Moms: Know Your Options for Birthing Pain

Special to the Herald-Leader,Dr. Stephanie shumate PartinJanuary 19, 2014 

Many women request epidural anesthesia when the pain of labor becomes uncomfortable. In fact, it is the most frequently used method of pain control.

Understanding choices for pain management before labor and delivery better prepares a mom-to-be for the decisions she will make during the birth. Intravenous medications such as morphine or stadol are common choices among laboring women during early stages of labor. Other popular choices of labor pain relief, also called regional anesthesia, include epidural anesthesia, spinal anesthesia (most commonly used in cesarean deliveries), or a combination of epidural and spinal analgesia. Patient-controlled analgesia is also a popular choice. Approximately 60 percent of laboring women choose regional anesthesia for pain relief during childbirth. An epidural is a form of regional anesthesia that helps to block pain.

Medicines called local anesthetics (ropivicaine, lidocaine, bupivacaine or chloroprocaine) achieve this goal by blocking nerve impulses from the spinal cord. They are most often used in combination with narcotics (fentanyl or sufentanil) so as to decrease the total dose of local anesthetics used.

Most obstetrical anesthesiologists use very low concentrations of local anesthetics and narcotics in their laboring epidurals. This combination allows for effective pain relief throughout labor with minimal adverse effects in both mother and baby.

Benefits of epidurals in obstetrics include:

 Reduces pain and stress

 Allows the laboring mom to rest

 Enables the mom to be more alert during the birthing process

 Provides anesthesia for episiotomy, if necessary

 May allow the mom to participate in the delivery experience should a cesarean section be required. The prior placement of a functioning epidural catheter may allow for extension of the block for surgical anesthesia.

 Avoids opioid-induced mother and baby respiratory depression from intravenous opioids

Disadvantages of epidurals include:

 Low blood pressure. An intravenous fluid load prior to epidural placement helps to decrease this drop.

 Difficulty urinating, a severe headache, fever, backache, nausea and vomiting, itching or shivering

 Additional interventions such as Pitocin, vacuum extraction, forceps or cesarean section may become necessary, but these events may not be related to the epidural

 Although rare, paralysis, seizures and cardiac arrest are possible.

The ultimate decision for getting an epidural is totally up to the laboring mother. It is important to be informed, educated and open-minded regarding the choices. A health care provider can help a mom-to-be with her decision making. The goal is a happy and healthy mother and baby.

Dr. Stephanie Shumate Partin, an obstetrical anesthesiologist with Baptist Anesthesia, practices at Baptist Health Lexington.

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