Patient Information
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| Should I get an epidural? |
What are my options for pain control during labor?
“Natural Labor” usually means not having an epidural (see below for an explanation of what an epidural is). Some patients elect to go through labor with no pain medication—that is, no medicines given through an IV and no oral medicines. We at Linn County OB-Gyn, P.C. respect a woman’s right to make that decision for herself, and we will support her choice.
IV Pain Medicines: there are drugs that can be given through your IV (IntraVenous line) to blunt the pain a woman often feels during labor. These medications are used cautiously, since they cross the placenta and can have a similar effect on your baby. This is not to say they are dangerous! Used carefully, these drugs can make a patient more comfortable throughout her labor and/or they can be used while a patient is still trying to decide whether or not she wants to get an epidural. They last anywhere from a few minutes to a few hours, and they are used usually “to take the edge off”.
Epidural: an epidural is when an anesthesiologist places a very thin, plastic, flexible tube (catheter) in a space near your spinal cord (the epidural space). This method of pain control is very reliable and safe. In almost all cases, you will not feel pain with your contractions. Some women can take a nap during labor because they no longer feel labor pain!
One benefit of an epidural is that a woman can push when the doctor says it’s time—she usually feels pressure from the baby’s head and can control the delivery of her baby by pushing at the same time her uterus is contracting. The epidural can be turned off at any time as desired by the patient—she will still have the catheter in her back, but no medicine will be given through it. In this way, she will rapidly regain all movement and sensation in her legs and abdomen.
So what should I do about pain medication?
The best answer to this question is…whatever you feel is the best option for you. Some women feel a lot of pressure to do what their mothers or sisters or friends did—whether that means having an epidural or “going natural”. Some women read advice in magazines or on websites that have a strong bias in one direction or another and are persuaded to make a decision based on what they heard or read.
The most important thing to remember is that no two labor experiences are the same—you won’t necessarily progress as quickly or as slowly as your friend did, and you and she likely have different pain tolerances. You may even decide, on your second or third delivery, to choose something different than you did with your first baby. You must do what you feel is right for you!
Some other things to consider: would you consider having an operation (like having your appendix removed) without any pain medications? The pains of labor are very real and probably similar to the situation described above, and you should not feel any shame in wanting that pain taken away. Some studies have suggested that when a laboring woman is in severe pain, her body releases stress chemicals into her bloodstream. These chemicals can alter the baby’s environment in a negative way. If you are choosing not to have an epidural and are tolerating the pain of contractions well, then keep up the good work! If you’re dealing with the pain, but it’s really tough on you and your emotional stamina—then you may actually be helping the process of labor along (and maybe improving your baby’s environment) by getting some pain relief.
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Is there some point during my labor when I shouldn’t get an epidural?
Good question! If you’re getting near delivery; that is, if your cervix is almost completely dilated and the baby has descended well in your pelvis, sitting up for an epidural can make monitoring the baby difficult. There’s usually time for a woman to get an epidural any time she wants one, and the above situation is about the only exception to that rule.
So what’s a “spinal”?
A spinal block is when the anesthesiologist inserts a thin needle into a slightly different space in your back that she/he would with an epidural. The anesthesiologist injects medication through that needle and then removes the needle. You don’t have a catheter in your back at all. The medicine makes your abdomen numb for about 1½ hours; and during that time, your legs feel numb and hard to move.
This is plenty of time for a C-section and/or tubal ligation to be performed, but you can’t get more medicine that way once it has worn off (like you can with an epidural). The spinal starts to work almost immediately, and the anesthesiologist usually injects a long-acting narcotic so the woman won’t feel pain for 24 hours after her C-section. Her legs will move just fine, so the new mom can walk around just fine, eat, drink, use the bathroom, and so forth.
How does your group feel about C-sections?
The C-section rate in the U.S. is about 30 percent. That is, almost one in three babies born in this country is born by C-section. We are pro vaginal delivery! We believe C-sections should be performed if the mother or baby is not tolerating labor well. Essentially, if it’s unsafe to continue labor, we recommend C-section. There are some cases when we recommend C-section because labor could be dangerous to the mother and baby—as is the case with placenta previa or when the mother has had a C-section before.
Can I choose to have a C-section if that’s what I want?
Yes. Some patients prefer to never go into labor (if they can help it!) for a variety of reasons. Talk with your doctor about your preference early in your pregnancy so the risks and benefits of an elective C-section can be discussed.
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