Obstetric Anesthesiology

We also support a variety of non-medicinal pain management strategies, including water therapy, breathing techniques, and mobility and positioning to manage labour pain.

The goal of our entire health-care team is to make your labour and birth as comfortable and safe as possible. 

We encourage patients to discuss pain management options with their care providers prior to labour and to communicate their birth preferences.

For more information on pain management during birth, please visit the following resources:

• Labour Pains
• Society for Obstetric Anesthesia and Perinatology 
• Sinai Health prenatal classes

Pain relief options

If you choose to use pain medication during labour, our care team can help you decide which type of pain relief is best for you. 

Nitrous oxide

Nitrous oxide is a gas used for pain relief. It is sometimes known as laughing gas. It helps reduce pain, but does not eliminate pain. Nitrous oxide is safe and does not make your baby sleepy. It may cause some patients to feel slightly dizzy and disoriented. Nitrous oxide can be administered by a nurse or midwife. It is most often used in the transitional stages of labour or while waiting for an epidural.

Opioid pain medication

Opioids are a frequently used medication to manage the pain of childbirth. Certain opioids, such a morphine, are only offered in early labour because they can cause sleepiness for both you and your baby. Other opioid pain medications may be given by your nurse or by using a pump called a patient-controlled analgesia (PCA). PCA allows you to safely self-administer pain medication according to your needs. 

Epidural

Epidurals are the most effective and widely accepted method of pain relief for labour and birth. Pain medication is administered into the space surrounding your spinal cord and nerves. This space is called the epidural space. This safely reduces and manages pain in the lower body without any drowsiness and minimal medication side effects.

What to expect

When labour is well-established and you are ready to have an epidural, an anesthesiologist will come to your room to administer the epidural.

You will be asked to sit up on your bed with your knees folded and head slouched forward. The anesthesiologist will inject a small amount of numbing medication into the skin over your lower back. This will reduce the feeling of the needle used to place the epidural.

You may feel some pressure while the anesthesiologist carefully advances the epidural needle and identifies the correct space. You will be reminded to stay very still at this time. Your anesthesiologist will provide a clear description of the procedure so you know what to expect. 

A very small plastic tube (or catheter) is inserted through the epidural needle. Once it is in place, the needle will be removed and the catheter will be taped in place. This allows for the continuous administration of medication that can provide pain relief for as long as it is needed. 

The catheter will be connected to a pump which will administer medication to manage your pain. This pump also has a button that will allow you to push for an extra dose of medication if you feel pain. The epidural should be fully effective after 15 or 20 minutes. At that point, you may continue to feel tightening and pressure sensations. If you continue to feel pain, however, tell your nurse or midwife so adjustments can be made.

Risks

The medications used in epidurals are safe for both you and your baby. 

Epidurals do not significantly affect the progress of labour or the way you deliver.

Studies do not show an increase in long-term back pain or back problems after an epidural. You may experience some soreness or bruising at the needle site for a few days. Pregnancy and childbirth can cause backaches whether or not an epidural was given.

The most common complications with an epidural are minor and easily treated. They may include:

• A brief drop in blood pressure that can be treated with a change in position or medication
• Shivering and itching
• Difficulty urinating, in which case a catheter can be used intermittently

More rare complications may include an accidental spinal tap which may cause a headache in the days after your epidural. The spinal headache can be treated with rest, fluids, and pain medication. Other options are available if the headache does not resolve. 

Most patients are concerned about nerve damage or paralysis. These risks are extremely rare.  They are a result of an infection or bleeding in the around the nerves in the epidural space. If you are at risk of bleeding or infection, your anesthesiologist will not perform an epidural and suggest alternative pain management options.

Sometimes epidurals are not effective in treating pain. Inadequate pain relief should be reported to your anesthesiologist who will discuss further options to improve epidural pain relief. This can be managed quickly and effectively by your anesthesiologist.

Anesthesia for Caesarean births

Most patients are awake and pain-free during a caesarean birth. If you already have an epidural in place, your anesthesiologist will administer stronger medications into the existing epidural for the caesarean delivery.

If you do not have an epidural in place, a single injection of medication into the spinal space will be administered in the operating room. This will provide fast and effective pain relief. The risks and benefits are similar to an epidural. In rare cases, most commonly, emergency caesareans, general anesthesia may need to be administered.