Options for Obstetrical Anesthesia
Labor pains are the result of spinal nerves sending messages from the uterus, cervix, and pelvic floor muscles. The physiological changes during labor can be exhausting, and many women experience symptoms for hours. While mental preparation and emotional support from loved ones can make the pain more manageable, many women also request analgesics during delivery. Due to the potential risks of general anesthesia, it is rarely used during labor. Instead, localized anesthetics are used to reduce sensation while allowing the woman to remain alert and responsive.
Epidurals are a form of injectable anesthesia that is targeted to the lower spine. The anesthesia blocks out pain signals from nerves in the lower vertebra, which reduces sensation in the lower half of the body. Epidurals are administered in three ways. Typical epidurals deliver anesthesia through a catheter injected near the spinal cord. The catheter remains in place to provide the patient with additional anesthesia if needed. Epidurals may also be administered through a spinal injection or a combination of both, known as a walking epidural. Combination epidurals are less intense and enable the woman to move her lower body without assistance. However, neither of these options will enable a woman to walk directly after delivery.
Women who are undergoing types of cesarean delivery will require analgesics that are stronger than standard epidurals. During a cesarean, or C-section, the baby is delivered through an incision. Women who anticipate undergoing a C-section prior to going into labor are usually treated with spinal or epidural blocks. However, C-sections may also be elected due to emergency situations, such as stalled labor or an immediate issue that can threaten the baby or woman’s life. Depending on the circumstances, women who deliver by emergency C-section may be administered general anesthesia. In this case, doctors have determined that the risk to the mother or baby far outweighs any potential complications. Electing general anesthesia during delivery is still rare, even in emergency situations.
All types of epidurals are safe and commonly used. Receiving the injection causes minimal pain, and there are few long-term consequences. Unlike other types of analgesics, epidurals do not affect the infant in any way. There are potential side effects that women should consider when selecting their anesthesia method for delivery. Firstly, epidurals restrict movement and bodily control significantly. Most patients will need to wear a catheter to collect urine for a few hours after delivery. Rarely, epidurals can cause hypotension (a severe drop in blood pressure). Some women may also experience migraine-like symptoms that appear within a week of the procedure. This condition often clears up on its own and is treated at home with bed rest and hydration.
Some conditions preclude women from receiving epidurals. Women with pre-existing spinal conditions or infections cannot receive injections. Abnormal blood results or low blood pressure readings can also remove the possibility of epidurals. In rare cases, women may not be able to receive epidurals due to logistical issues, such as the lack of a trained anesthesiologist on site. Doctors can recommend other pain relief measures, including massage or nerve stimulation.
