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Obstetrical Anesthesia

 Giving birth to a child is one of the most exciting and rewarding experiences of one’s life. BVA anesthesiologists are committed to making the delivery of your newborn as safe, comfortable, and rewarding as possible.  We recognize that each pregnancy is unique and that every expecting parent has different expectations and goals.  We at BVA are committed to offering our skills and expertises to assist you experience the safest and most rewarding delivery experience possible.

BVA is skilled at providing all types of anesthesia and analgesia for our obstetric patients. We encourage all expecting mothers to become as informed as possible as you develop your birth plan.  We recommend that you understand as many options as possible as every individual has a different pain tolerance and not all labors are the same.  Additionally not all labors proceed as planned, and you may need to adapt to your particular circumstances.  By understanding all the available options, you will be better prepared for whatever nature many present you. 

We hope the following information will assist you in making informed decisions that will fit you best as you consider you labor options. 

Major Types of Pain Control:

Natural childbirth:  While this may not be for everyone, many mothers find it very rewarding to avoid medical interventions.  Some women are able to achieve adequate pain control through techniques such as controlled breathing, meditation, focused relaxation, massage, and other methods.  It is important to remember that labor can be unpredictable and everyone experiences the discomfort  differently.  Labor may range from a relatively quick and easy experience to one that is lengthy, painful and exhausting.  Discomfort that may normally be tolerable may become unbearable as fatigue sets in.  A woman should never feel guilty about asking for relief as only she knows the level of discomfort she is experiencing.  We at BVA are here to assist in any way that you may require.

IV (Intravenous) Medication:  Your obstetrician or midwife may order pain medications that can be administered through an IV that will be placed in one of the veins in your arm. These medications can effectively reduce the pains of labor, but generally do no stop the pain entirely. Some women have adequate pain control for labor with only these IV medications. These medications tend to work fairly rapidly, but have a limited duration of action generally from about 30 to 60 minutes.  They must be carefully administered and as they may sedate your newborn and may not be available close to the time of delivery.  We find this to be a good option for expecting mothers that desire a more natural experience, but desire a short break from labor allowing them to recompose themselves and then return to the labor process.

Local Anesthesia:  This option means the injection of a numbing medication directly into tissues in a localized area.  Your obstetrician may be able to inject local anesthetics directly into the vaginal or cervix area to relieve some of the pain associated with your actual delivery. This is only used during the deliver process and would not be an option to provide pain relief in the earlier stages of labor.

Regional Blocks:  This option means the injection of medications that effect a region or area of the body.  In obstetrical anesthesia, this usually means the lower part of the body.  This option is where we as the anesthesiologists of BVA most commonly become involved. 

The most common forms of OB regional anesthetics include epidurals and spinalsEpidurals are most commonly used for labor and vaginal deliveries and can provide excellent anesthesia for the labor process as well as the delivery.  The technique usually involves the placement of a very small plastic tube or catheter in the epidural space.  This then allows for the administration of medications over as long a time period as required for the labor process.

Another form of regional anesthesia is a subarachnoid block which is commonly called a “spinal”.  This typically involves the placement of a very small needle in the lower spine area.  Generally this is done as a “one shot” single injection but occasionally a small tube similar to an epidural catheter may be placed.  Medications are injected and then the needle is removed.  Spinals tend to have very rapid onset times and provide excellent anesthesia, but have a limited duration of action.

Occasionally combinations of a spinal and an epidural may be administered. 

Administering an Epidural:  The timing of epidural placement is usually determined by your obstetrician or midwife.  Once it is determined that you are in an adequate labor pattern and epidural placement is recommended, we will be called.  Upon our arrival we will review your general health, check your laboratory results, and you will be given an opportunity to have any last minute questions answered.  You will be asked to either lie on your side or sit up on the edge of the bed. Your back will be washed with a sterile solution and covered with a sterile drape.  It will be important that you do not attempt to reach back or touch this sterile drape to maintain our sterile field.  You will also be asked to hold as still as you possibly can while the epidural is being place.  We understand that you will most likely experience some contractions while we are performing the procedure, and we will help you work through these together.   A small area of skin will be anesthetized with local anesthetic, a epidural needle will be placed through this numbed area to the epidural space, and a epidural catheter (a tiny plastic tube) will be inserted. The needle will then be entirely removed leaving only the catheter in place. The catheter will then be secured to your back with tape.  Medications will then be injected through this catheter.  

We at BVA generally attempt to give the least amount of medication required to greatly reduce the discomfort of labor contractions while still allowing you to move your legs and push the baby through the birth canal.  Sometimes this is called an “epidural lite”.  The block can also be made stronger, if necessary, if your situation requires.  Generally we will attach a special pump called a PCEA or Patient Controlled Epidural Analgesia to the catheter.  This pump will contain medications that provide pain relief and will be programmed to continuously administer a small amount of medication.  This may be all that you need for pain relief, but as your labor progresses you may experience increasing discomfort. If this is the case, there is a button that you can push yourself and the pump will administer an additional dose of medications.  This pump will be programmed so that you can not give yourself too much medication and provides a nice option for you to have more control over the labor and anesthesia process.

Epidural anesthesia is safe for both you and your baby. Because medications are not injected into your veins, the possibility of them reaching your baby is very small. An expectant mother should feel more comfortable soon after the epidural is placed and the drugs are injected. When a mother feels less discomfort, her stress level is reduced, and her baby, in turn, experiences less stress.

Risks of Regional Anesthesia:  All of the physicians at BVA are board certified anesthesiologists and are experts in the placement and managing of epidurals and spinals. Even though special precautions are taken to minimize the risk associated with performing regional blocks, as with all medical procedures a minimal amount of risk still remains. Complications do not occur often and rarely lead to significant problems for the mother or baby.

Occasionally an epidural may cause your contractions to slow or spread out, generally this is limited to about 10 to 15 minutes. Your blood pressure may also lower, requiring an increased flow of intravenous fluids or occasionally medications. Sometimes women experience a mild sore spot or backache where the epidural was inserted.  Severe back pain is rare, as are headaches, leg weakness or numbness, infections or allergic reactions. Occasionally, mild itching may result from certain medications that may be administered. Most epidural work very well and provide superior pain relief.  While we work very hard to assure a properly functioning epidural, occasionally they may need to be adjusted or possible even replaced.  We will work with you until you are satisfied.

Both mother and baby are monitored closely throughout labor.  An anesthesiologist along with emergency drugs and equipment are always available to treat the rare complication.  Your anesthesia care provider will discuss these risks with you and any other questions you might have at any time.

Anesthesia for C-sections:  You may be scheduled for an elective C-Section or for a variety of reasons your anticipated vaginal delivery may require as C-Section.  Depending on your individual situation there may be several anesthetic options.  Scheduled C-Sections are usually done with a spinal.  If a laboring patient with an epidural requires a C-Section, the epidural can generally be used to provide an excellent anesthetic. Rarely, conditions may require that a General Anesthetic (going to sleep) be given. 

The policy at BCH allows for one family member to accompany a patient in the operating room during most C-Sections.

Questions:  The physicians of BVA are glad to answer any questions you might have concerning your anesthetic needs for your labor and delivery. If you attend one of the birthing classes provided by BCH, frequently a member of BVA will give a short presentation and answer your questions.  If this does not work with your schedule, a consultation can be arranged if necessary.   This can be arranged by contacting the Labor and Delivery deck at BCH by calling 720-854-7100.

We at BVA appreciate the opportunity to be a part of this most memorable day of you life!

Disclaimer

IMPORTANT - This website is intended to provide an introduction to information as it relates to the practice of anesthesiology and is not intended to be construed as medical or anesthesia advice for your or any other particular situation. For additional information please Click Here.