What Every Expectant Mother Should Know

Main Category: Pain / Anesthetics
Also Included In: Pregnancy / Obstetrics
Article Date: 20 Aug 2009 - 2:00 PDT

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While four million women experience labor and delivery annually, the month of August historically has the highest number of births in the United States, according to the National Center for Health Statistics. Just as parents spend months preparing for the birth of a child, they should also be informed about the pain management options available to them during the labor and delivery process.

The American Society of Anesthesiologists (ASA) has developed a set of facts about pain management during childbirth to help prepare expectant mothers for this important experience.

"In the last 30 years, tremendous advancements have been made with respect to pain management options during labor and delivery," said Craig Palmer, M.D., Chair, Committee on Obstetrical Anesthesia, American Society of Anesthesiologists. "While the Internet has vastly increased the quantity and accessibility of medical information, it has also fostered the spread of misinformation about pain management and childbirth. The goal of this campaign is to provide the public with accurate, impartial, and scientifically-supported information to help expectant mothers make choices that are right for them."

Additional information may also be found at LifelinetoModernMedicine, the ASA's Web site dedicated to educating and empowering the public about anesthesiology.

What Every Expectant Mother Should Know About Pain Management During Labor

Following are some key facts to help women prepare for labor and delivery:

Fact: Pain management during labor and delivery is a personal choice for women.

Women should not feel pressured to either accept or refuse pain management treatment during labor. It is an individual choice that should be made in consultation with a doctor either an obstetrician or anesthesiologist and with all the available information at hand.

Fact: Pain during labor is different for every woman and depends on a variety of factors.

Some women need little or no pain relief medication, while others find that pain relief medication gives them better control over their labor and delivery. It is important that every woman be as informed as possible about the process and options for delivery before being admitted to a hospital and in labor.

The ASA encourages expectant mothers to be flexible and keep their options open throughout the entire birthing process. Pregnant women should talk to their obstetrician about their options and, if desired, meet with an anesthesiologist before labor and delivery. Fact: There are four basic types of anesthesia used during the labor and delivery process. These include epidurals, spinal blocks, a combination of both the epidural and spinal block, and, if needed, general anesthesia. Each has its benefits and women should work closely with their anesthesiologist to determine the most appropriate response to their individual case. Fact: Except in rare and exceptional cases, pain management has no impact on labor. In the overwhelming majority of cases, there is no impact on the mother, the baby or the labor delivery process. The decision whether to use pain management treatments is largely a question of the comfort of the mother.

Furthermore, contrary to myths frequently cited on the Internet, there is no credible evidence to show that epidurals (or other pain management procedures) slow labor, cause C-sections or lead to a higher incidence of depressed babies. The biggest risk that faces most patients is that the epidural will not work as effectively as desired. In such cases, the anesthesiologists can make adjustments to provide the patient with adequate pain relief.

Fact: There is no arbitrary window for an epidural.

Women do not have to wait until they are dilated to a certain level before they can ask for, or receive, an epidural. According to the ASA's current guidelines, "patients in early labor should be offered the option of receiving neuraxial analgesia (spinal or epidural) when the service is available, and it should not be withheld to meet arbitrary standards for cervical dilation." The primary requirements for receiving an epidural are that the patient wants pain relief, can hold still while the epidural is being administered and the baby is not already in the process of being delivered.

Fact: Women with lower back tattoos can get an epidural.

There is no evidence that lower back tattoos cause harm in this situation. Initiating an epidural through the ink of a lower back tattoo will not cause ink to enter the blood stream or the spinal canal, or cause further complications for the mother or baby.

Fact: It is important that an anesthesiologist administer treatment.

The administration and oversight of pain management treatments during labor requires both the medical judgment of a physician and technical skill. It is important that an anesthesiologist, who has the training and experience to provide optimal care, works closely with the mother to manage the delivery of these pain management therapies.

Source: American Society of Anesthesiologists (ASA)

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