Anesthesia for Labor

Several types of anesthesia are available for laboring patients as well as those scheduled for cesarean section. A brief explanation of these is provided below.

Intravenous analgesics: These are medications such as Nubain or Demerol which are given through the i.v. They have no numbing effect and are strictly painkillers which are typically used in the early stages of labor or until the obstetrician feels that it is appropriate to have another method of anesthesia. These medications are ordered by the obstetrician.

Labor Epidural: The labor epidural is the most common type of analgesia used for the laboring patient. It involves placing a small, flexible catheter in the patient's lower back and infusing a dilute solution of local anesthetic (such as xylocaine or bupivicaine) and narcotic to numb the lower half of the body and provide relief from pain felt during contractions. Most of the obstetricians on staff at TMC will require that their patients have a consistent labor pattern and a cervix dilated from 3 to 5 centimeters before requesting anesthesia consultation for a labor epidural. The epidural remains in place throughout labor and the amount of medication can be adjusted as needed to provide adequate relief from pain.

The safety of epidurals is well documented in both healthy and more critically ill patients. There have been no studies showing any ill effects on newborns in mothers who have delivered with an epidural. Of complications that do occur, the most frequent results from an accidental puncture of the membrane that contains the spinal fluid. This often results in a headache (spinal headache) which requires additional treatment before the patient is discharged. The spinal headache rate at TMC is approximately .5% which is well below published rates of 1 to 4%. The incidence of serious problems such as permanent nerve damage ranges from 1 in 40,000 to as low as 1 in 200,000 in published studies. To our knowledge there have been no documented cases of permanent nerve damage at TMC that were attributed to epidural placement.

Combined Spinal/Epidural: The combined spinal/ epidural consists of placement of a labor epidural with the addition of spinal narcotics to speed the onset of pain relief. The advantage is an almost immediate relief of pain from the contractions. There are however some drawbacks which have kept us from using this technique very often. First, the incidence of spinal headache may be higher due to the spinal. Second, everyone that receives the spinal narcotics will experience some side effects such as nausea or itching.Third, the speed of onset of a standard epidural (approximately 10 minutes) is felt to be adequate without any additional risks.