Anesthesia is blockage of all feeling, including pain. General anesthesia causes you to lose consciousness. Regional anesthesia removes all feeling of pain from specific parts of the body while you remain conscious.
Local anesthesia provides numbness or loss of sensation to a limited area such as when an episiotomy is performed to widen the vaginal opening. It does not lessen the pain of contractions. Local anesthesia rarely affects the baby and has no side effects once the numbness wears off.
Epidural Anesthesia, commonly called an epidural block, causes some loss of feeling in the lower part of your body. The decision to receive an epidural is between you, your obstetrician, nurse, and anesthesiologist. Your doctors will work with you to determine the right time as your labor progresses. If you decide you wish an epidural, do make this known well in advance before you are in severe pain. It is impractical to request an epidural when you start “pushing”. In certain situations and medical conditions, an epidural may not be an option.
Epidurals are usually very effective, but like any other procedure, there is a chance that yours may not work satisfactorily. By using stronger medications, an epidural block can be used for a cesarean delivery or if vaginal birth requires the help of forceps or vacuum extraction. An epidural block is given in the lower back into a small area called the epidural space. It contains nerve fibers, some of which carry pain sensations to the brain. You will be asked to sit or lie very still with your back curved outward and to stay in this position until the procedure is completed. You can move when it’s done but you will not be able to walk around.
The Procedure
The anesthesiologist will feel landmarks in the lower back and will cleanse the skin with an antiseptic solution. The local anesthetic used to numb the skin may sting for a few seconds.
You may feel some pressure as the hollow epidural needle is inserted through the numbed skin. A small tube (catheter) is inserted through it and the needle removed. In some cases, the catheter may cause brief tingling sensation down a leg as it slides past a nerve.
You should inform the anesthesiologist if this persists or if there is pain. The catheter is securely taped to your back and then connected to an “epidural pump.” There may be mild discomfort in the back with the first dose of medication, but there should not be any persistent pain in the back or pain down the leg.
Pain Relief
Pain relief usually begins within 10-20 minutes after the medication has been injected through the epidural catheter. Although an epidural will make you more comfortable, you may still be aware of your contractions. You may notice temporary numbness, heaviness or weakness in your legs. Your anesthesiologist can adjust the degree of numbness for your comfort and to assist in labor and delivery. These sensations will subside during the first few hours after delivery.
Side Effects and Risks of an Epidural
Most women have epidurals with no problems. However, just as there are risks associated with any medical procedure and pregnancy, anesthesia for pain relief during labor and delivery involves some risk to mother and baby. The following information will help you make an informed decision.
A drop in your blood pressure can occur. This may slow your baby’s heartbeat. Your baby’s heart rate will be monitored closely. To decrease this risk, you will first be given fluids through an intravenous line, instructed to lie on your left side, medications administered as needed, and some oxygen by mask may be given to you.
Shivering may be associated with an epidural, although this can occur without one. Warm blankets will help.
After delivery your back may be sore for a few days.
Some women (1-2 in 100) may experience a “spinal” headache after an epidural. You can reduce the risk of this happening by holding very still during insertion of the epidural needle. If a headache does occur, it usually subsides within a few days. If the headache does not stop or if it becomes severe, an epidural blood patch may be needed to help the headache to go away. The blood patch involves taking blood from the arm and injecting this into the epidural space with quick relief in many cases.
Mild itching is a side effect of narcotic medications and is easily treated.
When an epidural is given late in labor or a lot of anesthetic is used, it may be hard to bear down and push your baby through the birth canal. Adjusting the dose can help with this.
A small percent of women will develop a fever during labor, especially women having their first baby, long labor, and with epidural anesthesia. The reason is unknown, but very unlikely reflects true infection in mother or baby. In some cases, the pediatrician may do some tests on the baby to rule out any possibility of infection.
The present consensus of opinion is that epidural analgesia does not increase the risk of cesarean delivery, and that the effects on the newborn baby are small.
Serious complications are very rare. If the anesthetic medication enters a vein in the epidural space you may experience dizziness, rapid heartbeat, a funny taste and numbness around the mouth. If the medication enters the spinal fluid, it can affect your chest muscles and make breathing difficult. As with any needle placement, rare significant risks include infection or bleeding in the epidural space or nerve injury. You must notify your doctor if you have increasing back pain or persistent numbness and heaviness in the legs
Not all potential complications are addressed here. Many precautions, monitoring, and resuscitative equipment are in place to minimize these risks and possible complications and to ensure your safety and that of your baby.
Spinal Block, like an epidural, is an injection in the lower back. Once the drug is injected, pain relief occurs right away. A spinal usually is given only once during labor, so it is best suited for a time close to delivery. A spinal block can be used for a cesarean delivery or a vaginal birth where forceps or vacuum extraction is indicated. Spinal blocks can cause the same side effects as an epidural block and are treated in the same way.
General Anesthesia puts you to sleep (makes you lose consciousness) so you do not feel pain. General anesthesia is used when a regional block is not possible or is not the best choice for medical or other reasons. It can be started quickly and is often used for emergency cesarean delivery. Food or liquids in the woman’s stomach cause a major risk during general anesthesia. Labor usually causes undigested food to stay in the stomach.
During unconsciousness, this food can come back into the mouth and go into the lungs causing damage. To avoid this, you may be told not to eat or drink once labor has started. After you are asleep, your anesthesia provider will place a breathing tube into your mouth and windpipe for the duration of surgery, which is removed as you waken.
Whether you have general, spinal or epidural anesthesia for a cesarean birth will depend on your health and that of your baby and why the cesarean delivery is being done.
Anesthesia in Emergency C-Sections
In emergencies or when bleeding occurs, general anesthesia may be needed.
Anesthesia Options With Epidural Already in Place
If you already have an epidural catheter in place and then need a cesarean delivery, most of the time your anesthesiologist will be able to inject a much stronger drug into the same catheter to numb the entire abdomen for surgery.
Spinal Block
If you do not have an epidural in place, a spinal block is usually the first choice of anesthetic for a cesarean delivery. It is effective immediately. Although you should not feel pain, you may have sensations of “pulling, pushing and tugging” during the surgery.
For additional information or questions, talk to your doctor or call the Anesthesia Office at your hospital.