Regional Anesthesia
There are several different types of regional anesthesia avialable: dilute local anesthetics, combination narcotics and local anesthetics, or more concentrated local anesthectics alone. Your physician/midwife and anesthesiologist will help you choose which type will best meet your needs, based on your stage and situation during labor and the amount of pain relief you require. Discuss with them the importance of being able to feel the pushing sensations and being able to work with your contractions. Remember, you will be assisted to manage your pain so you will be able to maintain a sense of control.There are many options of pain relief so you are not faced with the choice of either unmanageable pain or no pain/no movement.
| Type | When/How Given | Advantages | Possible Side Effects/Disadvantages |
|
Intrathecal (Narcotic and/or local anesthetic |
Established for labor pain not relieved by other methods. Needle inserted into central spinal fluid where medicine is injected and needle is removed. |
Usually gives good pain relief. Takes effect immediately. Some mothers may be able to walk. Does not alter pushing efforts. |
Itching. Possible spinal headache (rare). Limited time duration. Possible infection. |
| Epidural Narcotic Only (Walking Epidural) |
Established for labor pain not relieved by other methods. Needle inserted into epidural space and small catheter placed for later use (needle pulled out after catheter is inserted.) |
Usually gives good pain relief for early labor. Some mothers may be able to walk. Able to use catheter for local anesthetic later if needed. |
Itching. Often restricts mobility. Can become Spinal anesthesia if epidural catheter goes into the spinal fluid when inserted. Intravascular injection. Blood pressure can drop within the first 30 minutes after epidural is started, so frequent monitoring of blood pressure during that time. Possible risk of infection. May necessitate vacuum or forceps delivery due to decreased pushing ability. May experience spinal headache postoperatively (rare). |
| Local Anesthetic Epidural |
As labor progresses, active/transition labor. Usually given as a continuous infusion via a control pump. |
Medication easily administered as labor advances. Can shorten labor by allowing the mother to relax. Mother can usually push with assistance; may feel pressure. Medication can be turned down or off during the second stage if necessary to assist with pushing sensation. Provides enough pain relief without sedation for Cesearean delivery; allows mother to remain awake during surgery. Total bloackage of sensation, yet the mother stays conscious. |
Often restricts mobility requiring bedrest during labor. Can become spinal anesthesia if epidural catheter goes into the spinal fluid when inserted. Intravascular injection. Blood pressure may drop druing the first 30 minutes after epidural is started, so frequent monitoring of blood pressure during that time. Possible risk of infection. May necessitate vacuum or forceps delivery due to decreased pushing efforts. |
| Spinal Block |
May be given for Cesearean birth. Medication is injected into the spinal canal |
Effective immediately. |
May experience spinal headache postoperatively (rare). Itch. |