Anesthesia Options for Labor and Delivery

• “Will I Remember Everything?”
• “Will It Affect My Baby?”
• “Will I be Able to Breastfeed?”

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 to discuss your options with your physician or Certified Nurse Midwife (CNM) and your anesthesia professional. The purpose of anesthesia 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 breastfeed 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.
 
This brochure, 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 brochure you may also want to meet with your physician or CNM and an anesthesia professional such as 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.

• Those who are certain they will want pain relief.
• Those who are unsure of their pain relief options and how they will affect their labor and delivery.
• Those who would prefer to give birth without any pain relief.

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.
 

There are several different forms of anesthesia administered for childbirth. They may be used independently or in conjunction with one another.

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, a pudendal block numbs your vaginal area in preparation for delivery.
 
Epidural—An epidural is a method for delivering pain relief drugs or local anesthetics 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, your anesthesia professional will start the epidural when cervical dilation is four to five centimeters. Under certain circumstances, it may be desirable to place the epidural earlier.
 
Spinal (intrathecal)—This method is similar to an epidural, but because the drugs are administered with a needle into the spinal canal, the 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 use of forceps is indicated. Epidurals or spinals cannot be used if time is of the essence or the patient:

• Uses blood thinners or has a bleeding tendency.
• Is hemorrhaging or in shock.
• Has an infection in the back or the blood.
• Has an unusual anatomic condition or spinal abnormality.

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.

In order to determine which type of anesthesia is best for you and your baby, it is important that you inform your anesthesia professional about:

• Food and drink intake for the last several hours.
• History of difficulty breathing after anesthesia.
• History of lower back problems.
• Family history of high fevers.
• Any respiratory problems such as asthma, bronchitis, pneumonia, or if you have a cold, sore throat or flu.
• Special medical concerns such as cardiac disease, diabetes, asthma, and other medical conditions.

If you are a woman with one of these conditions, it is especially important that you meet with an anesthesia professional prior to going into labor.

The ideal anesthetic should:

• Provide enough pain relief to allow you to deliver your baby with minimal pain and anxiety, leaving you free to fully participate in the experience.
• Allow you to push when it is time to do so.

The ideal anesthetic will not:

• Stop contractions.
• Make your baby sleepy.