Labor Anesthesia 

When a woman is in pain during the birthing process, it is her right to request the form of pain management that is safe, affective, and desirable to her.

Pain Management Options

Homeopathic Methods

• This is a natural method of managing labor pain
• Your provider will recommend breathing techniques, walking, birthing balls, squatting, labor bar, shower, massage throughout your labor to help you deal with labor pain.
• If you choose this method of pain management, we highly recommend for you and your partner to attend a birthing / Lamaze class before birth.
• Some couples hire a professional labor coach.
• Most patient will use homeopathic pain management until they are ready for other forms of pain management
• Ask you CNM provider for details about homeopathic pain management during your pregnancy. This is usually not a decision made when you are in labor. It needs planning and training.

Intravenous Pain Medication (IV Sedation)

• A single or a combination of mild narcotics / anxiety medication is given through your IV.

Advantages:

• It is very effective during the early part of labor and moderately effective during the active part of labor.
• Works well with Homeopathic Methods

Disadvantages:

• These medications can sometimes make interpretation of the baby’s heart rate and condition difficult (i.e. not only is mom asleep, the baby is also asleep).
• The patient can sometimes be too drowsy to appreciate / enjoy the laboring process.
• This is usually not given when you are close to delivery. The medication may cause the baby to have difficulty responding to the demands of birth.
• May need to supplement with local numbing medicine.

Pain Pills / Oral Pain Medication

During the early part of labor, this might be acceptable way of controlling your pain if you are not ready for IV or Regional anesthesia.

Regional Anesthesia

Pain medications are given through the various layers of the covering of the spine (Dura).

Myths about Regional Anesthesia

I am going to be paralyzed forever!

This is not true! You are only paralyzed (that is a desired affect) for the duration that you need pain control. After the medication wears off, your mobility is back in 2-6 hours.

My friend had an epidural last year. Now she has permanent back pain!

This is also not true! There are numerous studies that show those patient without a history of ever receiving regional anesthesia and patient with a history of regional anesthesia have the same rate of chronic back pain. In modern obstetrics, more than 80% of patients will get regional anesthesia for labor pain management.

An epidural will slow down my labor

This is also not true! In the past, we believed that epidural slowed down the laboring process and makes women have unnecessary C-sections. Therefore, epidurals were given if the woman is dilated to 4 centimeters or more. This has been refuted by recent studies. You may request an epidural whenever you want.

The American College of OB/GYN and American Society of Anesthesiologist jointly endorse the practice of offering to patients pain management whenever it is desirable for the patient:

“Labor causes severe pain for many women. There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. The fear of unnecessary cesarean delivery should not influence the method of pain relief that women can choose during labor.” 
ACOG Committee Opinion #339, 2006

When you are admitted to labor, your Provider and anesthesia Provider will talk to you in more detail regarding the various options that are available to you. They can also make recommendations that are individualized to your needs / medical issues.

There are two common types for OB/GYN:

Epidural

• The skin over the lumbar (lower back) part of the spine is numbed.
• A very small catheter is placed above the covering of the spine.
• Various types of pain medications are continuously infuse to create long lasting pain control during labor.
• The infusion is usually turned down or off during / before pushing.
• A longer acting morphine is administered for 12-24 hour pain management for C-sections. This does not interfere with walking
• Patient can move their legs and will be strong enough to walk 4-6 hours after the continuous infusion is stopped

Spinal

• Just like an epidural. Instead of a catheter with continuous infusion, a fixed amount of medication is used to provide numbing affect that lasts for about 1-4 hours later.
• Candidates for Spinal are those needing pain management only for a short period of time:
  • C-sections
  • Advance Cervical Dilation (greater than 7 centimeters)
  • External Cephalic Versions
  • Postpartum Tubal Ligation
• A longer acting morphine is administered for 12-24 hour pain management for C-sections.
• This does not interfere with walking.
• Patient can move their legs and will be strong enough to walk 4-6 hours.

Local Analgesia

These are usually injected in the Perineum during the pushing process when the baby is crowing; repair of the genital tract after delivery, injected into the wound after a C-section or any abdominal wound for gynecologic surgeries.

A mixture of some type of immediate acting and longer acting "caines" are used to numb a localized area so you will be more comfortable.

General Anesthesia

• This is to put the patient completely to sleep.
• The patient is paralyzed and sedated through medications that are given through the IV.
• A breathing tube is placed to help the patient breath.
• Various types of gases are administered through the breathing tube to keep you asleep and comfortable throughout the procedure.
• This is rarely used in obstetrics. This is only used when there is no time for Regional Anesthesia or when regional anesthesia is not effective.