Epidural
What it does: An epidural numbs sensation from the waist down -- how much depends on the drug and dosage used. It eases the pain of uterine contractions and pain in the vagina as the baby is being delivered. You'll be awake and alert. During a long labor it can prevent you from becoming exhausted or distressed.
When it's used: An epidural can be given in active labor, in the second stage of labor, and before a cesarean birth. An epidural is administered after 4-6 cm cervix dilation.
How it's given: An epidural is administered either as a single injection or a continuous flow. You'll be asked to sit or lie on your side for about 10 minutes while it's injected into a small space around your spinal cord in your lower back. You'll respond to the drug in about 10-20 minutes.
Pros:
- You'll feel pressure, but not pain.
- A low concentration of the drugs is used, which reduces side effects.
Cons:
- Your legs will feel heavy, and you may have trouble moving or urinating.
- You may lose the urge to push, which can slow down labor or increase the use of interventions such as IVs, fetal monitors, and forceps delivery.
- Your blood pressure may drop, which may slow the baby's heart rate.
- If the needle punctures the membranes around the spinal cord, you may develop a headache. More rarely, it can cause nerve injury or infection.
- You may get only spotty pain relief.
Local Anesthetics
What they do: Local anesthetics relieve pain by numbing or reducing sensation in a small area. They ease the pain of delivery, but they don't lessen the pain of contractions.
When they're used: This type of drug is used in the second stage of labor to numb your birth canal and perineum for forceps delivery, episiotomy, and repair.
How they're given: Local anesthetics are generally injected around the pudendal nerves inside the vagina. You'll usually respond in about two to three minutes and the effects of the drug may last one hour.
Pros:
- You probably won't experience any lingering aftereffects. There are no known negative side effects for your baby.
Cons:
- Pain relief is limited to specific area and it's relatively short-lived. Also, it doesn't relieve the pain of uterine contractions.
General Anesthesia
What it does: General anesthetics are medications that make you lose consciousness. When used during childbirth, the mother will not be awake or feel any pain during delivery.
When it's used: General anesthesia is used only for emergencies. It is not used to relieve the pain of labor. It may be used for cesarean delivery or other urgent situations.
How it's given: These drugs are given through a face mask or injected through an IV line. Once the drug is given, it works very quickly.
Pros:
- You'll feel no pain and be unaware of labor or delivery distress.
Cons:
- It may cause nausea and vomiting.
- It depresses your central nervous system.
- You blood pressure may drop.
- The drug may cross the placenta to the baby.
- Forceps may become necessary for delivery.
- Grogginess may make it difficult to hold and bond with your baby right after delivery.
Spinal Block
What it does: A spinal block numbs the lower half of your body, and works more quickly than an epidural. It provides relief from pain, and is effective in small doses.
When it's used: It's best suited for pain relief during delivery -- not labor -- because it's usually only given once and the effects don't last long. It's most often used when the mother is too tired to push. A spinal block is frequently used for a cesarean birth, or if forceps or vacuum extraction are necessary.
How it's given: A spinal block is administered as a single injection into your spinal fluid while you're lying on your side. A thin needle is inserted in the same location of your back as the epidural. Once the spinal anesthetic is injected, the onset of numbness is quite rapid.
Pros:
- It works more quickly than an epidural.
- A much smaller dose is needed than for an epidural.
Cons:
- You may experience a drop in blood pressure, headache, and some difficulty with urination.
- As your blood pressure drops, oxygen flow to your baby decreases.
- You'll need to lie flat on your back for four to eight hours after delivery.
