Pain Relief Available During Labor
Thomas Wood, D.O, is a board-certified anesthesiologist at Page Hospital.
Question: What kind of options are there for reducing pain during delivery?
Answer: Many women choose to give birth naturally, without the use of pain medications. An excellent way of controlling labor pains during natural labor is through breathing and relaxation techniques that are often taught to expectant moms prior to labor.
However, for those women who want pain relief during labor, there are a number of pain relief choices available. These range from injections (or shots) that last a short period of time and do not numb large areas of the body, to spinal analgesia which does numb large areas of the body.
There are a number of factors that must be considered when choosing the type of anesthesia to use during labor, with the safety of the mother and baby being the most important consideration. There are always risks with any medical procedure; therefore anesthesia cannot ever be taken lightly. Although infrequent, bleeding and infection are the most common complications, even despite sterile protocol and good technique.
The circumstances of the patient and her labor pattern will determine which pain relief option is most appropriate. For instance, first-time mothers can expect to labor for awhile before receiving pain medication. It is best to wait until there is a well-establish labor pattern and dilated cervix before administering an epidural. Having an epidural too soon can slow labor down or make labor last longer.
There are three types of labor anesthesia available. Injections of medications in the form of short-acting narcotics are usually the first option for pain control. Relief from these injections may be enough to avoid needing numbing of larger areas of the body.
Spinal analgesia, sometimes in the form of an older technique known as a saddle block, is a popular and effective method for controlling pain in the latter stage of labor. Because it typically lasts only three to five hours, it is usually reserved for first-time mothers with near complete cervical dilation. Women who have had previous deliveries usually have a labor that progresses more quickly, so they may benefit from this type of pain block a little sooner.
The third type of pain relief is called a term epidural anesthesia and it is the type most people are familiar with. The term epidural comes in two forms. The first is the single-shot epidural, which is good to use when labor is progressing quickly. This technique works exactly the same as a spinal epidural, but its advantage is that the spinal canal is not penetrated, thereby eliminating the possibility of a spinal headache later.
The second form of term epidural involves the placement of a small tube, or catheter, into the outer most part of the spinal column, known as the epidural space. This technique allows pain medicine to flow continuously into the epidural space. The main advantage of this technique is that it can be started sooner in labor and lasts a long time. A disadvantage of this procedure is that it is difficult to perform. It requires a much larger needle and threading the catheter can be a challenge. In addition, it is possible the catheter might be moved out of place after it was properly placed. Each of these difficulties can lead to bigger problems and can be harmful to both mother and newborn.
C-sections are routinely performed when labor is not an option. The preferred anesthetic for a c-section procedure is a spinal analgesic. It works very quickly and has a deeper blockade than an epidural. It also prevents the need for medication, which can be absorbed by the baby.
Meeting with your doctor to discuss the details of your pregnancy and what you can expect during birth is an important factor in determining what is best for you and your baby. Safely delivering a healthy baby and a having a happy, healthy mother remain our goals.