Your Pregnancy After 35 : Labor and Delivery (part 12) - Analgesics and Anesthetics

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Analgesics and Anesthetics

Recent studies indicate more women are asking for pain relief during labor. There are many different types available. Analgesia is pain relief without total loss of sensation. Anesthesia is pain relief with partial or total loss of sensation.

Effective pain relief can be achieved with smaller doses of anesthetics, which can help reduce side effects and aftereffects. About 65% of all women who deliver at large hospitals ask for pain relief. In smaller hospitals, the number is under 50%.

Analgesia

Analgesia is injected into a muscle or vein to decrease the pain of labor, but you remain conscious. It provides pain relief but can make you drowsy, restless or nauseated. You may find concentrating difficult. Analgesia may slow baby’s reflexes and breathing, so this medication is usually given during the early and middle parts of labor. Examples of analgesia are Demerol (meperidine hydrochloride) and morphine.

Anesthesia

There are three types of anesthesia—general anesthesia, local anesthesia and regional anesthesia. You are completely unconscious with general anesthesia, so it is used only for some Cesarean deliveries and emergency vaginal deliveries. Using a general anesthesia has certain disadvantages. Sometimes the mother vomits or aspirates vomited food or stomach acid into her lungs. The baby is also anesthetized and needs to be resuscitated after delivery. General anesthesia is not often used for childbirth. Its advantage is that it can be administered quickly in an emergency.


Local anesthesia affects a small area and is useful for an episiotomy repair. It rarely affects the baby and usually has few lingering effects.

Regional anesthesia affects a larger body area and includes pudendal blocks, spinal blocks and epidural blocks. A pudendal block is an injection of medication into the pudendal nerve area in the vagina to relieve pain in the vaginal area, the perineum and the rectum. You remain conscious, and side effects are rare. Pudendal block is considered one of the safest forms of pain relief; however, it does not relieve uterine pain.

A spinal block involves medication injected into spinal fluid in the lower back, which numbs the lower part of the body. It works within seconds and is effective for up to 45 minutes; you remain conscious. This type of block is administered only once during labor, so it is often used just before delivery or for a Cesarean section. It works quickly and is an effective pain inhibitor. Up to 90% of all elective Cesarean deliveries are done with spinal anesthesia.

A spinal block may cause a woman’s blood pressure to drop suddenly, which in turn can cause a decrease in the baby’s heart rate. This type of anesthesia is not used if a woman is bleeding heavily or if the baby has an abnormal heartbeat. Another possible side effect from spinal anesthesia is severe headache if the needle punctures the covering of the spinal cord.

A walking spinal, also called intrathecal anesthesia, can be given to women who suffer extreme pain in the early stages of labor (dilated less than 5cm). This type of anesthesia won’t affect your ability to push in the same way as a regular epidural will. See the discussion of epidurals below. A small amount of narcotic, such as Demerol, is injected through a thin needle into the spinal fluid, which eases the pain and causes few side effects. Because the dose is small, neither mother nor baby becomes overly drowsy. Sensory and motor functions remain intact, so the mother can walk around with help, sit in a chair or go to the bathroom.

One of the most commonly used pain-relief methods for labor and delivery is the epidural block. It is discussed below.

 
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