Obstetric Anesthesia

Dear Mom:

This letter provides information about pain control during labor and delivery or cesarean section. Please carefully read this information.

Holy Cross Anesthesiology Associates, a private practice of physician anesthesiologists, provides anesthesia services to women in our labor and delivery unit. An attending physician anesthesiologist is dedicated to the care of mothers in our labor and delivery unit 24 hours a day, seven days a week.

Medical advances have made epidural and spinal anesthesia safe and effective. For labor, we use a continuous epidural. With this method, anesthetics are infused during the course of labor through an epidural catheter placed in your lower back. A computerized pump provides anesthetic medications until delivery. If a cesarean section is needed, the epidural catheter placed for labor can be used to provide more anesthesia. The anesthesiologist also may give a combined spinal-epidural. This method administers a small dose of anesthetic into the spinal space at the time of epidural placement. Spinal anesthesia without an epidural is our preferred technique for elective cesarean sections or if our patient does not have an epidural for labor.

SIDE EFFECTS–EPIDURAL AND SPINAL

Though rarely serious, you may experience the following side effects:

1. Lower blood pressure – Your blood pressure will tend to be lower. Your anesthesiologist and nurse will monitor your blood pressure closely. They can easily manage these changes. The lower blood pressure will be helpful to patients with high blood pressure from pregnancy.
2. Lower fetal heart rate – The fetal heart rate may decrease right after the procedure is completed. Almost always, these changes are not serious and go away in a few minutes.
3. Shivering – Shivering is common during labor and has many contributing causes.
4. Itching – You may experience some itching. This is not an allergic reaction. It will go away shortly after a vaginal birth and by 24 hours after a cesarean section.

POSSIBLE COMPLICATIONS – EPIDURAL AND SPINAL

As with general anesthesia, there are risks involved that could affect the health of the mother and baby. These complications are rare. Most often, they respond to the treatment provided by your anesthesiologist and obstetrician.

1. Headache – You may experience a headache when you stand that is not present with lying down. The frequency of a headache from epidurals and spinals administered by anesthesiologists is low. Less than five out of 100 patients get this type of headache.
2. Back pain – Back pain is common during pregnancy and after labor and childbirth. Mothers with preexisting back problems may have increased back discomfort after pregnancy, labor, and childbirth. Significant back pain from epidurals or spinals is uncommon. In fact, epidural injections are a common treatment for severe back pain.
3. Nerve injury – Both temporary and permanent nerve injury from epidurals or spinals is extremely rare. Rare problems with loss of sensation or strength in the legs are more likely related to pushing during childbirth, the passage of the baby through the birth canal, or lower back disc problems.
4. Need for emergency cesarean section – Rarely, serious changes in breathing or blood pressure after epidurals will result in the need for an emergency cesarean section.

KEY INFORMATION FOR MOM AFTER A LABOR EPIDURAL IS STARTED

1. After the anesthesiologist finishes the epidural, do not lie completely flat on your back until delivery.
2. You will begin to feel more comfortable within 10 to 15 minutes after the procedure.
3. Your legs may feel a bit numb and heavy. It is common for one side of your lower body to feel less than the other. Tell your nurse or anesthesiologist if are unable to move your legs.
4. The epidural will continue to control your pain throughout labor. As labor progresses, you may experience cramping, pressure and some discomfort.
5. To help control labor pain, our epidurals provide you with some control of how much epidural medication you receive. This is called patient-controlled epidural analgesia or PCEA. It allows you to self-administer additional epidural medication at safe doses and controlled time intervals.
   1. If you are feeling too much discomfort, there is a button you can push that will give you additional epidural pain medication.
   2. After you push the button, it will take about 10 minutes to notice an effect.
   3. The epidural pump is set-up so you can receive three extra doses each hour, as long as each button push is ten minutes apart.
6. Occasionally, to improve pain control, the anesthesiologist will need to repeat the epidural or spinal procedure.

An anesthesiologist is available on the labor and delivery unit to address your questions or concerns. We look forward to meeting you and participating with your care.

Sincerely,
Your Anesthesiologist on Labor and Delivery