Types of Pain Control


Analgesics

Analgesia is the relief of pain without total loss of feeling or muscle movement. Analgesics do not always stop pain completely, but they do lessen it.

Anesthetics

Anesthesia is blockage of all feeling, including pain. In some forms of anesthesia, such as general anesthesia, you lose consciousness.  Regional anesthesia removes all feeling of pain from parts of the body while you stay conscious.  Analgesia is offered more regularly for labor, surgery or after delivery. Anesthesia is used during surgical procedures like a cesarean delivery.

It is best to discuss your pain relief options with your physician, as not all hospitals are able to provide all types of pain relief medications. However, at most hospitals, an anesthesiologist will work with your health care team to pick the best approach for you.

Systemic Analgesics

Systemic analgesics are often given as injections into a muscle or vein. This will decrease the pain but you will not lose consciousness. This will take effect on the entire nervous system rather than a specific area. Occasionally, additional drugs are given with analgesics to relieve the varying symptoms that may be caused by these types of pain relief.  Most of the side effects are minor, such as nausea, feeling drowsy or having trouble concentrating. Systemic analgesics are not given right before delivery because they may slow the baby’s reflexes and breathing at birth.

Local Anesthesia

Local anesthesia provides numbness or loss of sensation in a small concentrated area. It does not, however, lessen the discomfort of contractions.

Prior to delivery, your doctor may perform a procedure called an episiotomy. Local anesthesia is helpful when an episiotomy needs to be done or when any vaginal tears that happened during birth are repaired.

Local anesthesia rarely affects the newborn. Typically, there are no side effects once the local anesthesia has worn off. 

Regional Analgesia

Regional anesthesia has been found to be the most effective form of pain relief during labor and often has few side effects. Epidural analgesia, spinal blocks and combined spinal & epidural blocks are all types of regional analgesia that are used to decrease labor pain.

Epidural Analgesia

Epidural analgesia, also sometimes referred to as an epidural block, causes loss of feeling in the lower part of your body, but you remain awake and alert during the delivery. An epidural block with stronger medications can be used for cesarean birth or the delivery requires additional assistance for extraction.

An epidural block is given to you in the lower back while lying on your side with your back curved outward. You can move while this is being done, but you will not be able to walk around.

Spinal Block

For a spinal block a small amount of medication is injected with a thin needle into the spinal fluid to numb the lower half of the body. While only lasting an hour or two, a spinal block takes effect quickly.

Generally, a spinal block is only given once during labor and is provided during delivery. This pain option can be used in a vaginal birth if the baby needs to be helped out of the birth canal by vacuum extraction or with forceps.

Combined Spinal–Epidural Block

Choosing a combined spinal-epidural block has benefits of both types of pain relief. The spinal part helps provide pain relief almost immediately. Additionally, the drugs through the epidural provide pain relief throughout the course of labor. This pain relief option is injected into the spinal fluid and into the space below the spinal cord. This option is often referred to as "walking epidural" as some women are still able to walk after the spinal block is in place. 

General Anesthesia

General anesthetics are medications that put you to sleep (lose consciousness). By choosing general anesthesia you will feel no pain and are not awake during your delivery. General anesthesia often is used when a regional block anesthetic isn't possible or isn't the best choice. This option is often used for urgent cesarean delivery as you lose consciousness rapidly.

Anesthesia for Cesarean Births

Your health and that of your baby will assist in determining whether you have general, spinal or epidural anesthesia. Why the cesarean is being done will also factor into this decision. In emergency situations when bleeding occurs, general anesthesia may be necessary.

If you already have an epidural catheter and then need a cesarean, it is likely your anesthesiologist will inject a much stronger drug through the catheter to increase your pain relief and numb your abdomen for surgery. In this scenario, there is no pain but only a feeling of pressure.