During Pregnancy, Pregnancy

Anesthesia During Childbirth

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Anesthesia During Childbirth

Childbirth is often welcomed with excitement and joy, but it can also be associated with heightened nerves and immense pain. The pain is mostly caused by the baby being pushed out of the female’s body. As mothers have been giving birth since the beginning of humankind, there have been countless forms of anesthesia that have evolved over generations and cultures. In contemporary society, a large portion of mothers opt to use doctor-administered anesthesia during the childbirth process. Modern medicine has enabled the use of anesthesia as a pain management option during pregnancy. Anesthesia is a medicine which can be administered in a variety of different ways to help alleviate pain or cause patients to purposefully lose consciousness for a set period of time. It is the rendering of a patient satiated and is administered in a hospital or an appropriate medical setting. The ideal anesthesia during childbirth should provide enough pain relief to allow the pregnant female to push at the appropriate time and remain alert to participate in the childbirth.1 Anesthesia during childbirth should not stop contractions or make the baby sleepy.1 The anesthesia administered during childbirth is different than anesthesia used during most surgeries. The anesthesiologist must balance two patients: the expecting mother and her newborn. Thus, there is an intricate balance between pain management and the health of the baby. Many expecting mothers become nervous about the pain associated with childbirth. However, with information, a game plan, and consultation with their doctors, the correct pain management plan can make the childbirth process as painless as desired.

Some mothers may decide against using anesthesia during childbirth because they want to experience a natural childbirth. However, there is no set or current definition for a “natural childbirth”. Some believe that natural childbirth takes place outside of the hospital and without any medications; others believe that receiving anesthesia during childbirth can still be considered natural.

Various Types of Anesthesia During Childbirth    

There are a few types of anesthesia that can be administered during childbirth. Learning about each of the different types of anesthesia can enable expecting mothers to engage in an informed discussion with their doctor about which form of anesthesia will best fit the female’s desires and birth plan.

Epidural

An epidural is the most common form of pain relief administered to females in labor.2 This type of anesthesia blocks nerve impulses from the lower spine to decrease pain felt in the bottom half of the body.3 The epidural is administered by an anesthesiologist. A needle and a catheter, a small tube, is inserted into the lower part of the female’s body, usually below the belly button area.2 An epidural can take effect in as little as 15 minutes and can be administered for as long as needed. The medication can also be altered in quantity and strength to match the needs of the expecting mother.2 More than 50 percent of expecting mothers will use epidural anesthesia at the hospital.2

While epidurals are usually safe for expecting mothers, there is a small risk for potential side effects. The most common side effect is a decrease in blood pressure. Epidurals decrease both the expecting mother’s heart rate, as well as that of her unborn baby.2 To minimize the risk of low blood pressure, doctors will insert an intravenous (IV) line into the expecting mother’s arm to administer extra fluids. Expecting mothers may also be asked to lay on their side in order to increase their blood flow. Another side effect is soreness of the back. This soreness is usually only temporary and is located where the needle was inserted to administer the medication. The back soreness and pain typically last for only a few days. A third complication associated with epidurals are headaches. Headaches can occur if the needle pierces the covering of a spinal cord. If this complication occurs, an anesthesiologist will be able to treat the expecting mother accordingly.2

Spinal Block

A spinal block is administered into the lower spinal canal via a large needle.2 This medication is a strong pain-reliever and has an immediate effect. Expecting mothers will feel no pain when the needle is inserted, and they will be temporarily numb from the waist down. The pain relief will last between one to three hours, meaning that the effects can wear off prior to the delivery of the baby. Due to the varying times of delivery, it is crucial that the spinal block be administered at the right time.2

Analgesics

Analgesics consist of opioid and non-opioid options and are administered via an intravenous (IV) line. Opioids, also known as narcotic analgesics, are a schedule II/III controlled substance derived from opium, a natural drug, and are a powerful form of pain relief. Schedule II and III have the potential to be abused. Non-opioid, also known as non-narcotic analgesics, are most often over-the-counter pain medication and are not as strong when compared to opioids.4 The IV is inserted into either a vein or a muscle. While analgesics can temporarily relieve pain, they do not eliminate the pain. As a result, it is critical to administer the analgesics at the most optimal time.2

General Anesthesia

General anesthesia is the only form of anesthesia administered during labor that puts the expecting mother into a controlled state of unconsciousness.2 General anesthesia takes an almost immediate effect and is usually only used during an emergency Caesarean section (C-section) or other critical medical emergency, including severe bleeding. Expecting mothers who require general anesthesia will not be awake for their child’s birth. General anesthesia is rare and is not recommended for healthy pregnancies and childbirth, and should only be used as a last resort.

Complementary Methods

Complementary methods of pain management during labor may be performed by a number of people including the expecting mother’s partner, loved ones, family, friends, and nurses. The complementary methods listed below are considered more natural and are sometimes used to manage pain in addition to other forms of anesthesia.2

  • Massage: Massaging the expecting mother’s feet or back can not only relieve pain, but also help her feel more relaxed and comfortable. It is important to have strong communication between the expecting mother and the person giving the massage.2
  • Breathing: There are a number of breathing exercises that the expecting mother can practice to relieve pain. Deep and slow breaths can help relax the expecting mother and help her to stay focused. Grunting may also be an effective form of pain relief and expecting mothers should not feel embarrassed about any noises or sounds they may make during childbirth.2
  • Visualization: An expecting mother may close her eyes and visualize a more relaxing and comforting place to help distract her from the pain. Working through visualization exercises prior to the delivery has proven to be effective in helping the expecting mother be more comfortable and familiar during the delivery process.2
  • Water: There are various ways in which water can be used to manage pain during childbirth. Taking a warm bath or a shower can help relax muscles and relieve some of the pain that the expecting mother may be experiencing. When the expecting mother is close to delivery, a cold and damp wash cloths placed on the forehead, armpits, wrists, and back of the neck can be soothing, especially if the expecting mother is feeling nauseous.2 Ice chips may also be used and placed on the forehead or the back of the neck. Working with a doctor, an expecting mother may create her own plan to utilize a combination of these options.

Administration of Anesthesia During Childbirth

A physician anesthesiologist administers the anesthesia to expecting mothers. Anesthesiologists complete between 12 to 14 years of formal medical education, coupled with 12,000 to 16,000 hours of clinical training.2 They are specialists in managing pain during childbirth and surgeries. Anesthesiologists will work with the expecting mother and the obstetrician/gynecologist (OB/GYN) to formulate the best game plan to manage the pain.

What Expecting Mothers Should Tell Their Doctors

Effectively communicating with doctors can help in formulating a birth plan which includes the appropriate anesthesia. Upon first meeting with their OB/GYN, expecting mothers may want to discuss their options for anesthesia. This conversation can start during the first visit and continue until the moment of delivery. Even if an agreed upon form of anesthesia is planned, it is normal for patients and doctors to decide to change course based on new factors, such as an increased level of pain. Talking early and often with doctors about anesthesia will allow for a more comprehensive and complete list of all the possible options. When talking with doctors, it is crucial for the patient o list any history of lower back pain or any respiratory conditions including asthma, pneumonia, or have a family history of high fevers. Any known allergies should also be communicated.1 On the day of delivery, expecting mothers should tell their doctors their “food and drink intake for the last several hours” or any illnesses or conditions not associated with the pregnancy, such as a cold or flu. The more information provided to the doctors, the more specialized, safe,  and effective the administered medicine will be.1

Anesthesia in Different Birthing Locations

Anesthesia is most often administered by an anesthesiologist, who typically works in a hospital. Giving birth in a hospital allows for the most flexibility, meaning that if the expecting mother suddenly experiences more pain than expected, the hospitals are equipped with the anesthesia and doctors necessary to provide appropriate pain relief at a moment’s notice.

Birthing centers typically do not offer anesthesia and instead boast about offering more holistic forms of pain relief. Therefore, if unanticipated pain during childbirth occurs, the expecting mothers will have fewer resources to help manage the pain.  However, in some instances, birthing centers will have an anesthesiologist. Therefore, if the expecting mother is planning on giving birth in a birthing center, it is recommended to call ahead and inquire about the center’s ability to provide anesthesia, and what type of anesthesia they have available.

Giving birth at other less traditional locations, such as at home or a place of work, provides the least amount of anesthesia. While expecting mothers in these situations may be able to tolerate the pain, every expecting mother is unique and each have different pain thresholds and desires for childbirth.

Cost of Anesthesia

The cost of anesthesia during childbirth is usually included in the total hospital bill for the expecting mother. The cost of anesthesia to the expecting mother differs depending on the healthcare system in their country. For example, universal healthcare in countries such as Canada and the United Kingdom typically cover all maternity related costs, including the anesthesia. In the United States, the cost of anesthesia and total cost to deliver a baby in a hospital depends on what type of insurance one has. Therefore, it is highly recommended that an expecting mother contact her insurance provider for more specific information. With some insurance plans, expecting mothers will pay nothing out of pocket, however with other plans, or no insurance, a hospital bill for maternity care can be as much as $50,000. As of 2012, the cost to deliver a baby in the United States was $9,775 with insurance.6

Pain During Childbirth   

A majority of mothers who have given birth describe being in a great deal of pain during this process. However, in some cases, mothers do not report feeling any pain or discomfort. Each expecting mother and childbirth situation is different. Even mothers who have previously given birth can have a different experience with pain in subsequent childbirths. Some mothers compare the pain of childbirth with that of severe menstrual cramps. Other mothers report pain from their insides or lower back. It is important to communicate one’s pain to the doctors so they can best treat the expecting mother.

Factors such as age, culture, and religion can play an important role on how expecting mothers perceive pain and how they react to the pain.7 For example, in Korean society, women are expected to remain silent during childbirth, so they do not bring shame to their families.7 However, in western society, and particularly the United States, there are numerous ways expecting mothers respond to the pain. Particularly in western society, media has a tendency to perpetuate a belief that childbirth is one of the most painful experiences humans can have.

There are two main types of pain that expecting mothers can experience during childbirth: physiological and psychological. Physiological pain is the pain that is physically present and a direct result of the baby getting ready to exit the birthing canal. Physiological pain includes the expecting mother’s fear of the birthing process, delivery, and responsibilities of becoming a mother. To address the physiological pain, anesthesia and other techniques such as breathing and cold water compresses may be used. Positive thinking, reinforcement, and encouragement along with a game plan can help to address the possible physiological pain associated with childbirth. 

Pain After Childbirth

Many expecting mothers report some pain and discomfort in the days and weeks after childbirth. This phenomenon is normal and is most often caused by the tremendous amount of work the expecting mother’s body has endured when giving birth.8 After childbirth, the mother’s uterus begins to shrink back to its normal pre-pregnancy size.8 This transition, commonly known as after pains, can last between 6 and 8 weeks after birth.

After giving birth, the expecting mother can feel soreness in her arms, neck, and jaw for just a few days. Breast engorgement, when the breasts begin to fill with milk, can be painful for some new mothers and takes place between three and four days following the delievery.8 In order to relieve the soreness or pains in the muscles and breast engorgement, new mothers can use ice packs, warm compresses, or hot showers to help relax the muscles and alleviate any pain.8 If the pain becomes unbearable or persists for an extended period of time, new mothers should contact their doctors as soon as possible.

Vaginal soreness, bleeding, and vaginal discharge is also common for a few weeks following the birth.8 It is therefore recommended that new mothers use pads rather than tampons in the weeks after giving birth. New mothers should also consult with their doctors about taking over-the-counter pain medications such as ibuprofen.8 If there is pain or swelling surrounding the opening of the vagina, it is recommended that new mothers use ice to help decrease the swelling and discomfort. When applying ice, make sure there is a thin layer of material, such as cloth or a paper towel between the ice and the skin. Traditionally, ice should be applied for 10 to 20 minutes in one sitting. However, please consult your doctor prior to doing so to in order to find the best remedies for one’s specific situation and circumstances.

To help cleanse their vagina, new mothers may want to use a warm wash cloth to wipe their vagina, rather than toilet paper to decrease possible irritations. For the few weeks after delivery, it is recommended that mothers wear loose, and comfortable clothes. Wearing loose clothes will help take off pressure and irritation to sensitive areas such as the breasts and the vagina. Getting plenty of rest and sleep is also critical for new mothers. After an enduring nine months, it is normal for new mothers to feel exhausted. Especially with a newborn and their irregular sleeping patterns, new mothers should get as much sleep as they can when possible.

Eating healthy is also important following birth. In most instances, new mothers will be breastfeeding and the nutrients they put into their body are directly transferred to the baby.  Since many new mothers will be taking care of their newborns, it is important that the new mother stay healthy and do not harm their newborns.  Due to the stress associated with becoming a mother, the mental health of the mother is important. Regular exercise and time devoted to their hobbies can help new mothers stay active and happy following the birth of their newborn.

It is critical to consult with a doctor to schedule checkup appointments for the new mother and the newborn. Even if the baby seems healthy and the new mother is not experiencing any pain or discomfort, going in for regular checkups will help ensure that the best care is given.

Concluding Remarks

Managing pain during childbirth is an important and crucial part of the labor process. While many expecting mothers may be nervous about the amount of pain they will experience during childbirth, anesthesiologists and the OB/GYN will be able to utilize a variety of methods to ensure that the baby is healthy upon delivery, while minimizing the amount of pain. Each mother is unique and there is not a one-step solution for eliminating pain. Expecting mothers should do their best to communicate their feelings with their doctors in order to ensure that the correct pain management solutions and amounts are being applied. Even though anesthesia may help to reduce pain during childbirth, it may not fully eliminate it. It is most helpful to use complementary methods along with a more traditional form of anesthesia during childbirth. Labor is an uncertain process, and it is normal to change the pain management game plan, even at the last minute. For example, some expecting mothers may go into labor not wanting to use anesthesia, only to change their mind. Therefore, keeping your options open and having an open and flexible attitude toward pain management is helpful for expecting mothers. Learning about the various forms of anesthesia during childbirth is the first step to a successful delivery.   

References

  1. Anesthesia Options for Labor and Delivery – What Every Expectant Mother Should Know." American Association of Nurse Anesthesists. American Association of Nurse Anesthesists, n.d. Web. 18 Apr. 2017.
  2. "Childbirth and Anesthesia." American Society of Anesthesiologists. American Society of Anesthesiologists, n.d. Web.
  3. "Using Epidural Anesthesia During Labor: Benefits and Risks." American Pregnancy Association. N.p., 24 Mar. 2017. Web. 03 May 2017.
  4. "Differences between Opioid and Non-opioid Analgesics." Differences between Opioid and Non-opioid Analgesics. EMedExpert, n.d. Web. 03 May 2017.
  5. Whitfield, Ann. "A Short History of Obstetric Anaesthesia." The Journal of Royal Medical Society, 1992. Web. 3 May 2017.
  6. Martinez, Patty Adams. "Labor & Delivery Costs: Hospital Bill Shocker." Parents. Parents, 21 July 2015. Web. 23 May 2017.
  7. Beigi, Nastaran Mohammad Ali, Khadijeh Broumandfar, Parvin Bahadoran, and Heidar Ali Abedi. "Women’s Experience of Pain during Childbirth." Iranian Journal of Nursing and Midwifery Research. Medknow Publications, 2010. Web. 23 May 2017.
  8. "Postpartum: First 6 Weeks After Childbirth – Recovery At Home." WebMD. WebMD, n.d. Web. 23 May 2017.

Last Updated: 19 June 2017.