Anesthesia Options during Labor

Epidural anesthesia

An epidural is a common way to manage pain during labor and delivery. An epidural involves placing a small plastic catheter (tubing) through a needle into the epidural space (a cushioned, fatty “tunnel” that surrounds the sac containing your spinal cord and nerves). The needle is removed, but the catheter stays in place. Through the epidural catheter, your anesthesia professional, such as a Certified Registered Nurse Anesthetist (CRNA), gives you local anesthesia medications (like those used at the dentist) and pain-relieving medications such as morphine and fentanyl. These medications cause temporary numbness from where the epidural is placed down to your toes. 

Placement: 

• You will need to sit on the side of the bed and curve your lower back (like a “cooked shrimp” or “scaredy cat”). 
• This position can be difficult as labor progresses, so it’s important to tell your anesthesia professional if you’re having trouble staying still. 
• If you’re planning a natural delivery without an epidural, remember that there may come a point when you can’t sit still anymore, and an epidural may not be possible. 

During labor: 

• A weaker version of the medication allows you to move your legs while still having pain control. 
• As your contractions become stronger and more frequent, the medication can be adjusted to give you more relief. 
• You can press a button to give yourself a dose of medication when you need it (this is called patient-controlled analgesia or PCA). 

After delivery: 

• Your epidural may stay in for a short time after delivery. 
• When it’s removed, your anesthesia professional may place a long-acting pain medication called Duramorph® that provides partial pain relief for about 12 hours or more. 
• If you’re allergic to morphine, make sure to tell your anesthesia professional. 

Spinal anesthesia

A spinal is another way to manage pain during labor or for a cesarean delivery (C-section). A spinal uses a very small, thin needle that is placed through the covering of the sac containing your spinal cord and nerves. The needle goes into the spinal canal in your lower back, below where your actual spinal cord ends. Think of it like a sac filled with fluid and spaghetti noodles (the nerves). The medication is gently placed into this space and spreads throughout the fluid, causing temporary numbness to all the nerves it touches. The spread of medication is controlled by the anesthesia professional.  

Key differences from an epidural: 

• The needle is completely removed, and nothing stays in your back. 
• The effect happens almost immediately, while an epidural can take up to 15 minutes or longer. 
• Sometimes a spinal can be combined with an epidural for more flexibility in how your pain is managed.  

Your anesthesia professional will dose the medication based on your needs to provide temporary pain relief, whether for labor or for a surgical delivery like a C-section. 

Benefits and risks of epidural and spinal anesthesia

Epidurals and spinals are safe procedures that have been used for many decades. The benefits of pain control are very important for both you and your baby during labor and delivery. While there are some risks with any medical procedure, the benefits of epidurals and spinals outweigh the risks. 

One potential side effect is called a spinal headache. This occurs when there is a small tear in the sac that surrounds your spinal cord and nerves. This can cause fluid to leak. 

• A spinal headache is continuous and gets worse when you sit up, walk, or are in bright light. It may also cause nausea or vomiting.  
• The chance of getting a spinal headache is slim, about a 0.1-1% chance. Many times, a spinal headache will heal on its own with rest, caffeine, and IV (intravenous) fluids.
• If it doesn’t get better, there is a safe treatment called a blood patch, where your anesthesia professional places another epidural and injects a small amount of your own blood to seal the tear. 

General anesthesia

General anesthesia is rarely used for labor and delivery, but it may be necessary in certain situations: 

• Emergency C-sections 
• For certain medical reasons, such as if your body doesn’t have enough platelets for an epidural or spinal 
• Emergency situations involving bleeding where other options aren’t possible  

During general anesthesia, you are completely asleep during the delivery and will wake up in the recovery room after your baby is born. You won’t remember the delivery, but you will be told everything that happened. General anesthesia is safe and effective, but it can have some side effects, such as nausea and vomiting.

Important reminders

• Your anesthesia care will be tailored to you and your labor.
• Epidurals and spinals are safe procedures that have been used for many decades. 
• Ask questions! It’s okay to ask your anesthesia professional anything you want to know.
• Prepare for delivery by learning as much as you can during prenatal care.

Learn about What to Expect during Vaginal Birth and What to Expect during a C-Section.