Historically, anesthesiologists have played a major part in relieving the pain associated with childbirth.  Along the way, anesthesiologists have also been instrumental in making childbirth much safer.

The decision to choose pain relief in labor is very personal. For those who choose pain relief, the caring anesthesiologists of C.A.S. are privileged to provide 24-hour per day, 365-day per year in-house anesthesia coverage of the Sibley Memorial Hospital Labor and Delivery unit.

Epidural Anesthesia for Labor

Epidural analgesia, sometimes 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 is given in the lower back into a small area (the epidural space) outside the spinal cord. You will be asked to sit with your back curved outward and to stay this way until the procedure is completed.

After the epidural needle is placed, a small tube (catheter) is inserted through it, and the needle is withdrawn leaving only the catheter. The catheter is soft and flexible and not sharp. A continuous flow of the medication can then be given through the tubing, and you will be given a button to self-administer extra doses.

The epidural medication is a mixture of local anesthetic combined with a very low-dosage of a narcotic. The amount of narcotic administered is very small—much less than would be required if given intravenously to provide pain relief. Although an epidural block will make you more comfortable, you still may be aware of your contractions. You can move in bed when it is done, but you will not be allowed to walk around. The amount of medication that appears in the blood stream is unlikely to have any sedating effects on you or your child.

An epidural block with more or stronger medications can be used for a Cesarean delivery.  In a sense the epidural can provide a margin of safety since the epidural can be “strengthened” quickly and safely in the setting of an unplanned Cesarean delivery. Patients with indwelling epidural catheters rarely require general anesthesia for their Cesarean section.

Out of all the options for pain control, epidurals provide the best and most reliable pain relief and patient satisfaction.

Anesthesia for Elective Cesarean Section

Patients scheduled for elective Cesarean sections will receive either an epidural or spinal anesthetic or a combined spinal epidural. In certain unusual situations a general anesthetic may be required for a Cesarean section.

Educational Videos for Obstetric Patients

http://www.epiduralwithoutguilt.com/educational-videos

Can everyone get a labor epidural?

There are very few reasons why a patient may not receive a labor epidural.  Some reasons include: a serious bleeding tendency (including ongoing treatment with low-molecular-weight or unfractionated heparins), uncorrected maternal dehydration, infection at the needle-puncture site, severe, untreated systemic infection or increased central nervous system pressure.

Misconceptions About Pain Management in Labor and Delivery

When planning for the arrival of a new baby, there is much to prepare for. Parents are often focused on equipping the nursery, attending birthing classes and maintaining mom’s health. What many expectant moms may not realize is that they should also be preparing to make important decisions regarding their pain management options during labor and delivery. In order to help expectant mothers prepare for childbirth, the American Society of Anesthesiologists (ASA) has prepared the following regarding common misconceptions about obstetric pain management. http://www.asahq.org/sitecore/content/Lifeline/Anesthesia-Topics/QA-Pain-Management-During-Childbirth.aspx

Misconception 1: Epidurals slow down the labor process.

There is no credible evidence to show that epidurals (or other pain management procedures) slow the first stage of labor (the start of labor to full cervical dilation). Since epidurals are more frequently used in “difficult” labors versus relatively easy labors, some have tried to infer that epidurals, therefore, cause difficult labors. This is not an accurate interpretation of the data. Conversely, there is some evidence that epidurals can actually speed labor for some women, by allowing them to relax.

The best information we have is that pain management procedures have no significant impact on the cervical dilation process.

Misconception 2: Epidurals cause C-sections.

Again, there is no definitive evidence that concludes an epidural will cause a C-section. Women who request epidural anesthesia report higher pain levels earlier in labor than those who do not.  Such pain itself may be a marker for an unusual labor, which may be longer or more likely to end in a C-section. Women requesting epidurals also tend to be dilating at a slower pace than those who do not; they deliver larger babies; they are more likely to be receiving medication to augment labor, and they are more frequently having their first baby.

Misconception 3: You can’t get an epidural until a certain level of dilation has occurred.

Women do not have to wait until they are dilated to a certain level before they can ask for, or receive, an epidural. According to the ASA’s current guidelines, “patients in early labor should be offered the option of receiving neuraxial analgesia (spinal or epidural) when the service is available, and it should not be withheld to meet arbitrary standards for cervical dilation.” If a woman is in active, established labor, and is uncomfortable, epidural analgesia is the most effective method of pain relief. There is no medical reason to wait for a specific dilation target.

Misconception 4: Women with lower back tattoos can’t get an epidural.

There is no evidence that lower back tattoos cause harm in this situation. Initiating an epidural through the ink of a lower back tattoo will not cause ink to enter the blood stream or the spinal canal, or cause further complications for the mother or baby.

Misconception 5: Having an epidural is extremely painful.

For most patients, the only painful part of the epidural procedure is the numbing of the lower back before the epidural is placed, which does cause a momentary stinging or burning sensation. The insertion of the epidural itself is usually felt as just pressure. In the hours and days following delivery, some women experience discomfort in the lower back where the needle was placed, but this is rarely a significant problem.

Misconception 6: Epidurals can cause permanent medical problems for the mother and/or the newborn.

Serious complications from an epidural procedure are extremely rare. The biggest risk that faces most patients is that the epidural will not work as effectively as desired. The anesthesiologists can administer more medication or make other adjustments in such cases.

Misconception 7Epidurals depress babies so they can’t breast-feed.

Some women worry that the medication they receive via the epidural may somehow reach their baby and make him or her less able to breast-feed. While learning to breast-feed is not always easy, most delivery centers have “lactation specialists” to help new mothers and infants master the skill. Epidural analgesia actually exposes the baby to less medication than many other methods of pain relief.

Misconception 8The window for receiving an epidural can close.

Some women worry that the medication they receive via the epidural may somehow reach their baby and make him or her less able to breast-feed. While learning to breast-feed is not always easy, most delivery centers have “lactation specialists” to help new mothers and infants master the skill. Epidural analgesia actually exposes the baby to less medication than many other methods of pain relief.

Misconception 9Epidurals are guaranteed to provide optimal relief.

Like all medical procedures, with epidural analgesia, each individual responds differently to medication and sometimes not enough medication is delivered to the right spot. These instances are rare and even when they do occur, an anesthesiologist can make adjustments.

What about headache and backache after an epidural?

The following paragraph from a recent review in the New England Journal of Medicine provides a good summary of the issue:

“Headache may occur after dural puncture, usually when the dura has been unintentionally punctured with the typical 17- or 18-gauge epidural needle, which is known as a wet tap. The incidence of wet tap is about 1%, with subsequent headache developing in about 70% of cases. Approximately half these cases of headache require an epidural blood patch, in which sterile injection is used to introduce 15 to 25 ml of the patient’s blood into the epidural space; treatment is successful in 65 to 90% of cases. Although patients are often concerned about back pain after epidural analgesia, the incidence of long-term back pain is not increased after the administration of epidural anesthesia as compared with the use of parenteral opioids or of no analgesia during labor.” (Joy L. Hawkins, M.D., N Engl J Med 2010; 362:1503-1510)

Can Someone Stay with Me During the Epidural Placement?

Yes. One person may stay with you during the placement of the labor epidural. However, they must wear a hat and mask to help limit the chance of an infection. Epidurals or spinals for Cesarean section that are performed in the operating room are performed with the patient alone with the nurse and the anesthesiologist.  Space in the operating room is limited.  The patient’s significant other will be allowed in the operating room just prior to when the obstetrician make the surgical incision.

Will I have to wait for the epidural?

The anesthesiologist attempts to perform the procedure as soon as he/she is notified of the patient’s request. Sometimes there may be a wait for pending lab results. Rarely, there may be a short delay because the anesthesiologist is involved in another patient’s care.

Can I talk to an anesthesiologist?

Of course. Your obstetrician’s office can help you schedule an appointment with the Pre-Admission testing center.

Who should talk to an anesthesiologist?

Any patient with specific questions or concerns may talk with an anesthesiologist. Those with a history of back surgery with hardware or fusion should consider talking to an anesthesiologist. Patients with a history of any anesthesia complications should talk to the anesthesiologist. Patients on blood thinners, bleeding disorders, a history of heart problems or complex medical conditions should also consider talking with an anesthesiologist.