Obstetric Patient Education

Obstetric Patient Education

Pain Relief for Labor and Delivery: The Basics

Duke Anesthesiology’s Division of Women’s Anesthesia hopes the information below will address some frequently asked questions regarding anesthesia for labor and delivery at Duke Birthing Center. More complex issues that are not addressed on this page will need to be discussed between you, your obstetrician and your anesthesiologist.

Click the “play” button to watch new parents share their story of childbirth and talk about how the “Gentle Cesarean” and the anesthesiologists with the Women’s Anesthesia Division enhanced their birthing experience at Duke University Hospital!

What is an “epidural?”

An epidural refers to a method of controlling pain during a woman’s labor.  A thin plastic catheter is placed in your lower back. Medicines are then given through the catheter that lowers the amount of pain you feel from your contractions. We can keep giving these medicines to reduce your pain until you deliver your baby. Sometimes stronger medicines are given in an epidural so you won’t feel pain even during an operation, like a Cesarean delivery.

What is a “spinal?”

A spinal is a single injection of medicines given through a needle in the lower back. Once the injection is given, the needle is removed, and the lower part of the body becomes numb. This can be used for surgical procedures of known length, like a Cesarean delivery. Sometimes your anesthesiologist will combine a spinal with an epidural for faster pain relief during labor.

How are these procedures performed?

We will have you curl your lower back, either while sitting or lying on your side. We will then clean your back to prevent an infection, and numb the skin. The more you sit still, the easier and safer it will be to place. We will then put a needle into the epidural or spinal space. During this part, you should only feel pressure with little or no pain. We will explain each step. One birth partner may remain in the room with you during the procedure, but we ask that they wear a mask and a hat, and hat and remain seated during the procedure.

Will these procedures affect my baby?

By using medicines that work directly on your nerves in your back, we keep the medicines away from the baby. Generally, very little medicine ever reaches your blood stream or the baby, even after many hours of labor. The medicines used in the epidural could lower your blood pressure and if not treated, this can affect your baby’s heart rate. Your nurse and your anesthesiologist will watch your blood pressure closely after your receive your epidural to try to prevent this. If needed, they can immediately treat your condition with medications and extra fluids.

When can I get an epidural?

Except in rare circumstances, you can get an epidural at any time after you go into labor. You do not have to wait until you are dilated a certain amount or have received a certain amount of IV fluids to receive an epidural. Studies have shown that an epidural does not significantly slow down labor.

What can I expect from my epidural?

Expect to feel a little numb, but not all at once. Your legs and belly may feel like they have “fallen asleep,” and your legs may feel weak and heavy. It takes about 10-15 minutes after giving the medicine for you to be comfortable. Your contractions will first seem shorter, and then they will drift away.

Expect to feel something. You may feel tightness or pressure, especially close to delivery. The ability to feel pressure allows you to know when it is time to push.

Expect to need some fine-tuning. Many women will need an increase in medicine as labor continues. Less than one out of 10 women may be numb only on one side or not at all; we will adjust the epidural to try to help. Rarely, we may need to replace your epidural to make it work.

Expect to stay in bed and drink/eat clear liquids. The epidural medications can make your legs weak during your labor, and we ask that you remain in bed while your epidural is running and until the effects have worn off to keep you and your baby safe. You will probably have a catheter in your bladder after your epidural. We also ask that you eat or drink only clear foods/beverages such as broth, juices, gelatin or popsicles.

Are there any risks?

It may not work as well as we want. We may need to adjust or fine-tune the epidural or replace it (see above).

It may lower your blood pressure. We will watch your blood pressure closely, especially right after we give the medicine. We can treat your blood pressure if needed.

About one out of 100 women will get a headache after they have their baby. This headache usually goes away on its own, but if necessary, you can request medications that are considered safe even if you are breastfeeding. You may need other treatments to make it better; your anesthesiologists will discuss this with you if needed.

What happens if I need a Cesarean delivery?

If you already received an epidural, we can usually put stronger medicine in the epidural that makes you numb. If you did not receive an epidural, we can place a spinal. Either way, you will be numb from your chest down to your toes for a few hours. In emergency situations, or if you cannot have an epidural or spinal, we may need to give you general (asleep) anesthesia for your Cesarean delivery.

Are there pain relief options other than the epidural?

If you cannot have or don’t wish to receive an epidural, there are non-medicinal options (including breathing techniques, massage, heat packs and water baths), as well as pain medicines (such as morphine or fentanyl) delivered through your IV that can help reduce the pain of labor. At Duke University Hospital, we also offer patient-controlled intravenous analgesia (PCIA) with fentanyl.

Comparing types of labor pain relief

Patient-controlled intravenous analgesia (PCIA)

Epidural or combined spinal epidural (CSE)

What is it? Small dose of pain medicine (fentanyl) given from a pump into an IV in your arm. A mixture of local anesthetic and a painkiller given through a fine catheter in your back to numb your nerves. May not be recommended very early or late in labor.
What do you do? Press the button to give yourself a dose every time you feel a contraction starting. Sit still in a curled-up position for ten minutes while the catheter is put in.
How much pain relief? The amount of pain relief varies. Usually very good. One in 10 times, it may not work well and may need to be replaced.
How long until it starts to work? 10 to 15 minutes to set up then works in a few minutes. Up to 20 minutes to set up once the epidural is placed. Spinal medications work faster.
Any extra procedures? You will be on a drip.
You may be connected to a monitor to check your baby’s heartbeat.
You may need extra oxygen.
You will be on a drip.
You may have a urinary catheter.
You may be connected to a monitor to check your baby’s heartbeat.
Risks to baby? May be slow to breathe at first, and may require support and medications from the pediatrics team. You may have low blood pressure and this can affect your baby’s heart rate if not treated.
Side effects for mother? Feeling sleepy or sick to your stomach.
Itching.
Slow breathing – you will have to stop using it if it makes you too sleepy.
Stopping breathing or slowing your heart rate (rare).
Low blood pressure is common.
Difficulty passing urine.
Bad headache (1 in 100 women).
Increase in temperature.
Temporary nerve damage (1 in 1000 women).
Permanent nerve damage (1 in 13,000 women).
Severe complications (1 in 250,000 women).
Effect on labor and delivery? Feeling sleepy can make it harder to push when it is time. Can make it harder for you to push, but usually this just requires some extra coaching from your nurse, midwife or obstetrician. May increase the need for forceps.

Q&A adapted from the Society for Obstetric Anesthesia and Perinatology & Obstetric Anaesthetists Association.