Childbirth and Labor Pain Relief (Obstetrical Anesthesia)
Your anesthesiologist and obstetrician will work closely to provide comfort and safety for you and your baby throughout the birthing process. Most frequently, this involves epidural or spinal anesthesia. Intravenous medications for pain relief are also available from your obstetrician.
Frequently Asked Questions About Childbirth and Labor Pain Relief
In general, the medications given by an anesthesiologist are safe and do not affect the baby. Spinals and epidurals can cause the mother's blood pressure to decrease in the first few minutes after they are placed, and your vital signs will be followed more frequently during this period. An anesthesiologist and your nurse will closely monitor you and the baby during the anesthetic period.
Epidural anesthesia or "epidural" refers to the method in which an anesthesiologist inserts a catheter into the space next to the spinal cord, also known as the epidural space. Medication is then given that will slowly infiltrate to the nerves and that can relieve pain. For more information on epidural anesthesia, please see our regional anesthesia page.
Spinal anesthesia or "spinal" refers to the method in which numbing medication is injected directly into the spinal fluid. The anesthesia effect tends to be more intense and the pain relief more pronounced than epidural anesthesia. For more information on spinal anesthesia please see our regional anesthesia page.
Common side effects and complications of epidural and spinal anesthesia include a persistent headache ("spinal" headache), incomplete anesthesia, low blood pressure, shivering, and nausea. Persistent back pain is not considered a side effect of epidural or spinal anesthesia.
This decision will most often be made based upon the clinical situation and a discussion between the patient, surgeon, and anesthesiologist. Most often, however, for labor, an epidural is placed, and for a cesarean section, a spinal is placed.
If you are in active labor, you may request an anesthesiologist to place an epidural.
In general, it is never too early or too late to request an epidural, and an anesthesiologist is specifically available 24 hours a day, seven days a week in the hospital to provide this service on the OB-GYN floor.
The anesthesiologist will make every effort to ensure your comfort during the placement of an epidural or spinal. This involves alerting the patient to each step of the process, use of local anesthetic (to numb the skin), and reassurance and support from the labor room nurse. Of course, each patient's perception and pain threshold is different, but in general epidural/spinal placement is not painful.
It usually takes 10 to 15 minutes before the full effect of the epidural is seen. For women who receive the epidural in the active stage of labor, analgesia can take up to 20 minutes.
Most patients experience numbness or tingling after the initial dose of medication. This gradually gives way to less numbness, but the pain relief effect continues. Keep in mind that every patient is different, and experiences differ, but the goal of epidural analgesia is pain relief, not total numbness. The reason for this is that significant numbness often leads to decreased ability to push.
Yes. Epidural catheters are connected to a continuous infusion of medication that is stopped only after the baby is delivered. Except in rare circumstances, spinal anesthetics greatly exceed the time required for a cesarean section.
The anesthesia team will assess the patient's response to the initial dose of medication. If the relief is not satisfactory, the epidural is reassessed. Options include administering additional medication, adjusting the catheter, or replacing the catheter.
Most patients experience numbness after the initial dose of medication. This gradually gives way to less numbness, but the pain relief effect continues. Patients are often aware of their contractions, but they should not be painful. As labor progresses, especially close to delivery, the mother often experiences more intense pressure. This pressure is difficult to alleviate, and attempts to do so can lead to ineffective pushing, which can delay delivery.
A bolus is the administration of additional medication(s) through an epidural to alleviate pain.
PCEA stands for patient-controlled epidural anesthesia. In short, it is an additional method that allows the patient to administer her own "extra" dose of medication when the pain intensifies.
These materials have hand selected and reviewed by Vituity physicians.
- Childbirth and Anesthesia Handout [PDF download] from the American Society of Anesthesiologists
- FAQs: Medications For Pain Relief During Labor And Delivery from the American College of Obstetricians and Gynecologists
- Pain Management During Childbirth video from UCSF Labor Education