Information for Patients :: Obstetrics (Labor and Delivery)

Obstetrics (Labor and Delivery)

Whether or not this is your first pregnancy, you may wonder about what types of pain relief will be available during your labor and delivery. There is a wide variety of pain relief options available and your obstetrician, nurse and anesthesiologist will work closely together to meet your needs.

There are two general categories of pain relief.

 

Recovery

Once the pain medicine has worn off, you may feel discomfort around the vagina, perineum, lower abdomen, or back. If your birth was vaginal, you may be given an over-the-counter pain medicine such as ibuprofen for relief. If you had a cesarean birth, you will be given stronger pain relief medicine.

 

Common Questions

The following is a list of some of the most commonly asked questions and answers about pain medicine for relief during labor and delivery?

Q: When can I have an epidural during the labor process?
A: This is a decision you, your obstetrician or certified nurse-midwife and anesthesiologist must make. However, there are several variables to consider. The first consideration is your labor pattern and the degree of dilation of the cervix. Another factor is whether this is your first, second or third delivery.

Q: What should I do if I have special concerns or needs and if there has been difficulty in my family with pain relief procedures?
A: Be sure to discuss these issues with your doctor during one of your prenatal visits. Also, alert the anesthesiologist to any special concerns you may have when you first arrive in labor and delivery.

Q: Which is better, spinal or epidural anesthesia?
A: Each type of anesthesia has its advantages, so an epidural may be better for one situation and a spinal for another. You and your anesthesiologist will make the choice to fit your situation. For most normal labors, the epidural is the most appropriate.

Q: Can I be paralyzed if I have a spinal or epidural?
A: With modern techniques and medications to risk of paralysis is virtually zero. There have been no cases of paralysis ot SMH and none have been reported in the literature for many years

Q: What is a spinal (postdural puncture) headache? What are the treatments for spinal headache?

Both spinal and epidural anesthesia carry the risk of a spinal headache.

A spinal or postdural puncture (PDPH) (or also sometimes called a meningeal puncture headache) may occur after spinal or epidural anesthesia when puncture of the dural sac allows for spinal fluid to leak out of the dural sac. If enough spinal fluid leaks out, a headache may occur especially when standing or sitting. A spinal headache may occurs any time after spinal or epidural anesthesia but most cases generally show themselves within 3-5 days after a spinal or epidural anesthetic. The characteristics and severity of the headache may vary. With improvements in needle design, the risk of a spinal headache after anesthesia is much less than a few decades ago.

If you have a headache after spinal or epidural anesthesia, you need to contact your surgeon or primary care physician if you are at home or notify the health care providers caring for you if you are still in the hospital. If you are at home and do not have a physician contact person, you should be evaluated at an emergency room. There are many possible causes for headache other than spinal headache from spinal or epidural anesthesia and your physician may need to examine you and perform several tests to see what is causing your headache.

If your headache is the result of spinal or epidural anesthesia, then there are several treatment options depending on the severity of your symptoms. If your headache is mild, treatment is conservative and includes taking oral pain-relieving medications, drinking fluids, and consuming caffeine (usually in the form of caffeinated beverages). The leaking puncture will normally repair itself in a few days-weeks and your symptoms will gradually improve. If your symptoms are severe or your symptoms do not improve, your anesthesiologist may recommend an “epidural blood patch” . This involves carefully takes a small amount of blood from one of your veins and injecting it into the epidural space in your back. The injected blood in the epidural space will form a clot and seal the puncture site. After the epidural blood patch, your spinal headache should improve within 12-24 hours. If after this time period, you still have symptoms compatible with a spinal headache, your anesthesiologist may recommend repeating the epidural blood patch one more time. Your anesthesiologist will discuss the balance between the risks and benefits of an epidural blood patch.

Should you have any further questions, please call our office at 941-366-2360.