Anesthesia is injected during childbirth in three different places. These are local anesthesia, intravenous medicines, and epidural anesthesia. Let’s jump to find out more about this.
Where is local anesthesia injected during childbirth?
During a normal vaginal delivery, there is a possibility for the normal vaginal hole to be extended for the baby to come out. This process is called an episiotomy. According to statistics, as many as 20% of vaginal deliveries may require an episiotomy. To do this there is a small cut made in the vagina.
To achieve this in a pain-free situation there are two things that are done:
- Local infiltration: The local anesthesia is injected around the vagina. I have included a picture of where local anesthesia is injected.
- Pudendal nerve block: The local anesthesia is injected into the pudendal canal and this is where the pudendal nerve is. I have inserted a picture of a pudendal nerve block from a pin on pinterest.
The pudendal nerve block provides quick pain relief in the areas of the perineum, vulva, and vagina. It is usually timed to be given during the second stage of labor (by the way, there are four stages of labor). This helps with pain relief as the baby is coming out of the vagina and helps with episiotomy pain.
What is the intravenous medicine option?
During childbirth, an intravenous line is always placed. This is because of the expected and unexpected need for medicine administration.
To achieve pain relief during childbirth, the following medicines may be used in combination with local anesthesia and epidural anesthesia:
Opioid medication – administered by the nurse
- Meperidine (Pethidine)
Patient-controlled analgesia: This is opioid medication administered by the patient themselves. The medicine dose and duration are set by the doctor.
These options are insufficient by themselves. They also carry the side effect of affecting the baby and making the newborn baby making more sleepy. Mothers can also have side effects like
- Urinary retention
- Respiratory depression
How is epidural anesthesia injected during childbirth?
Epidural anesthesia is the most common and preferred modality of anesthesia injected during childbirth.
To perform this, obtaining consent from the patient is the first step. The procedure happens this way:
- You are made to turn to the side or sit up (preference based on the doctor and patient factors)
- The epidural space is identified. This is done with the experience and feel of the spine. Sometimes an ultrasound may be used.
- Local anesthesia is infiltrated into the skin. This is lidocaine
- Then an epidural needle is injected into the space. A syringe filled with saline (my preference) or air is placed on the needle. The needle is gently pushed in until the epidural space is identified.
- Following successful identification, an epidural catheter is placed there. This catheter is a thin plastic tubing (actually a PTFE material).
- After the position is confirmed using a small dose of lidocaine as a local anesthetic, this catheter will be used to administer medication either continuously or continually to provide pain relief.
Is epidural anesthesia placed in all childbirth?
I cannot comment on what is the best anesthesia for childbirth. It depends on the patient and the place they are in. What is best for you will be clear after your doctor talks to you and examines you.
Epidural anesthesia is generally placed in many women if not all for the reasons I mentioned above. It is generally placed when the cervix is dilated 4-5 cms and the woman is in active labor. Occasionally it may be placed before or after.
Providing anesthesia is quite challenging for the anesthesia doctor as they must make sure the mother has pain relief without making her sleepy or the baby sleepy and be able to contract or push whenever she is asked to do so.
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Check out other videos on general anesthesia and surgery:
How the Oscar Winner The Million Dollar Baby movie got a simple medical clip wrong
Here is a simple home remedy that can be used for nausea after anesthesia
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