When it comes to using anesthesia in childbirth, most women fall into one of three categories:
No matter which category you fall into, it is important for you to know how anesthesia and pain relief are used in labor and delivery. Even if you fall into the latter category, remember the old adage: It’s a woman’s privilege to change her mind! No two women experience childbirth in quite the same way, so it is important to keep your options open. Every woman should be prepared for the possibility of needing an anesthetic.
This information, prepared by the American Association of Nurse Anesthetists, will attempt to answer many of the questions you may have about the use of anesthesia in labor and delivery, and give you a general overview of the various types of anesthetics available today. After reading this information, you may also want to meet with your physician or Certified Nurse Midwife (CNM) and a Certified Registered Nurse Anesthetist (CRNA) to discuss the best pain relief and anesthesia options for you and your baby.
Obstetrical anesthesia is different from any other type of anesthesia in that there are two patients involved — you and your baby. It is important that you take both individuals into account when considering your anesthesia choices.
Another factor to be considered is that labor is unpredictable. It can range anywhere from relatively quick and easy to painful and exhausting. An important point to remember is that everyone experiences pain differently. Only you will know the level of pain you’re experiencing, so you should never feel guilty about asking for pain relief.
Anesthesia Options for Labor and DeliveryThe ideal anesthetic should:
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There are several different forms of anesthesia administered for childbirth. They may be used independently or in conjunction with one another. Some of the most commonly administered anesthetics include:
Local infiltration – This series of local injections can make you more comfortable for delivery and for the placement of sutures if you need them.
Narcotics or tranquilizers – Administered as an injection or intravenously, narcotics or tranquilizers can help reduce the pain of labor but will not eliminate the pain entirely. They are also used to ease the anxiety that sometimes accompanies the delivery process.
Pudendal block – Administered as injections of local anesthetics to numb your vaginal area in preparation for delivery.
An epidural is a local anesthetic delivered through a tiny tube called a catheter placed in the small of the back, just outside the spinal canal. An advantage of the epidural is that it allows most women to fully participate in the birth experience (continue to feel touch and pressure) while relieving most, if not all, of the pains of labor. In most cases, the anesthetist will start the epidural when cervical dilation is four to five centimeters. Under certain circumstances, it may be desirable to place the epidural earlier.
This anesthetic is similar to an epidural, but because it is administered with a needle into the spinal canal, its effects are felt much faster. You may feel numb and need assistance in moving during the delivery. Spinal anesthetics are sometimes used for delivery by cesarean section or when the forceps use is indicated.
Epidurals or spinals cannot be used if the patient:
General anesthesia is administered by giving anesthetic drugs intravenously and having the patient breathe anesthetic gases. A general anesthetic may be necessary if complications arise during delivery. General anesthetics can be administered quickly, so they’re considered the best choice when time is of the essence. Also, general anesthesia enables the uterus to relax if your obstetrical provider finds it necessary.
In order for your anesthetist to determine which type of anesthesia is best for you and your baby, it is important that you inform your anesthetist about:
If you are a woman with any of these conditions, it is especially important that you meet with an anesthetist prior to going into labor.
“Will I remember everything?”
“Will it affect my baby?”
“Will I be able to breast feed?”
These are some of the questions frequently asked by pregnant women about the use of anesthesia in labor and delivery.
Because no two women experience pain or react to drugs in quite the same way, and because different anesthetic techniques have different effects, the answers to these questions will vary. There is no ideal anesthesia for everyone. This makes it very important for you to be informed, and discuss your options with your physician or CNM and your CRNA. The purpose of anesthesia during labor and childbirth is to help you have the most positive birth experience possible. Anesthesia should not hinder you from enjoying your baby as soon as possible after delivery. You should be able to bond with and breast feed your baby, if you so desire. The better prepared you are before labor and delivery, the more rewarding the entire birth experience will be for you.
Certified registered nurse anesthetists (CRNAs) are anesthesia specialists who administer more than half of the 26 million anesthetics given to patients in the United States each year. CRNAs represent a long-standing commitment to high standards in a demanding field. They provide high quality anesthesia services combined with a personal concern for the health and welfare of the mother and baby.
Acknowledgment: We gratefully acknowledge the assistance provided by Divina J. Santos, MD, and Carolyn J. Nicholson, CRNA, BSEd, Department of Obstetrical Anesthesiology, University of Ohio, Cincinnati, Ohio, and their videotape, “What anesthesia is best for me and my baby?”
Source: American Association of Nurse Anesthetists website, 1/27/10
