Labor and Delivery

Before Delivery

No two labor experiences are the same. Every woman’s experience is unique as is each pregnancy. Her pain, labor, goals and expectations are all unique to her and each can even vary from pregnancy to pregnancy.

Some factors that influence pain during the labor process include the following:

  • Size and position of the baby
  • Size and shape of the patient’s body
  • Frequency and strength of the patient’s contractions
  • Past experiences
  • Cultural as well as personal expectations 

We know that this is one of the most important experiences of a patient’s life and we are here to support the patient during her labor and delivery while also respecting her wishes.

Pain Relief Options

A patient’s options for pain relief will vary based on whether the procedure will be a C-section or a vaginal delivery.

IV Medications

IV pain medications are prescribed by an obstetrician and either given in through the IV or into the muscle. They go to every part of a patient’s body to dull the pain. These medications have some side effects such as nausea and fatigue.

Epidural

An epidural is a procedure where numbing medicine is placed into a small space (epidural space) in a patient’s lower back. Unlike IV medications that affect the whole body, an epidural is more concentrated to areas involved in the labor process. It is safe and effective. In fact, more than half of women in the U.S. choose to get an epidural.

The anesthesia provider and nurse will help the patient get into position. The patient will sit on the edge of the bed and be asked to curl around the baby, pushing the lower part of her back out into a slouching position. Then her back will be sterilized with solution. Numbing medicine is injected underneath the skin to help make the rest be more comfortable. 

Once the epidural space is located, a small tube (like the IV but much smaller) is inserted. The patient may feel a funny sensation as that goes in. The provider will perform a couple of safety checks. If it passes those checks, medicine will be given through the catheter which usually starts to relieve pain in 15 to 20 minutes.

Then there will be a continuous infusion of medicine to keep the patient comfortable. It is normal to still feel some tightness and/or pressure with contractions.

The vast majority of women who get an epidural have no problems; however there are some possible risks.

As the body relaxes, a patient’s blood pressure may relax as well and this can cause some nausea. Blood pressure will be checked frequently after the epidural goes in to monitor this. The patient may be given IV fluids, medication, and/or oxygen or even need to change position to help maintain a normal blood pressure.

Sometimes the epidural doesn’t work as well as we hoped. Sometimes it works better on one side than the other. If this happens, the anesthesia provider may have to adjust medications or the catheter or even replace the epidural. 

A headache as a result from an epidural or spinal is rare (usually in less than 1% of patients). It is different than a normal type of headache but it does usually go away on its own. If it doesn’t, please let the anesthesia provider know so that they can make a plan to help relieve it.

Any sort of weakness or numbness that persists as a result of the epidural is extremely rare.

Anesthesia for C-Section

If you need a C-section, your anesthesia provider will discuss your options depending on your specific situation.

Similar to an epidural, a spinal is placing medicine through a needle in the lower back into the fluid that surrounds the spinal cord (but below where the spinal cord ends). Once the medicine is injected, the needle is taken out and nothing remains in the patient’s back. Most women start to feel numb about 10 minutes after the spinal is put in. It is most often used for scheduled C-sections as it is faster to make a patient numb with less chance of that numbness being unequal.

If a patient is in labor and already has an epidural, it may be able to be used for the C-section. The anesthesia provider will evaluate the patient and ask some questions. If it is used, different medication will be put through it to make the patient more numb. This usually takes closer to 20-30 minutes to be ready for the procedure.

General anesthesia is when a patient is put “all the way asleep” like for other procedures such as getting an appendix removed. General anesthesia is usually reserved for rare situations where the baby needs to be delivered by C-section in an emergency and there is not time to do an epidural or spinal. Other situations where general anesthesia might be used instead of a spinal or epidural include the mother’s history of low back surgery, certain bleeding disorders, or use of blood thinners.

After Delivery

If you received a spinal or epidural, you will have some pain relief until it wears off completely. You will not be allowed to walk until it has worn off and the nurses will help you do so the first few times. We work with the OB team to provide pain relief for the first 24 hours after delivery, and then the OB team will take over your pain medications.