Obstetric Anesthesia

Labor and delivery is an exciting area of patient care because of the joy that new babies bring to the world. Anesthesia has become a very important part of the team that takes care of expecting mothers.  

Whether you come in for an induction or whether you come to the hospital in labor you will usually be admitted very quickly.  Once you are in labor there are many options to help control pain.   Pain management for labor and delivery has improved dramatically over the last 25 years.  Initially many patients opt for IV pain medications such as fentanyl.  However, many patients eventually elect to have an epidural catheter; the catheter is inserted by an anesthesiologist and is then used to give a low dose of pain relieving local anesthetic until after the baby is born.  Another choice is a spinal anesthetic.  In some cases a very low dose of morphine is used as the anesthetic and it  will give pain relief for 12 to 24 hours.  When an expectant mother arrives at the hospital, is about to deliver, and in extreme pain a very low dose spinal anesthetic can be given; this is often very effective in relieving pain while still allowing the mother appropriate strength to push for the delivery.  Finally some anesthesiologists will combine a spinal and an epidural to get very fast onset of effective pain relief in a labor patient.  For patients who are not a candidate for an epidural or spinal anesthetic a PCA, an abbreviation that stands for patient care analgesia, can be used.  With a PCA, when a button is pressed, usually every 6 to 10 minutes a small amount of pain medication is given.  Many patients feel that they are in control of the pain when they can treat it themselves by pressing a button.

Natural childbirth is another good option that works for many mothers. When choosing this option, a spinal or epidural will not be used but patients can use IV and or oral medications to help with the pain.  It is also comforting to know that even if you plan to have a natural childbirth, it may be possible to change plans if the pain becomes unbearable or if you change your mind.  In this case you are in charge of your own destiny.

Complimentary and integrative approaches can also be very helpful when managing the pain associated with childbirth. Medical studies have shown that patients who practice yoga in pregnancy may experience less pain and have a smoother course through labor and delivery.  

There are times when a patient may need to have an unplanned cesarean section following labor.  This can happen for a variety of reasons.  If a patient has an epidural catheter in place, this can be used for anesthesia for the C-section.   If a patient does not have an epidural there is usually time to do a spinal anesthetic before the C-section.  

Some patients are scheduled for an Elective C-section.  The best choice for anesthesia is usually either spinal or epidural analgesia.  Most commonly in this setting a spinal anesthetic is used.  The effects of regional anesthesia on the baby are very small, and regional anesthesia is also very safe for the mother.

General anesthesia is an option if a patient is not a candidate for a regional procedure.  The effect of general anesthesia on the baby is generally very small.

In some cases an Emergency cesarean section may be necessary to protect the life of the mother or the baby. Often there is just enough time to do a spinal but in some cases urgent general anesthesia is used. Even in this setting, however, anesthesia is considered to be very safe.

Pain management after a cesarean section  can involve several different options.  If a spinal is used then long acting Morphine can be added to give 12 to 24 hours of pain relief.  The same treatment, long acting morphine, can be used if the patient has an epidural catheter in place.  In both of these cases, supplemental use of IV or oral medication can be used to provide even more effective pain control.  Even without the use of long acting morphine, there are several very good options for pain management.  These options include oral, IV and intramuscular pain medication as well as a PCA.  


Anesthesia
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