INTRODUCTION

The Midwest Physician Anesthesia Services (M.P.A.S) care team strives to make your childbirth experience as safe and pleasant as possible. Each woman’s labor is unique to her and everyone experiences a different level of pain. Exactly how much pain you feel will depend on your pain tolerance, the size and position of your baby, and the strength of your contractions. Your anesthesiologist, nurse anesthetist, OB nurse, and obstetrician will work with you to customize your specific anesthetic needs.

Types Of Pain Relief
There are several useful methods to relieve pain during labor and delivery.

Intravenous (I.V.) pain medications are used mainly in early labor and usually are prescribed by your obstetrician. I.V. medications dull the pain but do not eliminate it. They may make you and your baby somewhat sleepy.

Local Anesthesia may be used by your obstetrician at the time of delivery to numb the vaginal and rectal areas. Local anesthesia often is used when an episiotomy is necessary. While local anesthesia may ease the pain of delivery, it will not ease the pain of contractions.

Regional Anesthetics and General Anesthetics are administered by the Anesthesia Care Team (Anesthesiologists and Nurse Anesthetists). Regional Anesthesia includes spinal and epidural anesthesia. Regional blocks are administered by injection of an anesthetic solution into the lower back. Regional blocks may be used for easing the pain of labor or for anesthesia during a cesarean section. General Anesthesia can be used during cesarean section and rarely during vaginal delivery. You will be asleep during general anesthesia.

Regional Anesthetics For Labor
Epidural Anesthetics are very popular because of the excellent pain relief that they provide. While they do not eliminate all sensation, epidural blocks greatly diminish the pain of contractions. After evaluating your stage of labor and your baby’s condition, your obstetrician will decide when it is appropriate to prescribe an epidural. Then, the anesthesiologist or the nurse anesthetist, in consultation with the anesthesiologist, will perform a pertinent medical history and exam prior to placing your epidural. The epidural is administered in your lower back using a special needle. The needle is placed below the level of your spinal cord. Depending on the preference of the anesthesiologist you either will be sitting or on your side when the block is performed.

The anesthesiologist will wash off your back with antiseptic solution, and then will use a local anesthetic injection to numb your skin. The epidural needle will be placed in the epidural space, just outside the sac that holds your spinal fluid. Next, a tiny flexible tube is inserted through the needle. This tube will be left in place during your labor. Occasionally the tube will gently brush against a nerve and you will experience a brief tingling sensation similar to “hitting your funny bone”. Anesthetic solution, which bathes the nerves and blocks the pain, is continually administered through this tube.

It takes between 10 to 20 minutes for the epidural to take full effect. After that time your anesthesiologist will adjust the degree of numbness to meet your particular needs. The block will last as long as you need it. You may notice some temporary numbness or heaviness in your legs.

After delivery the epidural catheter will be removed and your normal sensation will return within a few hours.

What Are The Risks Of An Epidural ?
Complications or side effects can occur but are uncommon. Serious complications are very rare. At Riverside Hospital, over 5000 patients safely receive epidural anesthetics each year. Our anesthesiologists take special precautions to avoid any adverse effects. To prevent your blood pressure from dropping, you will be given IV fluids before the epidural is administered. After the epidural is placed, and until your baby is delivered, you will be positioned with your hips slightly tilted.

Shivering is common during labor and often occurs whether or not you receive an anesthetic. Warm blankets are available to help.

Although uncommon (1% or less), a headache may develop following a regional anesthetic. This occurs if the needle nicks the sac that holds the spinal fluid. Your anesthesiologist will ask you to hold as still as possible during the placement of the needle to help decrease the likelihood of a headache. When it occurs, the headache may last a few days. If the headache persists, there are several effective types of treatment available.

Since the blood vessels in the epidural space become swollen during pregnancy, your anesthesiologist will administer a test dose to make sure the epidural tubing is not within a vessel. After the test dose you will be asked if you notice any dizziness, a funny taste in your mouth, or a rapid heartbeat.

Other types of regional anesthesia are available during labor. Your anesthesiologist, obstetrician, and you will decide which type of anesthesia best fits your particular situation.

Anesthesia for Cesarean Sections
Epidural, Spinal and General Anesthesia can be used for Cesarean deliveries. The proper choice of anesthetic depends upon your particular medical condition and, when possible, your preferences. Your anesthesiologist will discuss your options and suggest the safest method for you.

Spinal Anesthesia
Most commonly, a spinal anesthetic is recommended for Cesarean delivery. A spinal provides a rapid, dense numbness.

The spinal needle is much thinner than the epidural needle and is placed within the sac of fluid that bathes the spinal cord. A small amount of local anesthetic is administered through the needle and the numbness begins almost immediately. Side effects are similar to those experienced with epidural blocks. In addition, after a spinal anesthetic, it is not uncommon for the skin on your chest to feel heavy because it is numb. Although your breathing is normal, it may seem to be different because of the heavy sensation.

Epidural Anesthesia
If you already have an epidural anesthetic in place when you need a Cesarean Section, a stronger dose of medication can be given through the tubing to make you numb for surgery. Also, there are some medical conditions that make an epidural anesthetic more appropriate than a spinal anesthetic for Cesarean delivery. Your anesthesiologist will discuss those situations with you if your condition warrants.

General Anesthesia
General Anesthesia is used when regional anesthesia is not possible or is not the safest choice for your medical condition. It is usually reserved for emergency situations when your baby must be delivered rapidly. One of the most significant concerns during general anesthesia is whether there is food in the mother’s stomach. As you go off to sleep, “aspiration” could occur, meaning that some of the food from your stomach could come up and go into your lungs. If this occurs you could develop a serious pneumonia. Your anesthesiologist takes special precautions to protect your lungs.

It is best to remember that YOU SHOULD NOT EAT OR DRINK ANYTHING AFTER YOUR LABOR PAIN BEGINS, regardless of your plans for delivery or pain control. Sometimes during labor, small sips of water, ice chips, or Popsicles are permissible with your anesthesiologists consent.

Can My Partner Be With Me During My C-Section ?
Your partner will be allowed in the room once your block has been placed and the Surgery is about to begin. During general anesthesia or emergent Cesarean deliveries, your partner will not be allowed in the room during the delivery. Your partner may be allowed in briefly to see the baby following delivery.

In Summary
The MPAS anesthesia care team will try to make your birthing experience as pleasant and safe as possible for you and your baby. If you have any questions or concerns, please discuss them with your obstetrician who can arrange a consultation for you with one of our anesthesiologists.

Billing for Anesthesia Services
You will receive a bill from Midwest Physician Anesthesia Services, Inc. separate from your hospital bill. This bill will reflect all the services preformed by our anesthesiologist or our CRNA during your delivery and hospital stay. The type of procedure, your physical condition, the total time of anesthesia, and the performance of special procedures determine the cost.

Insurance coverage for anesthesia varies greatly. Your individual policy may or may not cover the full charge. We will submit your claim on your behalf and according to your insurance you may be responsible for the balance. If you have questions please call our billing department 614-884-0641 or toll free 866-300-6019.