Questions about Childbirth Pain

The Department of Obstetrics and Gynecology at Cedars-Sinai offers free classes on Labor Pain Relief. For more information, click here.

Does being nervous affect the delivery process?

Nervousness and anxiety are types of stress. Stress affects hormone production, body chemistry, physical responses and emotions. It can be a factor in slowing labor and making it more painful.

How can I avoid being anxious and afraid about having my baby?

Being well informed is the best way to avoid being anxious and afraid. Try to relax and have a positive attitude as you approach delivery. Do not think about things going wrong. Other people's experience should not be used as a guide for what you will experience. Respect and have confidence in yourself. Acknowledge that people are different. Don't compare. Don't compete. Understand the basics of childbirth by reading a simple book on childbirth, enrolling in a prepared childbirth class and by asking your doctor questions.

When does the pain of labor begin?

There is no single answer to this question. People and labors differ. Some feel pain before going into labor. Others feel it only after being in labor for some time. When pain starts, your doctor should be called. He/she will instruct you as to what you should do.

Does abdominal pain signal the beginning of labor?

Not always. There must be changes in the cervix for labor to have started. Such pain is, nevertheless, worthy of your attention and merits alerting your doctor. He/she will guide you as to what to do.

Why must I not eat or drink upon going into labor?

During pregnancy stomach emptying is slowed. If an emergency occurs during labor that requires general anesthesia (sleeping anesthesia), there is a possibility that acid and food remnants present in the stomach might silently come up and go into your lungs while you are asleep. This can be very dangerous and sometimes fatal. It is, therefore, best to have the stomach as empty as possible as a precaution.

How can I manage pain that occurs before I go to the hospital?

Painful contractions often occur before one goes to the hospital. This is certainly an argument for learning the pain management techniques taught in prepared childbirth classes. The breathing and relaxation techniques will be very helpful. Best of all they are portable, and once learned, they are always with you.

What are intravenous medications and infusions?

Intravenous means given "into a vein" and refers to the route by which medications or fluid can be given into the body. Veins are a part of the circulatory system or bloodstream. Since eating and drinking are generally restricted during labor, fluid replacement is usually given intravenously. An intravenous infusion is a continuous flow of fluid (sometimes sugar water, sometimes a balanced salt solution) into a vein. Most laboring patients and all patients who receive anesthesia or epidural analgesia will receive an infusion of fluid. When a medication is given intravenously, it goes throughout the mother's bloodstream and usually enters the baby's bloodstream. Fortunately, the placenta is between the baby's circulation and the mother's. The placenta can affect the amount and form of medicine that reaches the baby. While the baby is inside its mother, her liver will break down medications and determine the period of time that they can be active in the baby's circulation. Medicines used for pain relief during childbirth are generally short acting and in amounts that do not have long-term effects on the baby. Intravenous medications are frequently given in early labor so that they are cleared from the baby's body before delivery.

What is the difference between analgesia and anesthesia?

Analgesia is simply the loss of one's ability to feel pain. Sensations of touch, pressure and the ability to move generally remain intact. The patient also remains awake. Accordingly, laboring patients with epidural analgesia feel pressure and have muscle strength to push when the time comes. Anesthesia is loss of all sensation. It includes loss of touch, loss of certain reflexes and loss of one's ability to move. With general anesthesia the patient is also asleep. Anesthesia is primarily used for surgery.

Is anesthesia bad for childbirth?

When administered properly, it is not bad for the mother or baby. It is essential for c-sections and appropriate for some complicated deliveries. It is not appropriate for labor and most uncomplicated vaginal deliveries.

What is an epidural?

An epidural is a type of regional anesthesia or analgesia. It is performed by advancing a needle between the bones of the spine to a region called the epidural space. Medicine is then delivered through the needle into this space so that the crossing nerves are bathed in the medicine. The result is that pain impulses are blocked from reaching the spinal cord. Accordingly, one's ability to feel pain is lost. While the needle is in place, a small tube called a catheter is slid through the needle into the epidural space. The needle is then removed over the catheter, leaving the catheter in the epidural space. It is then taped to the back so that it remains in place. With the catheter secured, medication can then be given repeatedly as needed. Sleepiness does not usually accompany epidurals.

Must I have an epidural?

No. Each individual's needs are different and should be respected. Patients having their first baby are more likely to need some assistance with their discomfort than those who have had babies before. Either can choose to have or not to have an epidural.

How safe are epidurals?

All procedures, including the epidural, have the potential of doing harm. Epidurals are, however, among the safest anesthetic or analgesic procedures available for labor, delivery and c-section. They have been responsible for a significant fall in the frequency of anesthetic accidents during childbirth. Accordingly, they are the most popular medicated technique used for pain relief today. Complications of significance are rare.

Is having an epidural painful?

Most often the answer is no. After a short sting as local anesthetic is injected to numb the skin, there is usually only pressure.

How long does it take to perform an epidural?

Most skilled anesthesiologists can give an epidural within five minutes. Sometimes an epidural may be difficult to perform, and it might take longer. Since carefulness is of greatest importance, speed should not be a major factor in judging performance.

How long does it take for the epidural to be effective?

It usually takes between five and fifteen minutes to be fully effective, although this varies from person to person. Should you not be comfortable within twenty minutes after completion of the epidural, notify the nurse, and she will tell the anesthesiologist.

How long does an epidural dose last?

A single dose usually lasts between two and three hours. If the catheter is attached to an infusion pump, a continuous flow of dilute medication can be delivered, which will provide virtually uninterrupted pain relief.

How does one feel after having an epidural?

Usually the only change that will be noted is that the pain disappears. Patients generally feel normal.

Does an epidural make one feel numb?

It can, but current techniques make numbness less likely than years ago. Most patients state that they notice no change of sensation or only a slight warmth or tingling in their legs.

How does one know when the epidural medication is wearing off?

Contractions gradually return as the medication begins to wear off. They will first be felt as mild pressure that increases to discomfort. Ultimately, it will return to the pain that it was initially or worse. Therefore, it is advisable to request re-dosing when the pressure first returns.

Why are epidurals so popular?

Epidurals are the most effective method of pain relief for childbirth. They provide the kind of birthing experience that most women seem to desire, and they are adaptable to most childbirth needs.

Why do some hospitals use more epidurals than others?

Over the past thirty years epidurals have become the most desired means of pain relief for childbirth. Accordingly, the availability of a full-time obstetric anesthesia staff capable of skillfully performing epidural techniques attracts both patients and doctors. When patients have a good experience they spread the word, and others come seeking the same experience.

Why is there so much conflicting information about epidurals?

Over the past twenty years many new developments have occurred in the way that epidurals are given. As with anything new, it takes time before it becomes mainstream. This is particularly true of patient information. Accordingly, some of the information that is published and taught may be old, inaccurate or applicable only to certain hospitals. It is, therefore, best to get information from your doctors, a teacher who works at your hospital or from the anesthesia staff who will be giving your epidural.

If epidurals are so good why doesn't everyone have one?

What is good for one woman may not be good or even desirable for another woman. Every woman has a right to choose what she feels is best for her.

Is there anyone who should not or cannot have an epidural?

Yes. Though epidurals are safe for most people, anyone with documented bleeding problems or an infection at the site where an epidural is given should not have an epidural.

What medications are used in an epidural for childbirth?

A very dilute local anesthetic solution, either by itself or in combination with a short-acting narcotic is the most frequently used medication.

What if I'm allergic to local anesthetics or narcotics?

You should mention any and all allergies to your nurse and anesthesiologist. The anesthesiologist can test for true allergies and use a different medication if necessary. True local anesthetic allergies are quite rare.

Are there side effects associated with epidurals?

A side effect is an undesired effect that accompanies the desired effect of medications. Yes, there are several side effects that may occur with epidurals. Not feeling the urge to urinate is quite common. Lowering of the blood pressure can occasionally occur and might cause lightheadedness or nausea. Slowing of labor can occur, as can itching. Each of these has become quite rare with today's use of diluted medications, except for not feeling the urge to urinate. Any unusual or unexpected feelings that occur should be reported immediately to the nurse or anesthesiologist so that appropriate responses can be initiated.

How early in labor can one have an epidural?

You may have an epidural as soon as you and your obstetrician feel it appropriate. Use of dilute concentrations of local anesthetic and medications in combination make it possible to give epidurals at any time with little likelihood of effecting labor.

How late in labor can one have an epidural?

If the baby's head is visible, it is too late. The anesthesiologist is capable of placing an epidural at any time. It is sometimes wise, however, to refrain from starting an epidural if delivery is so near that it might not have time to work fully.

Do epidurals sometime produce incomplete or one-sided relief?

Yes, this can occur. It usually indicates that the catheter needs adjustment. Accordingly, if you have not experienced uniform relief within twenty minutes, you should notify your nurse. After adjustment by the anesthesiologist, the problem is usually resolved.

Must I remain in bed after having an epidural?

Though most patients seem to prefer remaining in bed after becoming comfortable, some patients choose to walk. Very dilute medications allow muscle strength and coordination to be retained. Walking epidurals are given upon patient request and agreement from the patient's doctor. Such an epidural may not produce as complete or prolonged relief as the standard epidural since the medication is quite diluted. Walking is usually limited to trips to the bathroom or movement within the room. For safety reasons, the nurse and anesthesiologist must confirm the adequacy of one's muscle strength before walking can be permitted.

Will it be difficult to urinate after having an epidural?

It is not uncommon to lose the urge to go to the bathroom after receiving an epidural so it may be difficult to urinate.

Do epidurals slow labor?

Not usually. Old epidural techniques often slowed labor because much stronger local anesthetic solutions were used. Current techniques using dilute solutions usually do not lengthen labor. The pattern and frequency of contractions might be initially altered, but this is often followed by more efficient contractions that might shorten labor. It should be noted, however, that prolonged, painful labors are a frequent reason that patients request epidurals. Accordingly, epidurals are often used when labors are slow.

Do epidurals lead to c-sections?

No, this is a misconception. Though the way that an epidural is given can influence the likelihood of one needing a c-section, current epidural techniques should not cause c-sections. It should be noted, however, that more c-sections occur among women who have epidurals, but the epidural is rarely the reason for one needing a c-section. Some women are more likely to need c-sections than others. Women who have prolonged and extremely painful labors are not only more likely to need pain relief but they are also more prone to need c-sections. Extreme pain is often an indicator of a problem labor.

Do epidurals cause fevers in some mothers?

There have been reports to that effect, however, closer examination of these studies bring this conclusion into question. The studies need further evaluation. Considering that epidurals provide many benefits other than pain relief, it remains the safest and most reliable analgesic technique available.

Do epidural medications reach the baby?

Small amounts of medication can be detected in the baby since most medications do cross the placenta. These amounts are rarely sufficient to affect the baby.

Do epidurals cause backaches?

Backaches are not uncommon after childbirth, but epidurals are rarely the cause. More likely causes of backaches are positions and activities that occur during pushing.

Can a person who has had back problems or surgery receive an epidural?

The answer is usually yes, and good results are achieved most of the time. Such a determination should be made on a case-by-case basis, however.

What are the worst complications that can happen due to an epidural?

Paralysis has occurred, as well as death. Such occurrences are extremely rare.

What are some advantages to having an epidural?

  • It provides the most effective pain relief.
  • It allows patients to remain awake during childbirth.
  • It decreases the likelihood of stomach contents going into the lungs.
  • It decreases the amount of medication circulating during labor.
  • It allows patients to be well rested when it is time to push.
  • It prevents the need for hyperventilation and its possible bad effects.

What are some disadvantages to having an epidural?

  • A urinary catheter may become necessary.
  • Lowering of blood pressure occasionally occurs.
  • Itching sometimes occurs.
  • Slowing of labor rarely occurs.

Are there conditions that can make anesthesia risky?

Yes. Some conditions that increase risk during anesthesia are obesity, high blood pressure, diabetes, drug abuse, bleeding problems, infection and a full stomach.

If I do not need anything for labor and delivery, is there anything available for an episiotomy?

A local anesthetic can be injected by your doctor to relieve the pain of the episiotomy.

What is a spinal or saddle block?

A spinal is also called a subarachnoid block, an intrathecal block or a saddle block. It is also a type of regional anesthesia and is frequently used for c-sections but can be used to provide pain relief for labor. Sometimes a spinal is used in combination with an epidural (CSE or combined spinal epidural) for labor pain relief and/or c-section. It is performed in the same manner as an epidural, but the needle is advanced slightly further. Medicine is deposited in the subarachnoid space where it spreads in the cerebrospinal fluid to bathe the cord and nerve roots. A more rapid and complete loss of feeling results from a spinal than with an epidural, and less medication is required.

Do spinals cause headaches?

In the past, spinals were a frequent cause of headaches. As a result, spinals were avoided. Today, due to use of different types of needles, the incidence of headaches is less than one percent. Accordingly, spinals are frequently used for c-sections when an epidural is not already in place.

If I need a c-section, will an additional anesthetic be necessary?

When an epidural catheter is in place, most often the answer is no. This catheter allows easy conversion from analgesia to surgical anesthesia. In extreme emergency situations, it might be necessary to switch to a general anesthetic because the epidural will not work rapidly enough. Such situations are quite rare.

If I have had a c-section for a previous delivery but wish to try vaginal birth for my next, can I have an epidural?

Yes, you can. Since you remain at risk for needing a c-section, having a tested epidural catheter in place is an advantage.

What are the chances of an epidural wearing off before surgery has ended?

The chances are quite unlikely. Having a catheter in the epidural space allows re-dosing whenever necessary.

What will I feel during a c-section under epidural anesthesia?

The most obvious feeling will be numbness from the nipples down to the toes. Occasionally, this includes the arms. Some patients do not feel the movement of their chests while breathing, and think that they are not breathing. The best indicator as to whether you are breathing adequately is being able to talk. If you can talk, you are breathing quite well. During surgery, patients sometimes comment on feeling movement in their abdomens that they interpret as their baby moving. Actually they are feeling the doctor going about his work. At delivery, there will be considerable pressure in the upper abdomen caused by the doctor pushing the baby down through the small incision located near the pubic hairline. As the uterus is returned to its original position after delivery, a nagging sensation might be felt in the chest area. Reassurance from the anesthesiologist is usually sufficient to resolve these curious feelings. He will always be in your line of vision, and you will be able to talk to all of your doctors throughout surgery. If anything becomes bothersome, you should alert your anesthesiologist and he will help you with the problem.

Why is it considered better to remain awake during a c-section?

Changes that occur during pregnancy make women vulnerable to possible accidents while under sleeping anesthetics. Therefore, it is safer for pregnant women to remain awake during surgery. Since regional anesthesia allows patients to remain awake, it is the type most frequently used for c-sections. The second reason for being awake is that childbirth is one of life's true landmarks. It is an event that many women say that they would not want to have missed, even those women who initially wanted to be asleep.

When might a general anesthetic be necessary?

The most frequent reason for using a general anesthetic is an extremely urgent need to get the baby out of its mother's abdomen. No anesthetic technique can provide surgical anesthesia faster than general anesthesia. Additionally, there are a few medical conditions where epidural or spinal anesthesia is not considered a good choice. General anesthesia becomes the best choice for these situations.

Is a breathing tube necessary with a general anesthetic?

Yes. After you are asleep and throughout general anesthesia you will have a plastic tube (called an endotracheal tube) placed in your breathing passage to assure good breathing and to protect against the silent flow of stomach contents into the lungs. This tube will be removed as you awaken, and most people are totally unaware of its having been in place. Occasionally, a slight soreness in the throat may occur a few hours after surgery and may remain for a day or so. Insertion of an endotracheal tube is a most important practice since it saves lives by preventing the often fatal pneumonia caused by stomach contents flowing into the lungs.

Can husbands remain in the operating room when general anesthesia is given?

Usually, the answer is no. The need of a general anesthetic means that circumstances are more serious than usual. Distractions are not in the mother's or the baby's best interest, so the father is asked to leave the operating room until the mother has awakened.

How much pain is there after a c-section?

A c-section is a major surgery, and there is usually pain afterwards. People respond differently to pain, but it can be managed according to individual needs. There are a number of techniques available. The most popular method is epidural or spinal narcotics. Good relief is achieved within two hours with these methods and lasts for 18 to 24 hours. It is timed to become effective as the anesthetic is wearing off. There are several possible side effects associated with the narcotics used. Itching is the most common. Nausea, though less frequent, is more bothersome. Both can be reversed with medications ordered by the anesthesiologist. Other methods of pain relief are intravenous or intramuscular injections (shots). These injections, though effective, frequently cause drowsiness. Epidurals and spinal narcotics do not.

Will there be any lingering effects from my anesthesia?

For a day or so after surgery you might feel a slight soreness at the site in the skin where the epidural was inserted. This should be minimal and noticed only when touched. A slight soreness in the throat might be experienced after a general anesthetic but it goes away after a couple days.

Will my insurance pay for epidural pain relief?

Generally speaking, yes. Most insurance carriers do cover epidural analgesia for labor and vaginal delivery. Some of the managed care plans, however, try to cover epidurals for only certain types of deliveries, such as complicated deliveries or c-sections. Therefore, it is wise to check your coverage with your carrier before going into labor.

From whom will I receive a bill for my epidural?

You will receive a bill from your anesthesiologist for placing the epidural and caring for you during the time that the epidural is in place. You may also receive a separate bill from the hospital for the equipment used to perform the epidural.