8 February 2012

Anesthesia During Delivery

Posted by Jody under: Aches & Pains .

A reader wrote, “I had a Caesarean 14 years ago when I delivered my daughter. I had spinal anesthesia and was numb from my breasts down. I had been told I would be numb only from the waist down. I was so frightened that I was given a sedative, which knocked me out so much that I missed most of the delivery. I’m now looking forward to having my second child and I’m frightened that this will happen again. What kind of anesthesia should I ask for?”

I’m sorry you had a scary experience with your last delivery. There are different types of anesthesia for Caesareans. A spinal and an epidural are both considered regional anesthetics. Before administering either, the anesthesiologist will numb your skin with a small amount of a local anesthetic.

With a spinal, a very thin needle is placed through the skin of the back into the spinal fluid and a small amount of an anesthetic drug is injected. It produces two to four hours of dense numbing and causes a temporary inability to move the lower part of the body.

In order to numb your uterus adequately, you must be numb up to the lower or mid-chest. A thin tube (called a catheter) will be inserted into your bladder, and you’ll be given lots of intravenous fluids to keep your blood pressure from dropping. Spinals can occasionally cause headaches, but these usually resolve in a few days.

With an epidural, sometimes called a peridural, a larger needle is used to insert a catheter into the fatty tissues that surround the outer lining of the spinal cord. This area is called the epidural space. The anesthetic is injected through the catheter, and more can be given later if you need it. This is a key difference between epidurals and spinals. With spinals, once the medication is injected, no more anesthesia can be given.

Epidurals, which are used in vaginal as well as Caesarean deliveries, block the pain but not all sensation. Women report feeling pressure during surgery, but can also push effectively in a vaginal delivery.

Your motor function, including the ability to walk, will return more quickly than with a spinal. Headaches are uncommon, but many anesthesiologists add a small amount of a narcotic to the anesthetic drug in epidurals to get a better effect with less medication. In those women, about 1 in 7 will feel itching because of the narcotics. Narcan can be given to counteract the itching.

New Options
Anesthetic techniques have continued to improve over time. Talk with your obstetrician about your anesthesia choices for a Caesarean section and for a vaginal delivery. If you have medical problems, or are concerned, ask to have a consultation with the anesthesiologist in advance.

And, just because you had a Caesarean section last time, doesn’t mean you will need one with this pregnancy. Vaginal birth after a Caesarean is possible.

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