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OBSTETRIC ANESTHESIA QUESTIONS:

I am nervous about my cesarean; can I be asleep for it?

General anesthesia has added risks for mom and baby compared with spinal anesthesia, which include the risk of aspiration of fluid and solids from your stomach into your lungs. Therefore, we put you to sleep only in unique situations and emergencies.

Will I get back pain from a spinal or epidural?

Spinals and epidurals do not cause long-term back pain. You may have mild bruising and tenderness where the spinal or epidural is placed that can last a few days.

hOW LONG DOES AN EPIDURAL LAST?

Once the catheter is in place, the anesthetist can set up an epidural pump. The pump feeds the epidural solution into the catheter continuously, providing pain relief for as long as needed. The type, amount and strength of the anesthetic can be adjusted, as necessary. You might also be given the option of having control of the medication pump. This is called patient controlled analgesia. The amount of painkiller is still regulated, so you can’t accidentally overdose. You can have the dose lowered for second stage pushing, but it takes some time for the pain relief and numbness to wear off, so if this is important to you, discuss it with your care provider early on.

wHAT IS AN  epidural?

Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than anesthesia, which leads to a total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body. Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, or lidocaine. They are often delivered in combination with opioids or narcotics such as fentanyl and sufentanil in order to decrease the required dose of local anesthetic. This produces pain relief with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure.

HOW IS AN EPIDURAL GIVEN?

Intravenous (IV) fluids will be started before active labor begins and prior to the procedure of placing the epidural. You can expect to receive 1-2 liters of IV fluids throughout labor and delivery. An anesthesiologist (specialize in administering anesthesia), an obstetrician or nurse anesthetist will administer your epidural.
You will be asked to arch your back and remain still while lying on your left side or sitting up. This position is vital for preventing problems and increasing epidural effectiveness.

1. An antiseptic solution will be used to wipe the waistline area of your mid-back to minimize the chance of infection. A small area on your back will be injected with a local anesthetic to numb it. A needle is then inserted into the numbed area surrounding the spinal cord in the lower back.
2. After that, a small tube or catheter is threaded through the needle into the epidural space. The needle is then carefully removed, leaving the catheter in place to provide medication either through periodic injections or by continuous infusion. The catheter is taped to the back to prevent it from slipping out.
3. You’ll start to notice the numbing effect about 10 to 20 minutes after the first dose of medication, though the nerves in your uterus will begin to go numb within a few minutes. You’ll receive continuous doses of medication through the catheter for the rest of your labor.

wHAT ARE THE DIFFERENT TYPES?

There are two basic epidurals in use today. Hospitals and anesthesiologists will differ on the dosages and combinations of medication. You should ask your care providers at the hospital about their practices in this regard.
Regular Epidural
After the catheter is in place, a combination of narcotic and anesthesia is administered either by a pump or by periodic injections into the epidural space. A narcotic such as fentanyl or morphine is given to replace some of the higher doses of anesthetic, like bupivacaine, chloropropane, or lidocaine.
This helps reduce some of the adverse effects of the anesthesia. You will want to ask about your hospital’s policies about staying in bed and eating.
Combined Spinal-Epidural (CSE) or “Walking Epidural”
A spinal block is sometimes used in combination with an epidural during labor to provide immediate pain relief. A spinal block, like an epidural, involves an injection in the lower back. While you sit or lie on your side in bed, a small amount of medication is injected into the spinal fluid to numb the lower half of the body. It brings good relief from pain and starts working quickly, but it lasts only an hour or two and is usually given only once during labor. The epidural provides continued pain relief after the spinal block wears off.

What will i experience during my epidural placement?​

• You have to stay still for 10 to 15 minutes while the epidural is put in, and then wait up to 20 minutes before the medication takes full effect.
• Epidurals may cause your blood pressure to suddenly drop. For this reason, your blood pressure will be routinely checked to help ensure adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen.
• You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect. If symptoms persist, a procedure called a “blood patch”, which is an injection of your blood into the epidural space can be performed to relieve a headache.
• After your epidural is placed, you will need to alternate sides while lying in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop.
• You might experience the following side effects: shivering, a ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
• You might find that your epidural makes pushing more difficult and additional medications or interventions may be needed, such as forceps or cesarean. Talk to your doctor when creating your birth plan about what interventions he or she generally uses in such cases.
• For a few hours after the birth, the lower half of your body may feel numb. Numbness will require you to walk with assistance.
  In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
• Though research is somewhat ambiguous, most studies suggest that some babies will have trouble “latching on” causing breastfeeding difficulties. Other studies suggest that a baby might experience respiratory depression, fetal mispositioning, and an increase in fetal heart rate variability, thus increasing the need for forceps, vacuum, cesarean deliveries, and episiotomies.

wHAT ARE THE BENEFITS OF EPIDURAL ANESTHESIA?

• An epidural provides a route for very effective pain relief that can be used throughout your labor.
• The anesthesiologist can control the effects by adjusting the type, amount, and strength of the medication. This is important because as your labor progresses and your baby moves down into your birth canal, the dose you’ve been getting might no longer be adequate, or you might suddenly have pain in a different area.
• The medication only affects a specific area, so you’ll be awake and alert during labor and birth. And because you’re pain-free, you can rest (or even sleep!) as your cervix dilates and conserve your energy for when it comes time to push.
• Unlike with systemic narcotics, only a tiny amount of medication reaches your baby.
• Once the epidural is in place, it can be used to provide anesthesia if you need a c-section or if you’re having your tubes tied after delivery.