Patient Information
Obstetric Anaesthesia
Labour is among one of the most painful human experiences. Just as every baby is unique, every labour is also very different. No matter how well planned you would like your baby’s birth to be, many babies forget to follow that plan and will instead do things their own way. Some women will experience a short labour and fast birth whilst others may have a long intense labour with a prolonged birth requiring intervention. For this reason, it’s important that you keep an open mind with regards to the various choices of pain relief that are available to you as the situation may change quickly. Take time to learn about the different anaesthesia options and speak to your Obstetrician and/or Dr Goonan so that you are informed and prepared for whatever eventuates.
Obstetric anaesthesia is a specialised field of anaesthesia that focuses on providing pain relief and anaesthesia for women during labour and childbirth. This involves the use of different types of anaesthesia depending on the type of delivery, the patient's medical history and current health status as well as the status of the baby.
Types of Obstretric Anaesthesia
- Epidural anaesthesia - is a regional anaesthesia technique where a fine catheter is inserted into the epidural space outside the spinal cord. A continuous flow or periodic dose/s of local anaesthesia is then administered via the catheter.
- Spinal anaesthesia - is another regional anaesthesia technique that involves injecting a single dose of local anaesthetic directly into the cerebrospinal fluid surrounding the spinal cord. The effect is almost immediate and is shorter acting than an epidural.
- Combined spinal epidural (CSE) anaesthesia - combines both spinal anaesthesia and epidural anaesthesia to provide pain relief. A small needle is used to inject medication into the spinal fluid to provide fast pain relief, and then a small catheter is placed into the epidural space to provide longer acting pain relief. CSE is commonly used in childbirth and other surgical procedures.
- General anaesthesia - is typically used for emergency or urgent Caesarean sections or in cases where regional anaesthesia is not possible or preferred.
Anaesthesia for Caesarean section
In Australia, regional anaesthesia – spinal, epidural and CSE anaesthesia – is the most commonly used anaesthesia for a Caesarean delivery because the baby is exposed to lesser amounts of medication and it allows the mother to be awake and able to participate in the delivery of the baby. Partners/support person can also be present for the birth when performed under regional anaesthesia.
General anaesthesia is another option and although it is used less nowadays there are still instances when it is the most appropriate choice. This can be when:
- The baby’s condition deteriorates and needs to delivered quickly
- There are abnormalities or injury to the mothers back making regional anaesthesia difficult
- Maternal complications such as severe bleeding or high blood pressure
- Failure of the labour to progress
If your Caesarean section is planned, the options will be discussed with you and the most appropriate type of anaesthetic will be used depending on your circumstances. If you require an urgent or emergency Caesarean, the options available may change. If you have been in labour and have had an epidural inserted for labour and it has been providing you with good pain relief from contractions, then it is likely that this can be topped-up with different anaesthetic and pain relieving drugs, in order to provide anaesthesia for a caesarean section. Before an epidural for labour is used for a caesarean section, your Anaesthetist will thoroughly assess that you have a successful block. At times, it may be necessary for some patients to have a spinal anaesthetic in addition to the epidural infusion. This will also be thoroughly assessed by your Anaesthetist to ensure that you are pain free prior to surgery.
Epidural Anaesthesia for Labour and Delivery
Epidurals are an extremely effective form of pain relief available during labour. In Australia, all regional anaesthesia such as epidurals and spinals, are inserted by Specialist Anaesthetists and are used in almost one third of labouring women. Epidurals are especially useful when pain has not been adequately relieved by other methods such as TENS, Entonox (gas) and Pethidine. Other situations when an epidural may be useful:
- When a forceps, vacuum or caesarean delivery is likely.
- To lower the mothers’ blood pressure if it becomes high
- Breech deliveries
- Multiple birth deliveries
How is an epidural inserted?
- Prior to inserting an epidural, your Anaesthetist will assess you and discuss the epidural with you. They will talk to you about the benefits of an epidural as well as the potential side effects. It is important that you research pain relief options earlier in your pregnancy so that you are informed when the time comes.
- If you don’t already have one, an intravenous (IV) cannula will generally be placed into one of the veins in the back of your hand. This is so you can be given IV fluids (and it can also be used to give medication to increase the speed of your labour or if you are feeling sick).
- You will then get into the position for the epidural to be inserted. This will either be sitting forward with your legs hanging over the side of the bed or lying curled up on your side.
- Your Anaesthetist will examine your back for the insertion point and then clean your back with an antiseptic.
- Your Anaesthetist will then inject some local anaesthetic into your skin in order to lessen any discomfort.
- The epidural needle is inserted into the epidural space, which is located near the spinal cord and backbone. Some women say they feel a dull pressure which is usually not painful. This is when it is really important for you to keep still. Your anaesthetist has to be careful to avoid puncturing the bag of fluid that surrounds your spinal cord, as this may give you a headache afterwards.
- If you have a contraction during insertion of the needle you should stay very still and the Anaesthetist will wait until the contraction is finished before proceeding.
- Once the epidural catheter is in the correct place, the needle is removed leaving only the thin plastic catheter which is firmly secured to your back.
- Pain relieving medication can now be prescribed by your Anaesthetist and given through the epidural catheter.
- It usually takes around 15 to 20 minutes for the medication to give relief.
- Once the epidural medication is started, your Midwife or Anaesthetist will take your blood pressure regularly.
- The Anaesthetist will also check that the pain relief medication is working on the right nerves. This is often done by touching your leg and tummy with a small block of ice and asking how cold it feels.
Epidural medication
The pain relieving medication given via the epidural comes in several different strengths. Most women will be started on a lower strength medication. This medication will generally stop the pain of labour whilst still allowing the patient the sensation of touch and muscle strength.
However, just as all women are different, some may need to have a stronger medication to control the pain of contractions and labour. A stronger medication may do this effectively yet result in weakness of the legs, numbness and pins and needles.
Your Anaesthetist will assess your needs and prescribe the medication that is appropriate to your individual needs and circumstances.
Epidural Top-Ups
Once your Anaesthetist has the epidural up and running it will be necessary, in most cases, to give a repeat dose of the pain relieving medication every 1-2 hours. This will be done in consultation with your midwife and Obstetrician and is dependent on the progress of your labour.
Potential Risks and Complications of Epidural Anaesthesia
While epidural anaesthesia in Australia is very safe and can provide effective pain relief during childbirth or other medical procedures, there are potential risks and complications associated with this type of anaesthesia that should be carefully considered. If you have any queries or concerns about, please feel free to discuss them with Dr Goonan.
Click here to read additional information on the potential risks.