What options do I have for pain relief during labor?

There are several options for pain relief during labor. 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.   Some women choose “natural childbirth” without additional intravenous pain medications or an epidural. Intravenous pain medications are available, but their use may be limited by your health history, or stage and time of labor.

Most women choose an epidural as their pain management of choice during labor. Epidurals have been proven safe and effective for labor pain relief. The Anesthesiologist will place your epidural. Then you will receive a continuous infusion of medication through your epidural until after delivery of your baby.

For a C-section, patients will need a regional anesthetic (like an epidural or spinal block) or a general anesthetic.

What is an epidural?

An epidural anesthetic is simply numbing medicine infused through a thin plastic tube in the epidural space, which is near the vertebral column. This numbing medicine is continually infused until after delivery of the baby. To place the epidural catheter correctly, your Anesthesiologist will place a needle in the lower portion of your back. Once the needle is correctly positioned, a small plastic catheter is inserted through the needle, and the needle is removed. Only the plastic tube remains for the duration of labor.

Typically, the numbing medicines you receive will diminish or remove your contraction pain. Pain relief usually begins between 1 and 15 minutes after the medicine is administered. The goal of the epidural is to relieve the pain of contractions, while still allowing you to be aware of your contractions and push when the time comes for delivery.

What are the side effects and risks of an epidural?

Epidurals for labor are extremely safe and effective.   There are a few areas of common concern:

Back Pain:  Many women are concerned that an epidural will cause chronic back pain. This is not the case. You may experience some temporary soreness and bruising at the injection site. This is true for any injection. In fact, backache is after labor common even in women who never receive an epidural.

Headache: We call this “post dural puncture headache”. This complication is very uncommon. An epidural is typically placed in a very small area near your body’s container for your spinal fluid. This container is called the dura. If the epidural needle makes a small hole in this tissue, it can cause a spinal fluid leak and sometimes a headache. Typically, these leaks heal by themselves within a few days. If necessary for headache relief, some patients have found rest, adequate hydration, caffeine, and oral pain meds to be helpful. Occasionally, patients may require another procedure called an “epidural blood patch” to temporarily relieve headache pain while the body heals itself.

Inadequate Pain Relief:  Occasionally, but not often, an epidural will not provide adequate pain relief. There are multiple reasons for this including variations in patient anatomy, epidural placement location, and movement/dislodgment of the catheter after placement. Most of the time, this can be solved with extra doses of epidural medication. If that doesn’t work, your Anesthesiologist may need to replace the epidural with a new one.

Other: There are rare and sometimes serious complications from epidurals. Some of these can include being numbed too high requiring the epidural to be stopped, seizures, and cardiac arrest. Your Anesthesiologist makes use of a small “test dose” of medicine to help minimize the chance of any problem. The above list is in no way exhaustive and cannot serve as informed consent for the placement of an epidural. At the time of your epidural, your Anesthesiologist will discuss the best treatment options for your labor pain. Feel free to take the time to have all your questions answered before your epidural is placed.

Does the epidural affect my baby?

Epidural labor analgesia was designed to provide ideal pain relief for mothers without causing any harm to the baby.   They have been in use for decades, and have an excellent safety record. The amount of medicine for the standard labor epidural does not cause an appreciable effect in the newborn baby.

Does everyone get an epidural?

No. Some women choose natural childbirth without the aid of an epidural. Many women do prefer an epidural for pain relief.

Most women are excellent candidates for an epidural. However, there are some health conditions, which, if present, may make placement of an epidural difficult, dangerous or impossible. Some of these conditions may include:

  • Bleeding or clotting disorders
  • Ongoing infection at the epidural site or in another part of your body
  • Allergies to local anesthetics
  • Inability to cooperate with placement of the epidural
  • Previous extensive spine surgery or hardware
  • Certain neurologic conditions or tumors
  • Imminent delivery of the infant

What happens if I need a C-section?

The type of anesthesia required for a C-section will depend on the urgency of the surgery, your health history, and whether or not an epidural is already in place. Many elective C-sections are performed under spinal anesthesia. If you already have an epidural and your OB doctor recommends performing a C-section, you may be given extra numbing medicine through the epidural to prepare you for surgery. Rarely a patient may require a general anesthetic for an urgent C-section.

Whenever possible, your Anesthesiologist will tailor your anesthetic plan to allow you to be numb, comfortable, and awake for the delivery of your baby during a C-section.