We typically care for pregnant women in two settings:
- providing pain control (usually via epidurally administered medication) for women in labor who are expecting a vaginal delivery
- anesthesia for women undergoing cesarean section.
Epidural pain control for women in labor is safe and very effective. Epidural administration of anesthetics allows for excellent pain control while minimizing delivery of medications into the blood stream and to the baby.
The epidural catheter is placed through a needle after the skin has been numbed with local anesthesia. Once the catheter is in place, the needle is removed, leaving only the catheter. The epidural catheter is basically just a tiny straw that delivers the anesthetic medications to the epidural space.
Ten to fifteen minutes after placement, pain from labor contractions will ease. With a well functioning epidural, women are often not even aware that they are having a contraction. Leg numbness is common after epidural placement and will resolve a few hours after the epidural has been removed. Bladder dysfunction is also common during epidural pain control. Typically a bladder catheter is inserted to drain the bladder once the perineal area has become numb.
Serious complications from epidural catheter placement are extremely rare. The most common complication is accidental puncture of the sac containing the spinal fluid (which is intentionally performed during spinal anesthesia placement). If the spinal fluid sac is accidentally punctured during epidural placement, a spinal headache may result. Spinal headaches are very uncomfortable but usually resolve on their own. They are not dangerous and do not cause long term problems. If the spinal headache is debilitating or not resolving on its own then an epidural blood patch can be performed. Epidural blood patch for spinal headache has a success rate of at least 90%.
Cesarean section is usually performed under spinal anesthesia unless it is done under the most emergent situation. Spinal anesthesia for cesarean section is slightly safer for the mother compared to general anesthesia because it reduces the risk of airway problems. However, if deemed too emergent for spinal anesthesia, general anesthesia must be used instead. Typically two spinal medications are administered as a one time "shot". One medication is the actual anesthetic which causes complete numbness. The other medication is a small amount of narcotic pain medicine (preservative free morphine). The spinal morphine is given for pain control after the surgery is over and the numbness from the anesthetic has gone away. Spinal morphine is very potent and lasts about 20 hours. Because the dose is so small, absorption into the blood stream is negligible. Common side effects from spinal morphine include itching and nausea. You will have medications available to help counteract these side effects.
Learn more general information about spinal anesthesia.