Planning Your Childbirth

Types of Pain Relief

There are two types of pain-relieving drugs — analgesics and anesthetics. Analgesia is the relief of pain without total loss of feeling or muscle movement. Analgesics do not always stop pain completely, but they do lessen it.

Anesthesia is blockage of all feeling, including pain. Some forms of anesthesia, such as general anesthesia, cause you to lose consciousness. Other forms, such as regional anesthesia also known as an “epidural”, remove all feeling of pain from parts of the body while you stay conscious. In most cases, analgesia is offered to women in labor or after surgery or delivery, whereas anesthesia is used during a surgical procedure such as cesarean delivery.

Regional Analgesia

Regional analgesia tends to be the most effective method of pain relief during labor and causes few side effects. Epidural analgesia, spinal blocks and combined spinal– epidural blocks are all types of regional analgesia that are used to decrease labor pain.

Epidural Analgesia

Epidural analgesia, some- times called an epidural block, causes some loss of feeling in the lower areas of your body, yet you remain awake and alert. An epidural block may be given soon after your contractions start, or later as your labor progresses. An epidural block with more or stronger medications (anesthetics, not analgesics) can be used for a cesarean delivery or if vaginal birth requires the help of forceps or vacuum extraction. Your doctors will work with you to determine the proper time to give the epidural.

An epidural block is given in the lower back into a small area (the epidural space) below the spinal cord. You will be asked to sit or lie on your side with your back curved outward and to stay this way until the procedure is completed. You can move when it’s done, but you may not be allowed to walk around.

After the epidural needle is placed, a small tube (catheter) is usually inserted through it, and the needle is withdrawn. Small doses of the medication can then be given through the tube to reduce the discomfort of labor.

Because the medication needs to be absorbed into several nerves, it may take a short while for it to take effect. Pain relief will begin within 10–20 minutes after the medication has been injected.

Although an epidural block will make you more comfort- able, you still may be aware of your contractions. You also may feel your doctor’s exams as labor progresses.

Spinal Block

A spinal block—like an epidural block—is an injection in the lower back. While you sit or lie on your side in bed, a small amount of medication is injected into the spinal fluid to numb the lower half of the body. It brings good relief from pain and starts working fast, but it lasts only an hour or two.

A spinal block can be given using a much thinner needle in the same place on the back where an epidural block is placed. The spinal block uses a much smaller dose of the drug, and it is injected into the sac of spinal fluid below the level of the spinal cord. Once this drug is injected, pain relief occurs right away.

A spinal block usually is given only once during labor, so it is best suited for pain relief during delivery. A spinal block with a much stronger medication (anesthetic, not analgesic) is often used for a cesarean delivery. It also can be used in a vaginal birth if the baby needs to be helped out of the birth canal with forceps or by vacuum extraction. Spinal block can cause the same side effects as epidural block, and these side effects are treated in the same way.

Combined Spinal–Epidural Block

A combined spinal-epidural block has the benefits of both types of pain relief. The spinal part helps provide pain relief right away. Drugs given through the epidural provide pain relief throughout labor. This type of pain relief is injected into the spinal fluid and into the space below the spinal cord. Some women may be able to walk around after the block is in place. For this reason, this method sometimes is called the “walking epidural.” In some cases, other methods, such as an epidural or a spinal block, also can be used to allow a woman to walk during labor.

General Anesthesia

General anesthetics are medications that put you to sleep (make you lose consciousness). If you have general anesthesia, you are not awake and you feel no pain. General anesthesia often is used when a regional block anesthetic is not possible or is not the best choice for medical or other reasons. It can be started quickly and causes a rapid loss of consciousness. Therefore, it is often used when an urgent cesarean delivery is needed.

A major risk during general anesthesia is caused by food or liquids in the woman’s stomach. Labor usually causes undigested food to stay in the stomach. During unconsciousness, this food could come back into the mouth and go into the lungs where it can cause damage. To avoid this, you may be told not to eat or drink once labor has started. If you need general anesthesia, your anesthesiologist will place a breathing tube into your mouth and windpipe after you are asleep. If you are having a cesarean delivery, you also will be given an antacid to reduce stomach acid. In some cases, ice chips or small sips of water are allowed during labor. Talk to your doctor about what is best for you.

Many women worry that receiving pain relief during labor will make the experience less “natural.” No two labors are the same, and no two women have the same amount of pain. Some women need little or no pain relief, and others find that pain relief gives better control over their labor and delivery. Talk with your doctor about your options. He or she may arrange for you to meet with an anesthesiologist before your labor and delivery. Be prepared to be flexible. Don’t be afraid to ask for pain relief if you need it.

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