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ANALGESIA AND ANESTHESIA DURING PREGNANCY
Some time prior to delivery, every pregnant patient is faced with the decision of whether or not she will use some form of pain relief during labor and delivery. Some women are very certain that they will want pain relief, while others are unsure of whether or not they desire pain relief during labor and delivery. There are also those who prefer to give birth without any form of pain relief. For those women who do not desire any form of analgesia during labor, it is important for each woman to understand her options. During an emergency, some form of analgesia or anesthesia may be necessary.
Under ideal circumstances, an anesthetic agent would allow you to deliver your baby with minimal pain, have minimal risk, and would allow you to push when it is time to do so. The ideal anesthetic would also not stop your contractions or make your baby or you sleepy. There are a variety of types of anesthesia that can be used during labor and delivery.
- Local anesthesia: Local anesthesia requires a series of injections in the vaginal outlet. It is generally used for women who need an episiotomy or who require the placement of sutures after delivery.
- Intravenous Sedation: Sedatives are administered as an injection or intravenously and can help reduce the pain of labor but will not eliminate the pain entirely.
- Pudendal block: The pudendal nerve is one of the primary nerves that provide sensation to the vaginal outlet. Pudendal block is administered using an injection of local anesthesia through the vagina and into the pudendal nerve. It is given just prior to delivery and may be supplemented with local anesthesia.
- Epidural: An epidural is an anesthetic delivered through a tiny catheter placed in the lower part of the back in the epidural space. The woman will continue to feel touch and pressure, but the pains of labor are significantly reduced.
- Spinal: The spinal is similar to the epidural but the anesthetic is actually placed within the spinal fluid. Spinal anesthetics are sometimes used at the time of delivery (Saddle block) or at the time of cesarean section. Like an epidural, a spinal cannot be used it you are using blood thinners, have an infection in the back or the blood, or have an unusual spinal abnormality.
- General anesthesia: General anesthesia is administered by giving an anesthetic drug intravenously and through breathing an anesthetic gas. A general anesthesic may be needed for an emergency or if a cesarean section is required and the patient cannot have an epidural or spinal. Because it carries additional risks, it is not the first choice of pain relief during labor or delivery.
Thomas G. Stovall, M.D.
Dr. Stovall is a Clinical Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis, Tennessee and Partner of Women's Health Specialists, Inc.
Date Published: 2000-09-20
7800 Wolf Trail Cove, Germantown, TN 38138
Phone: (901) 682-9222; Fax: (901) 682-9505