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Childbirth and Labor Pain Management
Pain relief options for labor and delivery have advanced in the last decade. Most of these advances have been improvements to established techniques.
The attending obstetrician or midwife will formally consult an anesthesiologist regarding the choice of analgesia. After reviewing the mother’s medical and prenatal history, a recommendation is made to the patient regarding pain relief options.
For most women in labor, an epidural is the most appropriate technique. For elective and semielective cesarean sections, a spinal anesthetic is the most appropriate technique. For patients with specific conditions or significant medical histories, the attending obstetrician or midwife may recommend an anesthetic consultation well before the patient’s due date.
The following techniques may be used to treat pain in labor.
An SSAA anesthesiologist is present at the childbirth education class offered by the South Shore Hospital Maternity Center to present these options and answer questions about labor analgesia. Click here for more information.
Fentanyl
PCA (Patient Controlled Analgesia)
This is a device that allows a patient to control her own pain relief
immediately. Using a push button connected to a small programmable pump,
the patient initiates the release of pain medicine into the intravenous
(IV) tube.
Within 1-3 minutes, the patient will experience relief. The pump can also be programmed to provide a continuous infusion of pain medicine as well. (This may actually reduce the number of pushes on the button.)
Is it safe? Yes, but there are precautions. Fentanyl is a synthetic opioid in the morphine family and crosses the placenta easily. This means the medication may have some effects on the baby, mostly slow breathing and sedation. The effects on the baby are short-lived and often do not require treatment.
Is it for me? This device is not for most people, but there are situations where this option is indicated. If your doctors recommend the Fentanyl PCA, a neonatologist will be at the baby's delivery to assess your baby and begin treatment if needed.
Epidural
Analgesia
An epidural involves the continuous delivery of pain-relieving medication to nerves within the epidural space of the
spinal column. At SSH, almost all epidural pain relief is delivered using the PCEA technique.
The attending obstetrician or midwife determines the appropriate timing of the epidural placement (usually after the cervix has dilated to four or more centimeters). An anesthesiologist will be consulted to assess the mother and place the epidural.
The epidural is placed using a needle and catheter. Once the catheter is in proper position, the needle is removed. The small catheter is then secured to the patient’s back. The catheter is connected to a small programmable PCEA pump.
PCEA, or Patient Controlled Epidural Anesthesia, combines the PCA and Epidural Analgesia techniques. The programmable PCEA pump delivers a continuous infusion of pain-relieving medication and allows the patient to self-administer extra medication (a "bolus"). The device is programmed so that the patient CANNOT receive “too much” medication. If at any time, a patient fails to have relief with the PCEA technique, the anesthesia team will be called to reassess the epidural.
Is it safe? Yes. Risks include temporary headache (risk less than 1 in 200), temporary decrease in blood pressure, and infection (extremely rare). There are no significant effects on the baby.
Is it for me? For analgesia in labor, this is the most common technique used.
PCEA
PCEA, or Patient Controlled Epidural Anesthesia, combines the PCA and
Epidural Analgesia techniques. After the epidural is placed, the catheter
is connected to a programmable pump that delivers a continuous infusion
of pain-relieving medication and allows the patient to self-administer
extra medication (a "bolus").
Spinal
Anesthesia
A spinal anesthetic involves the one-time administration of local anesthetic
to the spinal sac located within the spinal column. Often other pain
medications are added to the spinal mixture to provide longer lasting
pain relief.
Some maternity centers use a combination of dilute local anesthetic and a narcotic (fentanyl) for pain relief during labor. At South Shore Hospital, this technique has not yet been implemented. In general, a spinal is used for almost all elective and semielective cesarean sections.
The procedure for placing a spinal is very similar to that for an epidural anesthetic. An anesthesiologist will be consulted to evaluate the mother and place the spinal. The spinal is placed using a small needle. Once the needle reaches the spinal sac, local anesthetic is administered and the needle is removed. The effect of the spinal is noted within minutes.
Is it safe? Yes. Risks include temporary headache (risk less than 1 in 200), temporary decrease in blood pressure, and infection (extremely rare). There are no significant effects on the baby.
Is it for me? For cesarean sections, this is the most common technique used.
Walking
Epidural
A walking epidural is often used to describe a pain relieving epidural
for laboring mothers. At South Shore Hospital, laboring patients are
not allowed to walk once an epidural is placed. In fact, at most centers
where a "walking epidural" is promoted, patients are discouraged
from walking or are not permitted to do so. There are many reasons for
this.
Links
For further information regarding anesthesia for labor and delivery, please consult the links below. Keep in mind that practices vary from hospital to hospital and these sites contain general information and should not be relied upon for specific instruction.
- Pain Relief during Labor & Delivery -- American Society of Anesthesiologists (pdf)
- Headache after an epidural or spinal anaesthetic -- Royal College of Anaesthetists