Pregnancy, Childbirth and Anesthesia

You’re having a baby! You’re likely excited and no doubt nervous about several things — including the hard work and pain of labor. Fortunately, there are a number of options available to ease the pain, ranging from medications to breathing techniques.

Every woman’s pain during labor is different. It’s important that you work with your health care providers, including your physician anesthesiologist, to decide which labor pain management methods are best for you. To have an enjoyable labor and delivery experience, you may choose to use none, some or more pain medication depending on your labor progress. It’s also acceptable to change pain management methods or use a combination of methods during your labor experience. No matter what you decide, we are available to help you.

Did You Miss Our #LaborPainChat?

Read the #LaborPainChat Here

The American Society of Anesthesiologists and the American Congress of Obstetricians and Gynecologists
recently hosted a Twitter Chat and answered questions on labor pain and delivery.
If you missed the #LaborPainChat, check out the conversation on Storify.

 


How Can You Ease Labor Pain?

Epidural: This is the most common type of pain relief during labor. If you choose to have an epidural, a physician anesthesiologist will insert through a needle a tiny tube, called a catheter, in the lower part of your back. An epidural numbs only the lower part of your body below your belly button and allows you to be awake and alert throughout labor, as well as to feel pressure to push when it’s time to deliver your baby. It can take about 15 minutes for the pain medication to work, but you can continue to receive it as needed.

Spinal: This can be used alone or combined with an epidural (referred to as a combined spinal epidural [CSE]). A physician anesthesiologist provides pain-relieving medication through a needle inserted in the lower back into the spinal canal. You’ll feel no pain, only numbness from your abdomen to your legs. A spinal can be used for vaginal childbirth as well as for a planned cesarean delivery. The pain relief is immediate and lasts from one and a half to three hours.

Analgesics: Pain medications (opioid and nonopioid) are delivered through an IV line into a vein or injected into a muscle. Analgesics can temporarily relieve pain but do not eliminate it.

Nitrous oxide: Nitrous oxide, often referred to as “laughing gas,” has not traditionally been used in the U.S. to manage labor pain. This option can help reduce anxiety and “take the edge off,” but it does not eliminate pain. It affects your whole body, decreases awareness, and may cause nausea, vomiting, and dizziness. It also may potentially affect your breathing. There is also limited research on its safety and the long-term effects on the baby.

General anesthesia: This is the only type of pain medication used during labor that makes you lose consciousness. It works quickly and is typically used only if you need an emergency cesarean delivery or have another urgent medical problem (such as bleeding). With general anesthesia, you will not be awake for the birth of your baby.

Complementary methods: There are also methods that do not involve medication and that may help women cope with labor pain. These techniques may be used alone or combined with pain medication.

  • Massage – Have your partner massage your back or feet.
  • Breathing – From deep, slow breaths to grunting, there are many different ways to breathe through the pain of a contraction.
  • Visualization – You may find it helpful to picture yourself somewhere enjoyable, such as on a beach or walking through a forest.
  • Water – Soak in a tub or take a shower to soothe some tension.

Are Epidurals Safe?

Many women choose an epidural to relieve labor pain. Women sometimes ask if an epidural can slow labor or lead to a cesarean delivery. There is no evidence that it increases your risk of a cesarean delivery. To decrease the possibility of side effects, ask for a physician anesthesiologist to be involved in your pain management plan.

Epidurals are safe, but you should be aware of some potential epidural side effects:

  • Decrease in blood pressure: The medication may lower your blood pressure, which may slow your baby’s heart rate. To counter this decrease in blood pressure and to maintain the baby’s heart rate, you will be given extra fluids through a tube in your arm (IV line) and may need to lie on your side to maintain a good blood pressure. Sometimes, your physician anesthesiologist will treat your lower blood pressure with a medication to increase it to its original value.
  • Sore back: Your lower back may be temporarily sore where the needle was inserted to deliver the medication. This soreness should last no more than a few days.
  • Headache: Rarely, the covering of the spinal cord may be pierced when the needle is placed, which can cause a headache that may last for a few days if left untreated.

Who Provides Anesthesia During Labor?

Before you give birth, talk to your physician to find out who will administer your anesthesia if you decide to have pain medication during labor. Your childbirth anesthesia care should be led by a physician anesthesiologist — a medical doctor specializing in anesthesia, pain and critical care medicine — who works with your other physicians to develop and administer your anesthesia care plan. With 12 to 14 years of education and 12,000 to 16,000 hours of clinical training, these highly trained medical specialists ensure safe, high-quality care.