The labor and delivery experience is unique for every woman. The pain of labor depends on many factors, including the size and position of the baby, the strength of contractions, whether pitocin is given to augment contractions, and the speed with which labor progresses.

For some women, breathing and relaxation techniques learned in prenatal classes will be adequate, while others may choose to combine these techniques with low dose IV medications administered early in labor by their obstetricians.

The majority of women, however, will ultimately request additional pain relief. The most common and effective form of pain relief in labor is epidural analgesia. Analgesia means relief of pain without total loss of feeling or muscle movement. A variation on this technique is a combined spinal-epidural, which may be used in certain situations, especially when labor is progressing extremely rapidly.

If you choose to have epidural analgesia for your labor, it will be administered by one of the physician anesthesiologists of Capitol Anesthesiology Association. At all of the hospitals where our group provides obstetric anesthesia services, we have an anesthesiologist readily available 24 hours a day, 7 days a week to place and manage your labor epidural until you deliver.

Prior to placing a labor epidural, the anesthesiologist will come to your hospital room to take your medical history and discuss the risks and benefits of epidural analgesia for labor. It is important at this time that you inform the anesthesiologist of any significant medical history you have, especially heart or lung problems, bleeding or clotting disorders, spine problems or prior surgeries, as well as allergies or sensitivities to medications or anesthetics. If you have a very complex medical history or significant concerns regarding pain control in labor, please discuss these with your obstetrician early in your pregnancy. He or she will likely be able to answer many of your questions, but may also choose to arrange a telephone or clinic consult with one of our anesthesiologists prior your delivery date.

Yes. There are a couple of options when it comes to the type of epidural used during your labor. The most common type of epidural used in labor and delivery is epidural analgesia. Epidural analgesia (also called an epidural block or a labor epidural) is a method of pain relief that causes you to have decreased sensation in the lower part of your body (below the belly button) so that the pain of contractions is relieved, but you remain awake and alert. You and your obstetrician will decide together when it is appropriate for you to have your epidural placed. Generally speaking, it can be placed any time after your labor has commenced once you have established a pattern of regular contractions and your cervix is beginning to dilate. On rare occasion, a patient’s labor may be progressing so rapidly that an epidural alone will not numb the nerves to her vaginal area quickly enough to allow for a comfortable delivery. In that case, the anesthesiologist may choose to place a combined spinal-epidural. In this case, your anesthesiologist will place the epidural needle in the usual fashion, and will then place a spinal needle through that epidural needle and put a dose of medication into the spinal fluid to hopefully achieve pain relief in time for delivery.

To place your epidural, the anesthesiologist will ask you to either sit up or lie on your side and curl around your baby so that your back curves into a C shape. After your back is cleaned with sterile soap, local anesthesia will be placed in your skin in the lumbar area of your back with a very small needle. The local anesthesia will numb the skin around the site where your epidural will be placed. You may feel a mild pinch with this. Once your skin is numb, a larger needle will be used to access your epidural space and feed in a soft plastic catheter that will then be taped flat to your back. Through this catheter, you will receive an initial dose of local anesthetic to numb the nerves that run through the epidural space. That catheter will then be connected to a pump that will infuse a continuous dose of local anesthetic with a small amount of narcotic medication. You will also be given a button that you can push in the event you feel the need for additional medication as labor progresses. This is called Patient-Controlled Epidural Analgesia (PCEA). Once an epidural catheter is placed, it takes 10-20 minutes for the medication to take effect and relieve your contraction pain.

Certain medical conditions may preclude the safe or successful placement of a labor epidural. Patients with bleeding disorders or on blood thinners, certain neurologic conditions, or with a history of extensive spine reconstruction surgery may present challenges to epidural placement. If you have any of these conditions, or any significant medical history about which you are concerned, please alert your obstetrician and request a consultation with one of our anesthesiologists well prior to your due date. In all cases, even if an epidural isn’t possible, we can assist in providing alternative methods of pain relief to optimize your delivery experience.

The combination of local anesthetic (bupivicaine) and narcotic (fentanyl) in the doses we use have been shown in multiple studies to be safe for both you and your baby. In fact, the main advantage of epidural analgesia for labor is that it offers you excellent pain relief with minimal exposure of your baby to medications as they are administered directly into your epidural space.

Multiple large well-conducted scientific studies have now demonstrated no clinically significant difference in the length of labor between patients with and without labor epidurals.

With all procedures in medicine there are both side effects and potential risks. As the nerves to the lower half your body become numb, your blood pressure may decrease as your blood vessels relax as well. In most cases this is not problematic, but at times the decrease may be enough to make you feel lightheaded or for your baby’s heart rate to decrease. In this case, you will be given medicine and fluids through your IV to restore your blood pressure. You may also be asked to lie on your side and breathe some additional oxygen until your blood pressure has returned to normal. As the epidural medication numbs the sensory nerves that transmit pain, it will also partially numb the motor nerves to your lower extremities. You will still be able to move your legs, but they may feel heavy or weak to you. Once your epidural is placed, you will no longer be allowed to get out of bed, as your legs may not reliably support you. In some cases, one leg may feel substantially weaker than the other after epidural placement. This is completely fine as long as you are comfortable and your labor pain is relieved. Serious complications from labor epidurals are unlikely.

In less than 1% of cases, the epidural needle may pass through the epidural space and pierce the covering (dura) over the spinal cord. This is not dangerous, but may create a leakage of spinal fluid that results in a bad headache after delivery that requires evaluation and treatment by one of our anesthesiologists. Other reported complications are even more rare. Unintentional injection of local anesthetic into a blood vessel could cause you to feel dizzy or even have a seizure. A very high epidural block could make you feel like you are having difficulty breathing or cause your blood pressure to drop extremely low. Finally, cases of residual numbness or permanent nerve damage have been reported, but are extraordinarily rare, especially in the hands of experienced anesthesiologists. While serious complications of labor epidurals are extremely rare, the physicians of Capitol Anesthesiology want to ensure your comfort and safety throughout your labor. When you have a labor epidural in place, there is always an anesthesiologist in the hospital and immediately available to answer questions or deal with any problem that arise.

Unfortunately, not every labor epidural that is placed, even by experienced anesthesiologists, will perfectly control all labor pain. Some epidural catheters may need to be re-dosed, adjusted, or even replaced. Rest assured that there is always an anesthesiologist in the hospital, day and night, to address your concerns and optimize your pain control.

Cesarean delivery, or C-section, may be required in many different circumstances, and the type of anesthesia used will vary with the situation. If the cesarean section is elective, prior to the start of labor and/or prior to placement of a labor epidural, a spinal anesthetic will most commonly be performed. If you have been in labor with a well-functioning epidural and are now proceeding to cesarean delivery, the epidural can often be used for the cesarean delivery, as well. Finally, if the cesarean section is an emergency because of severe fetal heart rate decelerations, a general anesthetic will often be required to deliver the baby as quickly as possible. At times, general anesthesia may be required if you have a medical condition which precludes you safely receiving spinal or epidural anesthesia.

A spinal block, just like an epidural, is placed in your lower back while you sit up or lie on your side curled around the baby. The procedure is performed in the operating room, as it is a one-time dose of medication that is placed directly into your spinal fluid, and the onset of numbness is very rapid. To make sure you are completely comfortable during your cesarean section, enough medication will be given to make you numb up to the level of your mid-chest. Once the medication is in, you will be placed on your back, and your blood pressure will be checked frequently and treated to make sure it remains stable. The anesthesia will be completely effective within 10 minutes of administration, and will last approximately 2-3 hours, wearing off completely during your recovery room stay. The risks of spinal anesthesia are the same as those already described for epidural placement.

If you already have a well-functioning epidural catheter in place for labor, your anesthesiologist will dose the epidural catheter with a more concentrated local anesthetic solution to make you completely numb for surgery. Once again, the aim will be to have the numbness spread up to the level of your mid-chest so you are completely comfortable during surgery. If, for any reason, your epidural has not perfectly controlled your labor pain, the anesthesiologist may choose to remove it and place a spinal block instead for your cesarean section.

General anesthesia means the administration of medicines through the IV to put you to sleep (make you lose consciousness). After you are completely asleep, a breathing tube will be placed through your mouth and into your windpipe to allow us to assist your breathing while you are under anesthesia. To minimize the amount of general anesthesia medication that gets to your baby, you will be completely prepped for surgery, including cleaning your abdomen with sterile soap and putting up the surgical drapes before you are given the anesthesia. At the end of the procedure, the anesthesia is turned off and the breathing tube is removed before you are transferred to the recovery room to meet your new baby.

Side effects of general anesthesia are typically minor and mild. Some patients experience a sore throat from the breathing tube, but this resolves quickly. Nausea and vomiting after surgery are more common, but anti-nausea medications can be given in the OR to minimize this risk.

Many pregnant women, especially in labor, will have impaired emptying of their stomach. This increases the chance of regurgitation of stomach contents and aspiration of food into the lungs when you are being put under general anesthesia. We use techniques to minimize this risk, but it is important that you strictly follow the instructions of your obstetricians and the nursing staff to eat no solid food at all during labor and/or to eat no solid food for 8 hours prior to a planned cesarean section. Clear liquids may be allowed during uncomplicated labor, but will be stopped once the need for cesarean section is declared.

A normal, uncomplicated labor epidural has virtually no effects on the newborn infant. Similarly, spinal or epidural anesthesia for cesarean section allows you to be completely numb for surgery, with almost no transmission of medications to the baby. Some medications required for general anesthesia do cross the placenta, and can make the baby a bit sleepy for a few minutes after delivery, but the pediatricians and nursery staff will be in the OR to make sure your baby is breathing well and recovers quickly.

Capitol Anesthesiology Association is a group of private practice anesthesiologists (MDs with at least 3-4 years of specialty training after graduation from medical school) who provide all of the anesthesia services at the hospital where you will deliver. We are not employees of the hospital; therefore, you will receive a separate statement from us for the consultation and anesthesia services we render. If an “anesthesia” charge appears on your hospital bill, it is for medications, supplies, and equipment. The fees for obstetric anesthesia services are determined by many factors, including your health status, the procedure performed by the obstetrician, and the amount of time you are in labor. Please don’t hesitate to call us at 512-454-2454 if you have questions regarding your bill. We welcome the opportunity to serve you.