Many women dislike the idea of being drugged during labor--after all, you've waited 9 months for your delivery date, and you don't want to be in a total fog during these life-changing moments. However, you may also be afraid of the pain you may feel. The good news is that anesthesia has come a long way since the medical practices of the 1950s, when women were typically drugged into unconsciousness during labor and babies showed the effects of medication for many hours after birth. Now drugs can be administered locally and in smaller doses with little impact on the baby. While natural childbirth is often best for moms and their babies, anesthesia is a good choice if your pain--or your fear of it--impedes your labor from progressing because you're hyperventilating, exhausted, or suffering from other stress reactions.
Opioids. Opioids don't completely remove the pain, but they do dull it considerably. Unfortunately you may also feel very groggy as a result, and so could your baby. Short-acting opioids are usually given intravenously (IV) or intramuscularly (IM).
If you choose to have an epidural, the anesthesiologist will ask you to sit up or lie on your side. She will first clean off a spot on your back with an antiseptic solution, then inject a local anesthetic under the skin in your lower back. Then she'll insert a thin tube (catheter) through a larger needle between the bones of your spine and near the spinal cord. The needle is removed, leaving the tube in the epidural space to deliver a local anesthetic continuously or every couple of hours or so.
In the past, epidurals were so powerful that they usually rendered women numb in the legs and pelvic region, making it impossible to move around and difficult to push when it came time to deliver the baby. Anesthesiologists now use a diluted anesthetic, usually combined with a low dose of an opioid drug, to relieve pain while leaving you less numb. In some hospitals, you might even be allowed to walk. Most epidurals won't prevent you from pushing when your baby is ready to make his appearance.
Combined spinal epidural (CSE). This option is gaining popularity for labor. It is administered much like an epidural. After a clean space on your lower back is prepared, a needle delivers an opioid and local anesthesia into the spinal fluid for immediate relief; a catheter is then put in the epidural space to deliver opioids and local anesthetics continuously.
Prior to a cesarean delivery, general anesthesia may be used. With general anesthesia, the pregnant woman is temporarily put to sleep and has a tube in her windpipe to allow the delivery of oxygen. Most women want to be awake to hear their baby's first cry, so general anesthesia is usually reserved for emergencies.
Risks. There are risks with any procedure and with the use of opioids. When opioids are given intravenously, mom will feel sleepy, and most babies will too. The fetal heart rate pattern usually shows this by having fewer accelerations, but this resolves as the baby awakens. If the opioid is given close to delivery, some babies will be sluggish in their breathing and will need a boost.
The risks of epidural and CSE include spinal headache (severe headache after regional anesthesia that worsens upon standing up) for less than 1 percent of women. Many women will complain of low-back ache after delivery, but very few of those complaints are related to the epidural. Other women worry that a needle near their spinal cords will cause nerve damage. This is an extremely rare complication of regional anesthesia.
Originally published in You & Your Baby: Pregnancy.
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