Q&A: Pain Management During Childbirth




Q&A: Pain Management During Childbirth

Do I need to decide about pain management treatment well in advance of labor?

No, but being well informed of your options for pain management prior to delivery may help ease your anxiety in the moment. However, you can’t count on everything to go as planned.

Expectant mothers should remain flexible and keep their options open in the weeks before labor. Some women plan to have pain management treatment, but then decide they don’t need it when in labor. Other women may plan not to have any treatment, but then change their mind once in labor. The key is to get all the relevant facts ahead of time.

Pregnant women should talk to their obstetricians about their options. If they want more information, they should speak with an anesthesiologist who practices where they intend to deliver. Lastly, women should not feel pressured to either accept or refuse pain management treatment during labor. It is an individual choice that should be made in consultation with a doctor and with all the available information at hand.

Is there any way to know in advance how painful labor will be for a particular person?

Unfortunately, there is not. Pain during labor is different for every woman and depends on a variety of factors. Some women need little or no pain relief medication, while others find that pain relief medication gives them better control over their labor and delivery. It is important that every woman be as informed as possible about the process and options for delivery before being admitted to a hospital in labor.

If I have a high tolerance for pain in everyday life, does this mean I’ll be more tolerant of labor pain?

Again, labor pain is different for every woman and different labors often are experienced differently by the same woman. So, no, there is no way to predict what you might experience based on prior processes.

What pain management options do I have for my labor?

There are several pain management options available in most birthing facilities, and each has advantages and disadvantages. Some, such as receiving medications through an intravenous catheter, can be administered by a labor nurse. Others, such as the basic types of anesthesia used during the labor and delivery process, require a professional trained in administering anesthesia and monitoring the effects of the medication. These include epidurals, spinal blocks, a combination of both the epidural and spinal block, and, if needed, general anesthesia. Each has its benefits, and women should work closely with their anesthesiologist to determine the most appropriate pain management for them.

What is the difference between a spinal and an epidural, and when is each used?

Spinal anesthesia and epidural anesthesia are both types of regional anesthesia which relieve pain or numb only a specific part of the body. Both spinals and epidurals are performed by placing a needle in the lower part of the woman’s back. With a spinal anesthetic, a single injection of medication is performed, and the needle is removed immediately and completely.

With an epidural anesthetic, a catheter (a thin plastic tube) is inserted through the needle to the epidural space which is near the vertebral column. The needle is then removed, leaving the catheter in place.

A spinal anesthetic is usually used for fairly short procedures of a known duration, such as a planned or scheduled cesarean section. The injected medication makes a woman comfortable or numb for a specific period of time, long enough to perform the procedure, and then the medication wears off. It is similar to getting an injection of “novocaine” at the dentist to have a tooth fixed – the single injection makes your mouth numb long enough for the dentist to do his work, then it wears off.

An epidural is most often used to provide the same effect, eliminating pain or causing numbness, but we don’t know how long we will need the effect for…like for a woman in labor. Some labors proceed very quickly, and some last several hours. We want to make women comfortable in both situations. Since we cannot predict, the epidural catheter allows us to administer the medication, usually continuously, and the pain relief can last as long as it is needed, for the entire labor. Spinal injections usually work faster than epidural injections; for this reason, they are often combined for labor pain relief as a “combined spinal-epidural anesthetic” or CSE. The spinal injection works very rapidly, and placing the epidural catheter allows pain control for as long as necessary. Modern techniques allow anesthesiologists to provide CSE with only one needle stick.

Does it hurt when an epidural or spinal is administered?

The anesthesiologist will numb the area where the epidural or spinal is administered, so there is very little pain associated with it. Instead, most patients will feel some pressure. That can be uncomfortable for some, but most find the relief it provides far outweighs any discomfort.

Once an epidural is administered, how long does it take to work?

Depending on the technique and the medications used, pain relief begins within 1 to 15 minutes.

Will I still feel contractions with an epidural or a spinal? Will I still be able to push?

The goal of modern anesthesia practice is to relieve only the pain of the contraction, while still allowing you to be aware of them and still push effectively. If you should require some additional support, your labor nurse can coach you.

Will an epidural or spinal make me feel groggy or tired during labor?

No. Avoiding these side effects is what led to the development of spinal and epidural techniques to relieve labor pain.

Can I walk or go to the bathroom with an epidural or spinal in place?

No, most delivery units do not want you to walk after receiving your epidural because of safety concerns.

How soon after delivery can the epidural or spinal be removed?

With a spinal anesthetic, there is nothing to be removed – it is a single injection of medication. Epidural catheters are usually removed shortly after delivery.

Is pain management treatment for labor safe?

Modern techniques were developed with safety as the major goal. Impact on the mother, the baby or the labor and delivery process is rare. The decision whether to use pain management treatments is largely a question of the comfort of the mother.

Furthermore, contrary to myths frequently cited on the Internet, there is no credible evidence to show that epidurals (or other pain management procedures) slow labor, cause cesarean sections or lead to a higher incidence of depressed babies. The biggest risk for most patients is that the epidural will not work as effectively as desired. In such cases, the anesthesiologist can make adjustments to provide the patient with adequate pain relief.

Is proprofol used in combination with any other drugs to help manage pain during the labor and delivery or Caesarean processes?

Proprofol is never used in a normal labor. Occasionally, when a woman needs to have a general anesthetic for a Caesarean delivery, propofol can be used. However, most patients undergoing a Caesarean will be given regional anesthetic.

How common are spinal headaches?

Headaches can occur, but they are quite rare, with less than 1 percent of patients reporting headaches. If a headache does occur it can be treated.

Are babies born via C-section negatively impacted by the spinal anesthetics used to numb the mother’s lower body?

A spinal anesthetic only blocks the mother’s sensation, so it has no effect at all on the baby. 

Is it true that a woman getting an epidural or spinal anesthetic may be paralyzed if she moves while the anesthetic is being administered?

No. There is no risk of paralysis from modern anesthesia techniques, including an epidural or spinal anesthetic. 

What are the chances that a woman getting a spinal or epidural may have an allergic reaction to the drugs used?

Allergic reactions due to spinal or epidural treatment are extremely rare.

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