Pain-Relief During Labour & Delivery

Analgesia is the full or partial relief of painful sensations. Anaesthesia is usually considered to be a more intense blockage of all sensations, including muscle movement.
Your wishes and your medical condition are important in selecting the type of pain relief administered to you. Be assured that your physicians will prescribe or administer medications only in the amounts and during those stages of labour that are best for the safety and well-being of your baby.
Also, bear in mind that, as the WHO states, "pharmacological methods should never replace personal attention to the labouring woman and tender loving care." [ 3 ]

There are several choices for pain relief during labour. These include:

1. Intravenous (I.V.) Medication ­ Pain-relieving medications that are injected into a vein or muscle will help dull pain but may not eliminate it completely. These IV medications are usually prescribed by your obstetrician. Because they sometimes make both you and your baby sleepy, they are used mainly during early labour.
2. Local Anaesthesia ­ Other pain-relieving medications may be injected in the vaginal and rectal areas by the obstetrician at the time of delivery. Theses are local anaesthetics, which provide a numbness or loss of sensation in a small area (e.g. during an episiotomy ).
3. Regional Blocks ­ Regional blocks can reduce the discomfort of labour and provide either analgesia or anaesthesia. Regional blocks refer to epidural and spinal blocks . They are administered in the lower back, usually by an anaesthesiologist. An epidural block administered below the level of the spinal cord is called a lumbar epidural block , and when given in the tailbone area is a caudal block . Local anaesthetics and other drugs are used for these procedures to reduce or block pain and other sensations over a wider region of the body. Epidural analgesia may be used for labour and vaginal delivery. An epidural block may also be used to provide anaesthesia for a caesarean section. A spinal block may be used to provide labour analgesia or anaesthesia for a caesarean delivery. A combined spinal/epidural block also may be used for labour analgesia and/or anaesthesia in certain cases. 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 labour may actually progress faster.

Anaesthesia for Caesarean Births

Epidural , spinal or general anaesthesia may be given safely for cesarean-section deliveries . Choices depend on several factors, including the medical conditions of the mother and baby and, when possible, the mother's preferences.

Epidural block . If the mother-to-be already have a labour epidural catheter in place and then need a caesarean delivery, it is usually possible for the anaesthesiologist to inject additional anaesthetic medication through the same catheter to enhance pain relief safely. This stronger concentration of medication converts the analgesia to anaesthesia Anaesthesia is necessary to numb the entire abdomen completely for the surgical incision.

Spinal anaesthesia is given using a much thinner needle in the same location of the back where an epidural block is placed. The main differences are that a much smaller dose of anaesthetic medication is needed for a spinal block, and it is injected into the sac of spinal fluid below the level of the spinal cord. Once the spinal anaesthetic medication is injected, the onset of numbness is quite rapid.

General anaesthesia is used when a regional block is not possible or is not the best choice for medical or other reasons. It can be started quickly and causes a rapid loss of consciousness. It is used when an urgent vaginal or caesarean delivery is required, as in rare instances of problems with the baby or vaginal bleeding. In these circumstances, general anaesthesia is quite safe for the baby.
One of the most significant concerns during general anaesthesia is whether there is food or liquids in the mother's stomach. During unconsciousness, aspiration could occur, meaning that some stomach contents could come up and then go into the lungs. Here they could possibly cause pneumonia. The anaesthesiologist, therefore, takes extra precautions to protect the mother's lungs, such as placing a breathing tube into her mouth and windpipe after she has been anaesthetised.

Please discuss your anaesthesia-related questions or concerns with your obstetrician/health care provider.

For further, more detailed information on this topic, please refer to the reference source for this page.

The information in this page is presented in summarised form and has been taken from the following source(s):
1. American Society of Anaesthesiologists: http://www.asahq.org/
2. The Society for Obstetric Anaesthesia & Perinatology, U.S.A.: http://www.soap.org/
3. Care in Normal Birth: A Practical Guide. Report of a Technical Working Group, World Health Organisation, Department of Reproductive Health and Research, 1999. http://www.who.org