Analgesia and Anesthesia in Labor and Delivery

After many months of waiting for the delivery of your new baby, most
women are anxious about the pain they expect to have during
childbirth. There are a number of techniques and medications that
may help you through the birth process.

The best thing a woman can do during pregnancy is to learn as much

as she can about labor and birth. You and your partner can attend
childbirth classes, which teach you about childbirth and how to
become an active participant in the process. You will learn coping
strategies including, breathing and relaxation techniques, position
changes, ambulation and water therapy which will help to overcome
some of the tension and fear you will feel during labor.

The following methods of pain relief are available to help you through
the birth of your baby. Our goals are to help you have a positive
experience and to ensure the health and safety of you and your
newborn. We encourage you to ask questions of your doctor, nurse
midwife or nurse if you have concerns about pain relief.

Narcotics
There are certain types of narcotics which can be given to help
reduce pain and anxiety. Nubain and Demerol, which are commonly
used, can be given as a shot or through an IV. These drugs can
cross the placenta to the baby and may depress breathing after birth
for a short while. You and your baby will be carefully watched during
the labor and delivery to decrease the chance of this happening and
the baby can be given a medication to reverse the effects of the
narcotics if this occurs.

Epidural Anesthesia
One type of anesthesia often used during labor is called an epidural.
With epidural anesthesia you will be awake and can watch the birth
of your baby. You can interact right away with your newborn. An
epidural involves medication being injected just outside the spinal
canal into the epidural space through a catheter which remains in
place until after the delivery. It causes numbness from the waist
down and contractions will be less painful.
In order to insert the epidural catheter, an area of the back is
numbed. Medication can be given through the epidural catheter
during labor and delivery as needed. An IV is started and the mother
and baby are monitored continuously. The epidural is put in when the
mother is in active labor and can be used for a vaginal or cesarean
birth. There are minimal side effects to the baby with this type of pain
relief. In some cases an epidural infusion may cause the mother's
blood pressure to drop, and this can be reversed with IV fluids and
medications. There are a few cases when the epidural cannot be
used.

Local
A local, or numbing medicine may be used right before your baby is
born if an episiotomy is needed. The medicine is injected into the
area where the episiotomy is performed and lasts through the birth of
your baby and the repair of the episiotomy.

Pudendal Block
A pudendal block is a type of pain relief that is frequently used just
before delivery. A numbing medicine is injected through the vaginal
walls to decrease the pain during the birth of your baby. It numbs
more area than the local. You will still be able to feel your
contractions and this anesthesia does not affect your baby.

Spinal Anesthesia
A spinal is like an epidural in many ways. After a numbing medicine
is put in the mother's back, an anesthetic medicine is injected. The
tube is not left in place as in an epidural. The spinal lasts for a limited
time and because of this, it is usually done shortly before a vaginal,
forceps delivery, or a cesarean birth. This type of anesthesia may
also, in rare cases, cause the mother's blood pressure to drop, which
can be reversed with IV fluids and medication.

General Anesthesia
In some cases, it may be better for the mother to be asleep during
the birth and a general anesthesia is used. These include an
emergency cesarean, a planned cesarean or a difficult vaginal birth.
The delivery must occur quickly because these types of anesthetics
can cross the placenta to the baby and may depress breathing in the
baby for a short while.