The Department of Anesthesiology at Women & Infants is comprised of physician anesthesiologists and certified nurse anesthetists who pride themselves on a record of excellence for patient safety. It is one of the first departments in the country to provide in-house coverage for obstetrical patients 24 hours a day, seven days a week.
In preparation for the birth, patients will also need to consider anesthesia options. Some women with uncomplicated pregnancies want to have their babies with little or no anesthesia, while others want every available means of pain relief. The different types of anesthesia should be discussed with the patient's physician to decide which method is the most appropriate. For Physician Referral, call our toll free number at 1-800-921-9299.
The choice of anesthesia for delivery is important for the mother's comfort and safety and the baby's well-being. Patients should discuss anesthesia options with their obstetrician before the baby's due date.
Women & Infants' Department of Anesthesiology offers the following kinds of pain relief.
These drugs are usually ordered by the obstetrician or nurse midwife and are administered by intramuscular injection use or intravenous line. They will diminish the intensity of pain but will not take it away entirely. Often this will be all enough to take the edge off contractions.
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- Local or pudendal anesthesia
At the time of delivery, the obstetrician or nurse midwife may use a local or pudendal anesthesia. This type of anesthetic numbs the birth canal and the surrounding skin.
- Epidural block
Epidural analgesia is the most common form of anesthesia used during labor and delivery at Women & Infants. It is a planned anesthesia and should be requested by the obstetrician in the early stages of labor. Epidural anesthesia may be used for a vaginal or planned Cesarean delivery.
This method involves use of a needle and a soft plastic catheter through which a local anesthetic and a low dose of narcotics are injected. While it alleviates the pain of labor contractions, the patient may remain awake, relaxed and comfortable.
Prior to the actual administration of anesthesia, the mother's blood pressure and pulse and the baby's heart rate will be monitored. The patient will receive an IV and be positioned on her side or in a sitting position. The skin of the lower back is cleaned with a special solution and a small amount of local anesthetic (usually Lidocaine) is injected into the skin of the lower back just about the hips. A needle and the catheter is inserted into the epidural space between the bones of the spine. When the needle is removed, the catheter remains and is taped in place on the patient's back. The anesthesiologist continuously injects local anesthetic through the catheter during labor and delivery.
With an epidural block, the patient may notice a tingling heaviness or numbness in the legs or have difficulty in moving them. The patient's blood pressure, pulse and baby's heart rate will be continuously monitored as will uterine contractions.
- Epidural block during Cesarean delivery
A more potent anesthetic agent is delivered through the catheter for a Cesarean delivery. This will allow the patient to be awake during the birth. Oxygen will be given through a face mask or tubing in the nostrils. If epidural anesthesia in place and the patient requires an emergency Cesarean, the patient's obstetrician and anesthesiologist will assess the patient's and the baby's condition and the amount of time available for adequate effectiveness.
The anesthesiologist may then choose to remove the epidural catheter and use spinal or general anesthesia. Should the patient experience any discomfort after the baby is delivered, some pain relief medication will be injected through the existing intravenous tubing.
Outcome and complications of Epidural block
Serious complications are rare. Perhaps the most common problem is lack of complete relief from pain. The patient may feel pressure or localized discomfort in the lower part of the abdomen. However, most of the pain should be relieved.
Some patients may also experience a fall in blood pressure when the epidural is first administered. This can be alleviated by giving intravenous fluids, medication or turning on her side and administering oxygen to breathe.
Occasionally, during the insertion of the epidural needle, there may be unintentional entering of the spinal canal. If this happens, there is a possibility of a postpartum headache.
- Spinal anesthesia
Spinal anesthesia involves the insertion of a thin needle between the spaces of the spinal bones into the spinal canal and a single injection of a local anesthetic directly into the fluid that surround the nerves in that area. This results in complete loss of pain, sensation and movement from the waist down.
Spinal anesthesia is most commonly used for Cesarean deliveries, but also occasionally for vaginal births. It is administered just before the delivery and provides pain relief for the birth, the episiotomy and its repair. With spinal anesthesia the patient will be awake, comfortable and able to watch the birth of the baby.
As with epidural anesthesia, complications associated with the administration of spinal anesthesia are also rare. A fall in blood pressure may sometimes occur. If this is the case, the mother will be given intravenous solutions and oxygen and be turned on her left side. Likewise, spinal anesthesia is sometimes followed by a headache. If the headache is severe, there are specific treatments available.
- General anesthesia
There are situations, in the case of emergencies, for example, when it may be necessary to give patients general anesthesia. The patient will be put to sleep with an intravenous injection of anesthetic medication. Once asleep, a breathing tube is placed in the windpipe, and other anesthetic agents are used to keep the patient unconscious and relaxed.
Once the surgery is finished, the anesthetic agent is discontinued. When the patient is awakened, the tube will be removed from the windpipe. Although the patient will be awake, drowsiness will persist for sometime.
Serious complications of general anesthesia are unusual. Probably the most serious complications are regurgitation and aspiration of food. This is why it is important that patients do not eat or drink anything once labor begins.
The anesthesiologist often gives the patient a fluid antacid to drink prior to the administration of anesthesia to minimize the risks of complications from aspiration.