EVEN IF YOU PREFER TO GIVE BIRTH WITHOUT ANY KIND OF PAIN RELIEVER, IT IS IMPORTANT FOR YOU TO KNOW HOW ANESTHESIA AND PAIN CONTROL ARE USED IN LABOR AND DELIVERY.

What are my options for controlling my pain while in labor?

Aside from practicing the breathing techniques you learn in prenatal classes, you can receive intravenous drugs (narcotics) which help to reduce pain. Intravenous narcotics are ordered by your obstetrician or nurse midwife and are given to you by your labor and delivery nurse. They are quick, easy, and can make your pain more tolerable. They may also cloud your thoughts and make you drowsy.

Another option is to have an epidural put in. This is an invasive procedure that takes time and preparation. An epidural can significantly reduce the pain of labor from the time it is placed until the baby is born.

Why would I need anesthesia in labor and delivery?

The anesthesia department provides epidural, spinal, and general anesthesia for labor and delivery patients when needed. Epidural anesthesia is used to control the pain of labor when intravenous pain medications are not enough or are not wanted. Epidurals can also be used for cesarean section (c-section) surgery. Spinal anesthesia is generally used for women who are scheduled to have a c-section, while general anesthesia (going to sleep) is usually reserved for emergencies.

Who provides anesthesia services in labor and delivery?

At Kaiser Hayward we have a full staff of highly skilled Certified Registered Nurse Anesthetists and Anesthesiologists, one of whom is dedicated to the labor and delivery ward 24 hours a day 7 days a week.

What exactly is an epidural?

An epidural is a small catheter (tube) that is placed between the bones in your lower back through which a mixture of local anesthetic and narcotic is given. This solution works on the spinal nerves to decrease (not eliminate) the pain caused by your contracting uterus.

How is an epidural placed?

The epidural is usually placed while you are sitting on the side of your bed. Your back is cleaned with an antibacterial soap and a small amount of local anesthetic is injected into the middle of your lower back. This injection is used to numb the skin and will sting and burn for a moment. After the area is numb, a larger needle is placed between the bones in your back into what is called the epidural space. A catheter is inserted through the needle, the needle is removed, and the catheter is taped securely to your back. Because the needle must be placed precisely it is important for you to hold very still during the procedure. Often the epidural can be placed between contractions, but not always, so your breathing techniques come in very handy at this time.

On occasion, a combination of spinal and epidural (CSE) is used. In this case a small spinal needle is placed through the epidural needle before the catheter is inserted in order to give a quick dose of medication directly into the spinal fluid.

What can I expect after the epidural catheter is in place?

After the catheter is in, the nurse anesthetist or anesthesiologist will inject a small dose of medication into it to check its placement. If you experience any symptoms like ringing in your ears or numbness in your legs at this time let your anesthesia provider know. This test dose of medication is used to determing if the catheter has gone into a vein or the spinal fluid instead of the epidural space. If this occurs the catheter will need to be replaced.

After the catheter is tested, a mixture of local anesthetic and narcotic is injected. The medication spreads over the spinal nerves, gradually relieving pain over the next 15 to 20 minutes. At first the contractions feel shorter. Eventually even the most intense pain will be reduced. As your cervix becomes more dilated and the baby’s head moves down into the birth canal, you may feel pressure with the contractions, often the epidural medication will not block this sensation. After the first dose an infusion machine will be used to give you a continuous flow of medication for as long as you need it.

Once the medication is put into the catheter your food intake will be limited to ice chips. You must remain in bed, as your legs will also be affected. The nurse will come to help you turn from side to side approximately every hour, which helps the epidural medication spread evenly.

Are there risks or side effects to having an epidural?

As with any invasive procedure there are some risks involved in receiving an epidural.

The most common side effect is a slight drop in blood pressure after the medication takes effect. You are given extra intravenous fluids to help minimize this side effect. If your blood pressure drops considerably you will be treated with medication.

Some women experience generalized itching from the epidural or spinal narcotic.

Another possible side effect is back pain. Women often experience back pain after childbirth even if they never have an epidural. The backache from an epidural is less common and is usually limited to a day or two, but on very rare occasions can last for a year or more.

Approximately 1 out of 100 women experience headaches caused by the epidural or spinal needle puncturing the membrane that contains the spinal fluid. Again, while it is common for women to have post-delivery headaches for various reasons, these “spinal” headaches are relatively infrequent.

Some very rare and unexpected complications are bleeding into the epidural space, nerve injury, and infection. Once in a while the epidural does not work well the first time, in which case it may need to be replaced in order to make you comfortable.

Will the epidural slow my labor?

There are some studies that suggest having an epidural can slow the progress of labor. There are also instances when an epidural has helped speed labor along. If slowing of labor seems to be a problem for you the epidural can be turned down or off. Your obstetrician can also order some intravenous medication to help improve your contractions.

Will the epidural medication affect my baby?

None of the medications, in the amounts that we put into the epidural, are toxic to your baby. In fact very little of the medication that is placed through the catheter actually reaches the baby. That is why, aside from the great pain relief, an epidural is a good choice for labor pain control. In addition, epidural analgesia will not interfere with breast-feeding.

How soon can I have my epidural?

Your obstetrician or nurse midwife will determine the appropriate time for your epidural (usually when the cervix is dilated to approximately 4cm and your labor is progressing well). As with any invasive procedure some preparation is required. It is necessary for you to have an intravenous catheter (IV) in place for fluids to be administered. You must have a blood test, which takes approximately 40-60 minutes for the lab to complete, and an anesthesia provider must evaluate you. The anesthesia provider will then determine whether or not an epidural is an appropriate option for you.

Once the preparation and evaluation are completed, the procedure will take about 15-20 minutes. As is the case in most hospitals, there is only one anesthesia care provider available to labor and delivery. Unfortunately this could mean that the provider is with another patient, involved in a c-section, or responding to an emergency when you are ready for your epidural. We cannot always predict when these situations will arise but we do make every effort to get to you as soon as possible.

It is important, however, to remember that the anesthesia provider’s first priority in labor and delivery is the safety of the laboring mothers and their babies. It helps to let us know as soon as possible if you know you want an epidural so we can begin the preparations.

What if I need a c-section?

A c-section can be performed with epidural, spinal, or general anesthesia. If you already have an epidural in place from labor, a dose of much stronger local anesthetic is administered so that you will become very numb and unable to feel the pain of surgery.

If your C-section is scheduled ahead of time, or you do not have an epidural from labor, a spinal anesthetic will most likely be used. A spinal is administered in much the same way as an epidural except that a smaller needle is used, no catheter is inserted, and the medication is injected directly into the spinal fluid. The numbness begins almost immediately after the injection and lasts for about 1–2 hours.

On rare occasions, when an emergency or other medical problem prevents the use of a spinal or epidural, general anesthesia is given. General anesthesia is reserved for these situations because it carries greater risks for the pregnant woman than does a spinal or epidural. The medications that are used for general anesthesia have been well tested on pregnant woman and do not have any long-term effects on the baby.

What can I do to help in the process?

Reading this pamphlet and attending the special prenatal pain class given by the Kaiser Hayward nurse anesthetists and midwives are very helpful starts to being informed about your options. The schedule for the classes can be obtained by calling Health Education at 784-4531.

If you have any serious medical or back problems it is advisable to talk with an anesthesia provider before you are in labor whether or not you want an epidural. This consultation can be arranged by your obstetrician or midwife.

It is the goal of the Kaiser Hayward anesthesia team to assist in making your childbirth experience as safe and pleasant as possible. We look for ward to seeing you on that special day.