Labor & delivery
We know this is a very special time for you and your family and we are honored to be part of this amazing life event. USAP is a group of highly experienced anesthesiologists dedicated to providing an individualized plan of care for the safety of you and your baby.
We understand that every woman’s labor and level of pain is unique and many factors contribute to the level of pain relief you might require. Some women prefer natural comfort measures (breathing or relaxation techniques), others choose pain medication and many choose a combination of both. The physician-led anesthesia team will start with assessing your overall health and preferences to provide the best labor pain relief options for you.
Some of the common questions our patients ask are:
What are the types of anesthesia for pain relief during labor and delivery?
- Regional Anesthesia/Epidural Blocks – This technique tends to be the most common and effective method of pain relief during labor. Epidurals provide pain relief without total loss of feeling or muscle movement and you remain awake and alert. This requires placement of a soft catheter in your back to inject the numbing medication with onset in about 10-20 minutes. It provides a continuous infusion of medication for pain relief throughout your labor. Epidurals do not increase your chance of having a cesarean section (C-section)
- Spinal Block – This is another form of regional analgesia and entails a single injection in the lower back that provides relief almost instantly and lasts approximately 1-2 hours. Spinal blocks are often used for C-sections
- General Anesthesia – General anesthetics provide complete unconsciousness. You will not be awake or feel pain. This technique is used when regional anesthesia is not possible such as in the event of an emergency C-section or when a regional block is contraindicated for medical reasons
- Local Anesthesia – Local anesthesia provides numbness or loss of sensation in a small area where the medication is directly injected. This is used by the obstetrician for pain relief if stitches are needed after the birth of your baby
Who will place my epidural?
A physician-led team will provide 24-hour anesthesia care for you. We work together to ensure your pain relief needs are being met, monitored and optimized. Your obstetrician and labor nurse will be monitoring various things such as a consistent contraction pattern, changes in your cervix and the amount of discomfort you are experiencing. They will maintain close communication with the anesthesia team to coordinate the optimal time for placement of your epidural. Although the most common reason you will see us is for an epidural, we are always there should you need additional care from our team.
Will my epidural relieve all of my labor pain?
The goal of your anesthesia team is to facilitate comfort during a natural but typically painful process. The epidural will significantly reduce the amount of labor pain you will experience but allows for enough sensation to feel pressure and provides the ability to push during delivery. Your anesthesia team will be available to monitor how you are doing and optimize your pain control.
What are the side effects of an epidural?
Although rare, side effects such as decreased blood pressure or headaches can occur. The decrease in blood pressure may make you feel lightheaded. This is quickly addressed by increasing your IV fluids given through a small flexible tube (IV) in a vein in your arm.
Some women (less than 1 in a 100) may experience a headache after the epidural block. One way to help minimize this from occurring is by holding as still as possible during the epidural placement. If a headache does occur, it generally subsides in a few days. In the instance where it persists, a simple treatment can be provided to help the headache go away. Please let your healthcare team know if this occurs for you.
An even rarer complication can occur due to the veins in your epidural space that become swollen during pregnancy. This may increase the risk of anesthetic injected in the vein which can cause you to feel dizzy, increase your heart rate and a possible funny taste and/or numbness around your mouth. Should you feel these symptoms, please inform your healthcare team promptly for further assessment and treatment.
Will my epidural “wear off” before I am ready to deliver?
The epidural medicine is delivered through a flexible catheter that is placed in your back. This catheter is connected to a pump that allows for a continuous infusion of pain medication and even provides a button for you to push when additional pain relief is needed. There may be an occasion that you have pressed the button, but have already received the maximum dose. At your request, our anesthesia team may override the pump to give you an additional dose that is safe for you and your baby.
Will the medication in the epidural affect my baby?
Multiple studies have demonstrated that the combination of local anesthetic (bupivacaine) and narcotic (fentanyl) in the recommended doses are safe for both you and your baby. In fact, the main advantage of epidural anesthesia for labor is that it provides excellent pain relief with minimal exposure of medication to your baby because they are administered directly into your epidural space rather than in the bloodstream.
Can I get out of bed and walk after an epidural is placed?
No. Although you will be able to move your legs, the strength and control needed for stability is not optimal for safe ambulation. Should you need to use the bathroom, your nurse will place a catheter in your bladder that will continuously drain your urine into a bag.
After delivery of my baby, how long before the epidural wears off?
Generally, your sensation and strength will return after approximately an hour or two once the pump that delivers the medicine is turned off.
What happens if I need a C-section?
Your anesthesiologist will be with you at all times to provide comfort and care for you and your baby. An epidural can also be used safely for a cesarean. If there is an urgency to deliver the baby, a general anesthetic can be used safely and effectively. Whether you have general anesthesia or regional anesthesia for a cesarean birth will depend on the reason for the C-section and you and your baby’s health.
What will your anesthesiology team want to know?
In order for your team to determine the safest anesthesia choice for you and your baby, we may ask the following questions:
- What have you had to eat or drink in the last several hours?
- Have you ever had anesthesia before? If so, any issues that you remember?
- Do you have any history of lower back problems or have you had back surgery?
- Do you have any general health conditions such as asthma, heart problems or diabetes?
- Have you developed any medical conditions specifically associated with your pregnancy?
- What medications are you taking and do you have any allergies to medications?
- What if I have had back surgery?
This is important information that your anesthesia team will want to know. They will discuss this with you in more detail and provide the options available for the most effective and safe anesthesia choice for you.
Please Note: The information provided on this website does not take the place of consultation with one’s physician. The advice given does not establish a physician-patient relationship.