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Labor Anesthesia

Labor Anesthesia

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 Today, we are joined by Dr. Jenny Dworzak, an anesthesiologist, who talks to us about anesthesia. On today's podcast we answer the following. 1) What kinds of medication-based pain relief are available for labor? IV pain medications: most have short-lived effects and require repeat dosing with a limit to benefits and more side effects (itching, nausea) for mom, most can affect baby’s heart rate and breathing and may increase the need for more resuscitative efforts for baby when baby is delivered; may interfere with baby’s ability to breastfeed immediately following deliveryEpidural: pain medication administered directly through a catheter to the nerves that transmit pain during labor. Dramatically decreases the systemic side effects for mom and makes the amount baby sees negligent. Also, because the medication can safely be given continuously it is the most effective form of pain relief during labor. 2) If I have a high pain tolerance, is there any benefit for me to get an epidural? Yes, when the body has a stress response to pain, it releases substances that can slow the contractions of uterus and decrease blood flow to the uterus which houses baby. Also certain breathing patterns associated with painful stimuli can affect baby’s heart rate during labor.Yes, with a working epidural in place, if an emergency arises where you or baby require a C-section delivery, there is a decreased chance that you will require general anesthesia for delivery. 3) How long does placing an epidural take? On average about 10-15 minutes with a few minutes for setup beforehand a few minutes for setup of the pump afterward. This can be longer in patients with anatomical variations or increased soft tissue overlying the spine. It takes another 15-20 minutes for the standard epidural medication used on our floor to have an appreciable effect on contraction intensity. 4) When should I ask for an epidural? And when is it ‘too late’? This is a personal decision. Once the epidural is placed you will remain in bed and a nurse will catheterize you every 4 hours to eliminate urine from your bladder. Some moms who want to walk around their room or otherwise be more mobile prefer to wait until a significant amount of discomfort before requesting an epidural.On the flip side, a couple key points in considering when might be ‘too late’ for an epidural.A major determinant of epidural ease and success is the mom’s ability to hold a reliable still position for the duration of the procedure, which is difficult to do with increasing discomfort.After placement of the epidural, it may take 15-20 minutes for our standard medication to demonstrate an effect on intensity of contractions, which may not be a tolerable period of time with increasing discomfort.There are limited anesthesia personnel available for the floor and sometimes depending on number of emergencies, surgeries, and other epidurals on the floor, there may be a wait time from the time of your request to the placement of the epidural. To avoid disappointment and waiting in increasing discomfort, try to plan ahead and ask for your epidural before you are too uncomfortable. 5) What should I do while getting an epidural? Always face forward in a straight line with your arms and legs in front of you.Maintain the hunchback position that your nurse and anesthesiologist will demonstrate for you.Sometimes your anesthesiologist may ask whether you feel they are exactly midline or more to the left or right depending on the curve of your spine and if there is soft tissue covering the spine. Answer as well as you can. 6) Does getting an epidural hurt? Before localizing the space in your back with the epidural needle, your anesthesiologist will inject local numbing medication into the skin and soft tissue overlying your bones. This numbing medication can sting slightly before it creates a numbing sensation that makes the rest of the procedure much more comfortable. Throughout the epidural you may feel pressure and manipulation but the local anesthetic will blunt sharp pain. 7) Can I be paralyzed by an epidural? Extremely unlikely. A rare complication of an epidural that usually occurs in patients that have risk factors for bleeding or an inability to clot blood because they have underlying medical problems, blood count aberrancies, or are on blood thinners is an epidural hematoma, which is a bleeding collection that can compress the spinal cord. The rate of this complication is 1/160,000-190,000 epidurals.Neurological injury due to labor and delivery is actually more common than neurological injury due to anesthesia for labor and delivery, primarily in the form of compression nerve injuries. These include compression nerve injuries and even ischemic spinal cord injuries. Persistent neurological injury of any kind > 1 year has a rate of 1/260,000 – incredibly low and is usually associated with spinal anesthesia and medications that we don’t typically use in ...

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