What is anesthesia?
"Anesthesia" means loss of feeling, either by way of "going to sleep" (general anesthesia) or just numbing an area or region of the body (for example, epidural anesthesia)
Will I require anesthesia for normal labor?
Normal labor can be a different experience for each woman. Some women need no anesthesia for labor. Women differ, however, in their ability to tolerate pain and anxiety when labor is long and contractions are stronger than expected. Even if you plan for a "natural" childbirth, the unexpected may sometimes occur, thereby making anesthesia desirable or necessary. Remember, the decision to have anesthesia for labor is yours.
What is a pre-anesthetic visit?
After you arrive in Sparrow Hospital’s Labor and Delivery Department and have been examined by your physician, nurse anesthetist or anesthesiologist will meet with you and ask questions regarding your medical and surgical history as well as your pregnancy. This is part of our normal routine and does not mean that there is a problem. It is very important for you to tell the anesthesiologist about past or present medical problems, such as diabetes, high blood pressure, asthma, tendency to bleed or heart problems. A brief physical exam may be performed.
Does pain affect my baby?
Pain may cause very high adrenaline levels in your bloodstream. If you are in great distress and breathing rapidly, your baby may actually suffer from a fall in blood flow to the uterus. This condition results in decreased oxygen delivery to your baby. This may stress your baby. Making you more comfortable can help to prevent this from happening. By helping you to relax and regain better control over your labor, anesthesia can ensure the lowest levels of stress to your baby.
If needed during labor, your physician may order pain medication given into a vein or muscle to “take the edge off” contractions. For some mothers, this mild medication may be enough. Others may benefit from another type of pain relief such as epidural anesthesia. In any case, there is never any reason for a woman to feel that she has failed if she needs medication to relieve pain. Your health and the safety of your baby are our chief concerns. At your request, a member of the anesthesia care team will work with your physician to determine which type of anesthesia, if any, is best for you and your baby.
What is epidural anesthesia?
Epidural Anesthesia is quite versatile; it can be given for labor and vaginal delivery or cesarean section. It is the preferred type of anesthesia by many pregnant women and their physicians because of the comfort it provides for you and the safety it offers for your baby.
Epidural refers to the space that lies just outside the covering of the spinal cord. Medicine (local anesthetics like Novocaine) can be put into this area via a small tube inserted through a special needle. The medicine blocks pain sensations from the uterus and cervix much like the dentist blocks pain sensations from your teeth.
How is it given?
A member of the anesthesia team will place the tiny epidural "catheter" or tube after numbing your skin with a local anesthetic. You will be asked to sit up on the side of the bed or lie on your side with your knees drawn up and your back arched. Once correctly positioned, the tiny tube will be taped to your back so that medications can be given when needed for continued pain relief. This tiny plastic tube is so thin and flexible you won’t feel it, even when lying on your back.
When can it be given?
Early labor does not usually cause painful contractions. Unless your physician suggests otherwise, epidural anesthesia is usually placed once labor is well established and the cervix has dilated to about four centimeters.
Prior to receiving any anesthesia, an intravenous (IV) line will be started and your blood pressure checked. Once medication is given into the epidural space it will be necessary for you to remain in bed. Fetal monitoring is used whenever an epidural anesthetic is given.
What is a "walking" epidural?
Normally, the local anesthetic injected into the epidural will cause numbness and weakness of the legs, making it unsafe to walk. For mothers who want to move about while in labor, a narcotic medication can be injected into the epidural, avoiding the numbness. Unfortunately, the pain relief will not be as strong but you will be able to walk in your labor room if this is a priority for you. Discuss this technique with your anesthesiologist if it is your preference.
How will I feel?
Normally, the anesthesiologist will give enough epidural medication to block only the pain sensation of each contraction. You will still be able to move your legs but they may feel a bit heavy. It is normal to feel a pressure sensation or awareness with each contraction. In this way, you receive pain relief with only minimal medication.
How long will it last?
Medication can be given into the epidural catheter continuously by way of a miniature infusion pump. We utilize a patient-controlled epidural pump that safely allows you to use more or less of the medication according to your preference.
What if a cesarean delivery becomes necessary?
If an epidural catheter is already in place from labor, it is easy to give additional medication to increase the area of numbness for your surgery. The anesthesiologist will check the level of numbness to be sure it is high enough before surgery is allowed to begin.
There are several reasons why epidural and spinal anesthesia are preferred for cesarean birth. It allows you to be awake and see your baby just after birth. If he wishes, the baby’s father can be present to give you emotional support and see and hold the newborn. Also, additional medication can be administered through the epidural catheter to keep you more comfortable after your surgery.
Will epidural medication affect my baby?
The medications used to produce epidural anesthesia are local anesthetics. Unlike most pain medications, they do not make your baby sleepy, depress its breathing, or make it slow to feed. Healthy babies with excellent APGAR (a test used to evaluate the general health of newborns) scores are born every day to mothers who have received epidural anesthesia.
What are the risks to me?
We are very proud of providing safe anesthesia to many thousands of women at Sparrow Hospital. Like any procedure, though, epidural anesthesia has some risks:
- Your blood pressure may become lower from the epidural. The nurse will check your blood pressure often, and plenty of IV fluids will be given to help maintain normal blood pressure. You should lie on your side to keep your baby from compressing the large blood vessels in your abdomen; this will help to maintain a normal blood pressure.
- The needle or catheter may go into one of the many blood vessels in the epidural space. While rare, if this happens, the anesthesiologist may have to reinsert the catheter.
- In approximately 1 percent of epidural and spinal anesthetics, the needle may cause a spinal fluid ‘leak’ leading to a headache. In most cases, the headaches will go away by themselves; sometimes another procedure may be necessary to eliminate them.
- Occasionally, a sensation of numbness or tingling may last for a few days or weeks after vaginal delivery even if epidural anesthesia was not given. Sensation usually will return to normal with no treatment necessary.
What is spinal anesthesia?
Spinal anesthesia may be used for forceps delivery, cesarean section or tubal ligation, but is generally not suitable for providing comfort during labor.
To do a spinal anesthetic you may be asked to lie on your side or sit up, depending on the circumstances. The anesthesiologist or CRNA numbs the skin and inserts a small needle between two of the lower backbones, well below the level of the spinal cord where there is any chance of injury. The needle enters the spinal fluid and medication is placed there.
You will soon notice that your legs and hips become numb. You will not be able to move your legs while the anesthesia is working, and any pain from labor contractions will disappear. The numbness will last one to two hours and then wear off.
There are two reasons why spinal anesthesia is not used for pain relief during labor: (1) no plastic tube is left in place, so it is not possible to give more medication over the course of a long labor; and (2) the lower half of the body becomes so numb with spinal anesthesia that you cannot push the baby out at the time of delivery.
What is general anesthesia?
Having general anesthesia means that you go completely to sleep. General anesthesia is rarely used for cesarean birth.
If the baby shows signs of distress and an emergency cesarean delivery is required, general anesthesia may be the fastest method for delivering your baby, unless an epidural catheter was placed earlier in labor.
Before you go to sleep, you will receive oxygen to breathe from a face mask for a few minutes. Then you’ll receive medication though your vein (usually "Pentothal") to make you lose consciousness, and additional anesthesia will be given as needed during the operation. After the baby is delivered, you will be given pain medication so that you will have less discomfort when you wake up after the operation.
What are the risks to me?
A very serious risk of general anesthesia is that you may vomit as you go to sleep. If stomach contents are inhaled into your lungs, you could develop a serious type of pneumonia. That is why it is so important for you not to eat or drink anything once regular contractions begin or your water breaks.
Even if you have not eaten for several hours, there is still a chance that you could vomit, since digestion of food is slowed during labor. Also, the pregnant uterus pushes up against the stomach, often causing heartburn and nausea even before labor starts.
To reduce the chance of vomiting and pneumonia, you will receive an antacid (Bicitra) just before the operation. As you go to sleep, we will put pressure on the front of your neck to reduce the risk of vomiting. The anesthesiologist or CRNA will insert a breathing tube to protect your lungs after you go to sleep and remove it just before you awake.
Can my baby’s father be with me?
Fathers are very welcome to be present at their baby’s birth, whether he or she is born vaginally or by cesarean. For many couples, the first sight of their infant is an unforgettable moment to share.
If the baby is born by cesarean, the father will be asked to wait outside the operating room while the mother is prepared for surgery. When ready, he will be escorted into the operating room and seated by the mother’s head. Many mothers find it comforting to hear the father’s voice and hold his hand. We will be glad to answer any questions for you during the cesarean section. You will see the baby as soon as it is born, and you will be able to hold your baby as soon as he or she has been checked by pediatricians.
The baby’s father cannot present when general anesthesia is used so that we can give undivided attention to the mother’s anesthetic.
Fathers need not feel pressure to come into the operating room. Do not come unless you want to. On the other hand, there is no reason to be worried about feeling dizzy or having a weak stomach; you do not have to watch any of the operation. If you wish to leave at any time, a nurse will be glad to escort you back to the waiting area and later bring the baby out to you.
How is anesthesia billed?
Your physician makes the arrangements for you to receive the anesthetic, but he or she will not charge for it. The hospital will charge for supplies, drugs, and services of the nurse anesthetist if one is involved in your case.
A separate bill for the services of the anesthesiologist will be sent to you sometime after your delivery. Fees are determined by the length of time spent and the difficulty of the type of anesthesia given. Therefore, we are not able to determine the exact charge for anesthesia until the procedure is completed.
Does insurance cover the anesthesiologist’s bill?
Services provided by an anesthesiologist are covered benefits by most insurance plans. However, some policies do not pay the entire amount, so you would be responsible for paying a portion of the bill. To determine your insurance benefit, contact your program administrator. If you have questions about your bill, please call our billing office at 517.484.2777.
What if I have more questions about anesthesia?
Anesthesia and Pain Management Consultants will be happy to refer particular questions or arrange pre-anesthesia interviews with one of our obstetric anesthesiologists. For more information, call 517.484.2777.