Types of Pain Relief
There are two types of pain-relieving drugs — analgesics and anesthetics. Analgesia is the reduction of pain without total loss of feeling or muscle movement. Analgesics do not always stop pain completely, but they do lessen it.
Anesthesia is blockage of all feeling, including pain. Some forms of anesthesia, such as general anesthesia, cause you to lose consciousness. Other forms, such as regional anesthesia also known as an “epidural” or “spinal”, remove all feeling of pain from parts of the body while you stay conscious. In most cases, analgesia is offered to women in labor or after surgery or delivery, whereas anesthesia is used during a surgical procedure such as cesarean delivery.
Regional analgesia tends to be the most effective method of pain relief during labor and causes few side effects. Epidural analgesia, spinal blocks and combined spinal– epidural blocks are all types of regional analgesia that are used to decrease labor pain.
Epidural analgesia, causes some loss of feeling in the lower areas of your body, yet you remain awake and alert. An epidural block may be given soon after your contractions start, or later as your labor progresses. An epidural block with more or stronger medications (anesthetics, not analgesics) can be used for a cesarean delivery or if vaginal birth requires the help of forceps or vacuum extraction. Your doctors and nurses will work with you to determine the proper time to give the epidural.
An epidural block is given in the lower back into a small area (the epidural space) below the spinal cord. You will be asked to sit with your back curved outward and to stay this way until the procedure is completed. You can move when it’s done, but you will not be allowed to get out of bed.
After the epidural needle is placed, a small tube (catheter) inserted through it, and the needle is withdrawn. Small doses of the medication can then be given through the tube to reduce the discomfort of labor.
Because the medication needs to be absorbed into several nerves, it may take a short while for it to take effect. Pain relief will begin within 10–20 minutes after the medication has been injected.
Although an epidural block will make you more comfortable, you still may be aware of your contractions. You also may feel your doctor’s exams as labor progresses. The overall goal of analgesia is to make labor discomfort tolerable.
A spinal block, like an epidural block, is an injection in the lower back. While you sit or lie on your side in bed, a small amount of medication is injected into the spinal fluid to numb the lower half of the body. It brings excellent relief from pain and starts working fast, but it lasts only an hour or two.
A spinal block can be given using a much thinner needle in the same place on the back where an epidural block is placed. The spinal block uses a much smaller dose of the anesthetics and analgesics and it is injected into the sac of spinal fluid below the level of the spinal cord. Once this combination of drugs is injected, pain relief occurs rapidly.
A spinal block usually is given only once during labor, so it is best suited for pain relief when delivery is imminent. A spinal block with a much stronger concentration (anesthetic and analgesic) is often used for a cesarean delivery. It also can be used in a vaginal birth depending on your labor progression and history. Spinal block can cause the same side effects as epidural block, and these side effects are treated in the same way.
Combined Spinal-Epidural Block
A combined spinal-epidural block has the benefits of both types of pain relief. The spinal part helps provide pain relief right away. Medications given through the epidural provide pain relief throughout labor. This type of pain relief is injected into the spinal fluid and into the space below the spinal cord. Again your delivery team will help you understand if this method may be desirable for your labor pain control.
General anesthetics are medications that put you to sleep (make you lose consciousness). If you have general anesthesia, you are not awake and you feel no pain. General anesthesia often is used when a regional block anesthetic is not possible or is not the best choice for medical or other reasons. It can be started quickly and causes a rapid loss of consciousness. Therefore, it is often used when an urgent cesarean delivery is needed.
A major risk during general anesthesia is caused by food or liquids in the woman’s stomach. Labor usually causes undigested food to stay in the stomach. During unconsciousness, this food could come back into the mouth and go into the lungs where it can cause damage. To avoid this, you may be told not to eat or drink once labor has started. If you need general anesthesia, your CRNA will place a breathing tube into your mouth and windpipe after you are asleep. If you are having a cesarean delivery, you also will be given an antacid to reduce stomach acid and medications to help with nausea. In some cases, ice chips or small sips of water are allowed during labor. Talk to your doctor and your delivery nurse about what is best for you.
Many women worry that receiving pain relief during labor will make the experience less “natural.” No two labors are the same, and no two women have the same amount of pain. Some women need little or no pain relief, and others find that pain relief gives better control over their labor and delivery. Talk with your doctor about your options. He or she may arrange for you to meet with a CRNA before your labor and delivery. Be prepared to be flexible. Don’t be afraid to ask for pain relief if you need it.