks for labor are better known as an "epidural," "spinal," or combination of the two. In short, an epidural involves placement of a catheter (a very small tube) in the back (for more details, see below). An epidural can remove most or all of the pain of labor and delivery. A spinal is similar but involves a single injection of anesthetic medicine without the catheter.

Who will administer my epidural?
An anesthesiologist will place your epidural. An anesthesiologist is a physician who is board certified in the medical subspecialty of anesthesiology. After completing medical school and a medical internship, anesthesiologists then undergo three additional years of training in the areas of anesthesia, pain management and critical care medicine. Some of our physicians have also taken additional years of subspecialty training in obstetric, neurologic, cardiac, or pediatric anesthesia, pain management or critical care.

How is an epidural performed and how "pain free" will I be?
An epidural block will be administered by an anesthesiologist in your labor room. You will be asked to lie on your side or sit up straight with your chin tucked on your chest and your knees close to your abdomen. The lower back is cleaned with a sterile solution and then a small area of skin is anesthetized with local anesthetic. The epidural needle is then passed into the epidural space, and a tiny catheter (tube) is threaded through the needle into the epidural space. After the epidural needle is removed, the catheter is taped to your back and you are free to move about in bed. To assure continuous pain relief, anesthetic medication is continuously delivered through the epidural catheter until after the baby is delivered.

The amount of anesthetic medication you receive will be adjusted by your anesthesiologist to provide as much pain relief as possible without interfering with your labor. Some women are able to sleep through their contractions until they are near complete cervical dilation. You may be aware of a pressure sensation with contractions or vaginal exams. You may also feel a temporary numbness or weakness in your legs. Our physicians are always readily available to place your epidural or make adjustments.

Will an epidural block affect my labor or my baby?
It appears that different mothers respond differently to epidural medications. Some may have a brief slowing of uterine contractions. Others find their labor actually progresses faster once they become more comfortable and relaxed. Well-conducted studies show that epidurals do not increase the risk of cesarean delivery. Considerable research has shown that epidural analgesia (and anesthesia as needed for cesarean section) is safe for both mother and baby.

If I use an epidural during labor will I be able to push my baby out?
Yes. Epidural analgesia allows you to rest during the longest part of labor, which occurs during cervical dilation. Then, when you are ready to deliver, you will have energy in reserve for pushing. In case your obstetric caregiver needs to use forceps or a vacuum instrument, the epidural can provide the comfort level essential to succeeding with theses techniques.

What are the risks of regional blocks?
Complications or side effects can occur even though you are monitored carefully. These complications do not occur often, and your anesthesiologist will take special precautions to avoid them. Rarely do these effects lead to serious problems for mother or baby. Your anesthesiologist will discuss these with you as well as any other concerns that you may have at any time.

What if I require a cesarean section delivery?
When possible, a regional type of anesthetic - epidural, spinal, or combined spinal-epidural anesthesia - will be administered for your Cesarean delivery. The type of anesthesia available to you at the time of your Cesarean delivery will depend on the medical condition of you and your baby, and when possible, your preferences. If you already have a labor epidural catheter in place and then need a Cesarean delivery, it is usually possible for your anesthesiologist to inject additional anesthetic medication through the same catheter to provide anesthesia for surgery. Otherwise, your anesthesiologist may administer any one of the three regional techniques mentioned above.

Regional anesthesia minimizes the baby's exposure to medications and allows you to be comfortable, awake and to have your significant other present for delivery. General anesthesia is used only when a regional block is not possible or is not the best choice for medical reasons. It can be administered quickly and is used when an urgent vaginal or cesarean delivery is required. In these circumstances, special precautions are taken to protect the mother and the baby during general anesthesia.

What if I have other questions?
Our physicians will be happy to discuss your questions or concerns. If necessary, a consultation can be arranged before your delivery. We look forward to helping you have a comfortable and safe birthing experience!

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