Babies Tale

Once your labor is well established, it is less likely that drugs can slow it for more than a short time. More effective pain relieving drugs may then be used. Also called analgesics [pain relieving drugs], they are given by injection under the skin, into the muscle, or into an intravenous line. Demerol [meperidine] is the narcotic analgesic most widely used in obstetrics. Its effects are similar to those of morphine and may be associated with a speeding up of labor in some circumstances. If anxiety, tension, and pain are great enough to actually slow labor, a narcotic or tranquilizer may reduce anxiety and allow labor to speed up again. These drugs reduce your pain, though you are still aware of the peaks of your contractions. They also help you sleep or relax between contractions. You may feel nauseated shortly after receiving them, and you may not like the dizzy, confused feeling. The pain relief lasts an hour or so, after which another dose may be given. The drug does accumulate in the baby’s body, however, and larger total doses may have more noticeable effects on your baby’s behavior. If your doctor sees that you will give birth when the narcotic effects on your baby will be at their greatest, she may give you [or your baby after birth] a drug called a narcotic antagonist, to reverse the effects of the narcotic.

Regional Anesthesia

Analgesia means relief of pain; anesthesia means loss of sensation. There are ways of injecting drugs in particular areas of the body to cause a loss of all sensation [numbness], in a limited area. Local anesthetic agents [like Novocain [procaine], used by your dentist] are used in this way. Agents like lidocaine and marcaine [bupivacaine] are used in obstetrics.

Depending on where they are injected, they cause varying amounts of pain relief. For example, a spinal or saddle block creates a rather large area of numbness. An injection of anesthetic is made in the lower part of the back, and the medicine enters the spinal fluid. The anesthetic is heavy and stays low in the spine. You might become numb from your ribs down to your toes [spinal block] or from your buttocks and lower part of the abdomen down your inner thighs [saddle block].the amount of numbness is determined by how low the injection is given and how low the drug remains in the body. You can have a “spinal headache” after a spinal anesthetic; this is very painful, can last for days, and usually requires that you lay down most of the time.

Epidural and caudal blocks differ from spinal blocks, since they are given with the same anesthetic agents but in slightly different places. The main difference is they are not given into the spinal fluid. The medicine is placed low in the back, just outside the canal where the spinal fluid is [therefore you will not get a spinal headache]. Although trickier to give than a spinal block, anesthesiologists prefer them for labor because they are not as likely to stop labor and the actual area of anesthesia can be better controlled [especially with the epidural].

The main difference between the caudal and the epidural is where they are given; the caudal is given at the top of the separation of your buttocks; the epidural, a few inches higher. As a result, the area of numbness with the epidural tends not to extend as far down into the birth canal and legs as with the caudal. You can push better and move your legs better with an epidural than a caudal.

Both spinals and epidurals are also used for cesarean births, allowing the mother to remain awake and alert to greet her baby.

Pain relief with these forms of anesthetic can be excellent; in fact, many women report total relief of pain. This welcome relief comes with no effects on your mental capacity. You do not become groggy or sleepy.

Because spinals can stop labor at a critical time, they tend to be used for very late labor and for cesarean births.

Forceps-assisted deliveries tend to be more common after regional anesthesia because women cannot push as well when anesthetized. Anesthesia can be “light or heavy”; women can push better [and feel more] if the anesthesia is light.

Another drawback to regional anesthesia is the possibility of a sudden drop in blood pressure soon after receiving the anesthetic. This sudden drop can temporarily reduce the oxygen available to the baby. Since this side effect is well known, measures are taken to prevent it [a large amount of intravenous fluid is given to rapidly increase blood volume which decreases the chance of low blood pressure] identify it as soon as it happens [blood pressure is checked constantly while the anesthetic takes effect] and treat it, if necessary with drugs to raise blood pressure.

Local Anesthesia

Three types of local anesthesia may be used for childbirth; the paracervical block, the pudendal block, and local infiltration of the perineum.

The paracervical block is given in the late first stage. Tow injections of local anesthetic drugs are made into the cervix and bring pain relief during contractions. Although this form of anesthesia rarely causes problems for the mother, it frequently causes sudden drops in fetal heart rate and noticeable effects on the baby’s muscle tone and reactivity after birth.

Although the amount of pain relief provided by a paracervical block is far less than with the regional blocks, a significant greater amount of anesthetic agent is used-thus, there are many more serious side effects. For this reason this form of block has been discontinued in many areas of the country.

The pudendal block causes anesthesia in the birth canal and is given in the second stage. Local anesthetic agents are injected into the vaginal wall. Again a larger amount of medication is used than for an epidural, but the incidence of drops in fetal heart rate appears not as serious as with the paracervical block. It can be used for forceps delivery or pain in the second stage. Most doctors give a pudendal block before an episiotomy is performed.

Local infiltration of the perineum consists of several injections to numb the area of skin and muscle between the vagina and the anus. It is most commonly used after natural childbirth if stitches are needed. It can also be given in the second stage after an episiotomy is performed. Side effects of a local block appear to be slight.

General Anesthesia

General anesthesia means a loss of consciousness along with pain relief. In other words, a woman is put to sleep and wakes up after the anesthetic has worn off. Nowadays, general anesthesia is uncommonly used-and is generally used for emergency situations.

General anesthetics are usually gases, which are inhaled. They cause a total loss of awareness. Nitrous oxide, trilene [trichloroethylene], and penthrane [methoxyflurane] are examples of such inhalation agents. Sometimes these are used along with sedatives that cause drowsiness. The sedatives might be injected into your vein.

One reason general anesthetics are used less often today is that they have profound side effects. The mother’s breathing may slow down or stop; her blood pressure could drop and cause her heart rate to change. General anesthetics may also stop contractions of the uterus and cause excessive bleeding after birth. The baby is also affected. Babies often have breathing difficulties, sucking difficulties, and poor muscle tone after general anesthesia have been used.

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