Planning Your Childbirth

Analgesics & Anesthetics
Regional Blocks for Labor
Anesthesia for Cesarean Births

Regional blocks for labor and delivery have become very popular because of the comfort they provide. The epidural block decreases sensation in the lower areas of your body, yet you remain conscious. The right time to ad-minister the epidural block will vary from patient to patient.

If you request an epidural block, your obstetrician and anesthesiologist will evaluate you and your baby, taking into account your state of health and past anesthetic experiences, the progress of labor and your baby's responses.

How is the epidural block performed?
An epidural block is given in the lower back. You will either be sitting up or lying on your side. The block is administered below the level of the spinal cord. This is called a lumbar epidural block. The block also may be given in the tailbone area. This is called a caudal block.

Before the block is performed, your skin will be cleansed with an antiseptic solution. The anesthesiologist will use local anesthesia to numb an area of your lower back or near the tailbone. A special needle is placed in the epidural space just outside the spinal sac. A tiny flexible tube called an epidural catheter is inserted through this needle. Occasionally, the catheter will touch a nerve, causing a brief tingling sensation down one leg.

Once the catheter is positioned properly, the needle is removed and the catheter is taped in place. Additional medications are given as needed without another needle being inserted. The medication bathes the nerves and blocks out the pain. This produces epidural analgesia.

How soon will the epidural block take effect?
Because the medication needs to be absorbed into several nerves, the onset is gradual, not immediate. Pain relief will begin to occur within 10 to 20 minutes after the medication has been injected.

What will I feel after the block takes effect?
Although significant pain relief will occur, you still may be aware of pressure or sensations with contractions. You may feel your obstetrician's examinations as labor progresses. Depending on your circumstances and your baby's condition, your anesthesiologist adjusts the degree of numbness for your comfort and to assist labor and delivery. You might notice some degree of temporary numbness, heaviness or weakness in your legs.

What is a combined spinal/epidural block?
A combined spinal/epidural block uses both techniques and can provide pain relief much faster. An injection of medication is made into the spinal sac followed by the placement of the epidural catheter. There may be less numbness with this technique. Some women may be able to walk around after the block is in place. A variation of this technique is sometimes referred to as a "walking epidural."

How long will the block last?
The duration of epidural analgesia can be extended usually for as long as you need it. After the epidural catheter is placed, additional medication can be administered through it as needed. Throughout your labor, your comfort and progress will be monitored frequently and medications adjusted accordingly. A nurse may assist your anesthesiologist with this monitoring. After delivery, the epidural catheter will be removed and, within a few hours, sensations will return to normal.

Will the epidural block affect my baby?
Considerable research has shown that epidural analgesia and anesthesia can be safe for both mother and baby, with little or no effect on the infant. However, medical judgment, special skills, precautions and treatments are required. That is why a qualified anesthesiologist should perform this procedure.

Will it slow down my labor?
Each mother may respond differently to the various epidural medications. Some may have a brief period of decreased uterine contractions. Many, however, are pleasantly surprised to learn that after the epidural medications have made them more comfortable and relaxed, their labor may actually progress faster.

Can I "push" when needed?
Regional analgesia allows you to rest during the longest part of labor, which occurs during cervical dilation. Then, when your cervix is completely dilated and it is time to push, you will have energy in reserve. The regional block can reduce your pain while allowing you to push when needed. Even if you do not have the urge to push, you should be able to do so with instruction.

If the baby's head needs to be guided through the birth canal with forceps or a vacuum instrument, the block can be intensified to provide anesthesia and muscle relaxation.

What are the risks of a regional block?
Although not common, complications or side effects can occur, even though you are monitored carefully and your anesthesiologist takes special precautions to avoid them. To help prevent a decrease in blood pressure, fluids will be administered intravenously (into one of your veins). In addition, during your labor, you will be positioned usually on your side. After delivery, you should remain in bed until the block wears off.

Shivering may occur and is a common reaction. Sometimes it happens during labor and delivery, even if you did not receive any anesthetic medications. Keeping you warm often helps it subside.

Although uncommon, a headache may develop following the block procedure. By holding as still as possible while the needle is placed, you help to decrease the likelihood of a headache. The discomfort, sometimes lasting a few days, often can be reduced or eliminated by simple measures such as lying flat, drinking fluids and taking pain tablets. Occasionally, a patient may need additional treatment if the headache persists.

On rare occasion, the anesthetic medication may affect the chest muscles and make it seem harder to breathe. Oxygen can be given to relieve this feeling and help the breathing.

The veins located in the epidural space become swollen during pregnancy. There is the risk that the anesthetic medication could be injected into one of them. To help avoid unusual reactions stemming from this, your anesthesiologist will first administer a test dose of medication and you may be asked if you notice any dizziness, a funny taste, rapid heart beat or numbness.

Your anesthesiologist carefully evaluates your condition, makes medical judgments, takes safety precautions and provides special treatment throughout the procedure. You should feel free to talk with your anesthesiologist about your options for pain relief and their possible side effects.

"Anesthesia & You ... Planning Your Childbirth" has been prepared by the American Society of Anesthesiologists through the cooperative efforts of the Society's Committee on Communications and the Committee on Obstetrical Anesthesia.