Obstetric Anesthesia

Frequently asked questions and answers about obstetrical care anesthesia:

Can nitrous oxide be used during labor?

Nitrous oxide—sometimes called “laughing gas”—can help you manage pain and anxiety during labor and delivery. Odorless and tasteless, nitrous oxide is a gas delivered via a small face mask that you can put on or take off as needed. It is a good option if you are prone to anxiety because you control its use. Nitrous oxide relaxes the central nervous system to dull the perception of pain, but does not completely block it. It can also create a sense of well-being. 

Nitrous oxide is the least expensive pain relief option for labor and delivery and you can choose to use it first. Then, if needed, you can move to a different option such as an epidural. 

Nitrous oxide takes effect within a minute and leaves the system quickly when discontinued. It will not limit mobility so you can walk or move around during labor. Nitrous oxide will not slow labor or cause significant risk to the baby and you can safely breast feed after delivery.

Will I experience pain in labor?

Most women find the experience of childbirth uncomfortable at some point. This discomfort varies greatly from person to person. Some women use relaxation or other techniques during the labor process and want minimal assistance with pain relief while others use one of the anesthesia options listed below.

Do I need to make my decision about the use of pain relief ahead of time?

Many women have researched this topic and have already decided what type of pain relief they prefer. Some select a "wait and see" approach. We do encourage you to educate yourself about the options available. This allows you to make an informed decision at the necessary time. Trying to make a knowledgeable decision while under the stress of labor can be difficult.

Information on this topic can be obtained from many places, which include the following:

• Your midwife, obstetrician or family practice provider.
• Overlake’s childbirth classes.

What choices are available for labor pain relief?

The options listed below are found to be the most effective and safest for both you and your newborn.

Intravenous (IV) pain medication

IV medications can assist in the management of labor discomfort. Stadol and Nubain are commonly used medications. They are given intravenously and usually only achieve partial pain relief, which is often sufficient for you to tolerate the labor process. These medications can make both mother and infant somewhat sleepy. This is why your healthcare provider will usually prescribe these medications only in the early stages of labor and will limit the total amount you receive.

Regional blocks

The most common types of regional blocks used in labor are epidural or a combined technique of a spinal and epidural. These methods are all administered at Overlake by an anesthesiologist. Local anesthetics, often in combination with narcotics, are injected near and around the spinal nerves of the lower back. These cause a numbness of these nerves and reduce labor pain. These techniques all have optimal times to be given in the labor process. At Overlake, epidural anesthesia is the most common method used to control labor discomfort.

What is involved in getting spinal or epidural anesthesia?

As with any type of anesthesia, you will need to be monitored during the procedure. Having an IV is necessary ahead of time. Sometimes lab work is needed and extra IV fluid is given just before your epidural. The epidural is administered while you are lying on your side or in the sitting position. After cleansing your skin, a local anesthetic is placed into the skin and deeper tissues using a very small needle. This sometimes produces a mild burning sensation that lasts only a few seconds. A spinal or epidural needle is then advanced through the numb tissues into the proper position. When the needle enters the epidural space, you may feel a strange sensation in the pit of your stomach.

As the spinal or epidural anesthetic takes effect, a warming sensation is usually felt beginning in your legs and spreading onto your belly. Numbness begins soon after the warmth, and how numb you become depends on the type of medication and amount used. You usually will also lose some muscle strength in your legs; however, in most cases this is minimal, leaving enough strength for you to help during the pushing phase of labor.

How soon will my epidural take effect? How long will the epidural last?

Starting the epidural takes 15 to 20 minutes, and significant pain relief typically occurs within about 30 minutes. After the epidural is working, you will be attached to an epidural medication pump. A small amount of anesthetic solution is continuously pumped into the epidural space until your labor is over. The intensity of pain relief can vary throughout the labor process. Most often you will feel a pressure sensation in your birth canal, which will be helpful when you need to push.

What are the effects on my baby?

Epidural anesthesia has a long record of safety for you and your baby. The effects of the epidural on your baby are minimal in the vast majority of cases. However, we carefully monitor you and your baby and are prepared to take care of problems if they occur.

What are the risks of a spinal and epidural?

Just like any anesthesia technique, side effects can occur. However, we rarely see more than the few discussed below. For more information on side effects, ask your anesthesiologist.

Lower back tenderness and backaches can result after childbirth. The discomfort is usually minimal and lasts only a short time. Medications prescribed by your obstetrician for discomfort from your birth are almost always sufficient to relieve back discomfort.

A headache (commonly called a spinal headache) can develop from a spinal or epidural and usually occurs within 48 hours. This headache usually becomes apparent when you stand and gets better when you lie down. Spinal headaches sometimes go away without any treatment; however, if the headache is severe, your anesthesiologist can do an epidural blood patch, which takes away about 95 percent of the headaches. Speak with your anesthesiologist if you have additional questions.

The epidural space contains small blood vessels and, on occasion, after the epidural is first placed, medication can be injected into them. To prevent this from occurring we will use a test dose (a very low dose of the epidural medication) to make certain the epidural catheter is correctly placed.

Is the option of spinal or epidural anesthesia in labor always available?

A few patients, including those with bleeding disorders, certain infections, previous back surgery, or extreme obesity, may not be candidates for epidural/spinal anesthesia; however, the vast majority of patients are.

What are my anesthesia options for cesarean delivery (C-sections)?

You and your anesthesiologist will make the decision of anesthesia type based on the urgency and nature of the reason for the surgery planned. Cesarean births are usually done either on an elective basis (i.e., for twin delivery or breech) or on an emergency basis. The timing often has the most influence on the anesthesia type chosen.

Epidural anesthesia

If previously placed for labor, epidural anesthesia can be used for a cesarean birth. This involves changing the medication given through the previously placed epidural catheter. In an emergency situation, epidural anesthesia may take too long to be effective and some other form of anesthesia (spinal or general) may need to be used. If an elective, non-emergency cesarean birth is planned, epidural anesthesia is a frequently used.

Spinal anesthesia

This is used for both elective and emergency cesarean birth. If you do not have an epidural in place for labor, this is often the method of choice in the emergency situation. Spinal anesthesia is usually effective very rapidly.

General anesthesia

Because epidural/spinal anesthesia is safer for both mother and baby, general anesthesia is usually only used in emergency cesarean births (or where regional anesthesia is not possible). This type of anesthesia can be achieved faster than most regional anesthetics.

Will the anesthesiologist be available when I need their help?

Our primary responsibility is to be immediately available to the needs of the patients in the obstetrical suite and we take that responsibility very seriously.

Please note: All information presented above is appropriate for the majority of obstetrical patients at Overlake. However, this information may not pertain to everyone. Please contact your healthcare provider’s office or the anesthesia hotline at (425) 646-5825 if you have any questions.