Obstetrics

Obstetrics

There are many situations during your pregnancy, during your labor, and in the immediate post-partum period where you may require an anesthesiologist.  Here are some frequently asked questions about obstetrical anesthesia.

 

FAQ's

What should I expect during labor with regards to discomfort or pain?

Many women experience some level of discomfort or pain during labor. The amount of discomfort varies from patient to patient, as well as from one birth experience to another due to factors such as the size and position of each baby. Your birthing experience is unique as are your requirements for pain management.

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What is the difference between analgesia and anesthesia?

Analgesia is pain relief without loss of consciousness and without total loss of feeling or movement; anesthesia is defined as the loss of physical sensation with or without loss of consciousness.

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What are my options for pain management?

Keeping in mind the uniqueness of each woman’s childbirth experience, the following options are available at both Evergreen Hospital Medical Center and Overlake Hospital Medical Center.

Natural Childbirth – some women use breathing and relaxation techniques to help them manage their labor discomfort. These techniques are taught in childbirth classes that are offered at both Evergreen and Overlake Hospitals. Lamaze techniques aim to increase a woman’s confidence in her ability to give birth by teaching different strategies such as breathing patterns, positioning, massage, relaxation and hydrotherapy that help a patient with her labor. For information about these classes please visit www.evergreenhospital.org, and www.overlakehospital.org.

Systemic Analgesics – pain medications administered either through the vein (intravenous, or “IV”) or in the muscle (intramuscular, or “IM”) are referred to as systemic analgesics, because they act on the entire nervous system. These medications provide pain relief without loss of sensation or consciousness and afford adequate levels of comfort for some patients. Potential side effects include nausea or drowsiness, and if given immediately before delivery, could potentially make your baby sleepy at birth.

Regional Nerve Blocks – regional blocks are commonly used for pain management during labor. They include epidural, spinal and combined spinal-epidural nerve blocks. All of these techniques provide analgesia with minimal side effects.

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Who can have an epidural or spinal?

Most women who desire an epidural or a spinal will be able to receive one. However, there are certain clinical conditions and situations where an epidural or spinal is contraindicated. In these rare instances, your doctors will discuss your available options for pain management and anesthesia.

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What is the difference between an epidural and spinal block?

Both epidural and spinal nerve blocks involve the placement of a needle into your lower back. For epidurals, a small plastic tube (catheter) is threaded through the needle before the needle is withdrawn. Medications (local anesthetics and/or narcotics) are then injected via the spinal needle or epidural catheter.

Epidural analgesia or anesthesia involves the injection of medication into the “epidural space.” Because the medication needs to cross the membrane (dura mater) surrounding the spinal cord before reaching the targeted nerves, it usually takes approximately 10-15 minutes for pain relief to occur. The placement of a catheter during insertion makes possible the continuous infusion of pain medications for the duration of your labor and for the addition of stronger medications if necessary.

Spinal analgesia or anesthesia involves the injection of medication into the fluid (cerebrospinal fluid, or CSF) that bathes the spinal cord. Spinal needles are much thinner than epidural needles and spinal doses are smaller than epidural doses. However, the duration of pain relief is finite (about 1-2 hours) because there is no catheter and therefore, no continuous infusion.

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What should I expect when getting an epidural or spinal block?

Preparations for your epidural or spinal block include the placement of an intravenous catheter (IV), adequate IV hydration, appropriate laboratory studies, and the monitoring of your vital signs. Your labor nurse will help you to sit or lie on your side with your back curved outward to facilitate the placement of your block. You will need to remain still during this procedure. The anesthesiologist with then “prep” your back with an antibacterial agent, place a sterile drape over the planned insertion sight, and numb your skin with a tiny needle before inserting the spinal or epidural needle. 

Once the epidural or spinal medication is injected, you may experience a warm and/or “tingling” sensation (often described as “pins and needles”) in your lower body before the numbness and pain relief sets in.

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What are the risks of an epidural or spinal block?

While most mothers who receive an epidural or spinal do not experience any side effects or complications, the following are potential risks: lower back tenderness, post dural puncture headache, intravenous injection, infection, and neurologic injury.

Lower back soreness at the injection site is usually self-limiting.

A post dural puncture headache (aka, “spinal” headache) may occur if the membrane covering the spinal cord (dura mater) is pierced, resulting in the slow leakage of cerebral spinal fluid (CSF). This headache usually manifests around 48 hours post-procedure and may require an epidural injection procedure called an epidural blood patch if symptoms persist.

Because the epidural space contains small veins that are engorged from pregnancy, there are rare instances when the medication gets injected directly into a vein. This can result in dizziness, auras, or in the extreme cases, seizures and cardiac events.

Neurologic injury following epidural or spinal nerve blocks is rare and occurs no more frequently than other anesthetics including general anesthesia.

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What are my anesthetic options for a cesarean delivery (c-section)?

Your anesthetic options will depend on the indications for the cesarean birth. During emergency situations requiring the immediate delivery of your baby, general anesthesia may be necessary. 

For less urgent or elective, scheduled c-sections, spinal anesthesia blocks are often used. If you already have an epidural catheter that was previously placed for labor analgesia, stronger medications can be injected through the catheter to achieve surgical anesthesia.

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What is general anesthesia?

General anesthesia involves the loss of consciousness and is most often used for emergency cesarean deliveries because it can be started quickly. General anesthesia is also indicated in those instances when a spinal or epidural is not possible for medical or practical reasons.

To prevent the aspiration of food or liquids into the mother’s lungs, your anesthesiologist will place a breathing tube through your mouth into your windpipe once you are asleep during general anesthesia.

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