Childbirth with no chemical anesthesia has had a resurgence in this country. There are several methods of accomplishing this, Lamaze being the best known. To be able to do this, most women require training, practice, determination and support from both husband and physician. I am more than happy to support any patient's decision to have a nature labor process, but I have no medical reason to recommend natural labor. I feel the medications I offer are safe, and I wouldn't offer them if I thought they were harmful to mother or child.

Medications such as Demerol and Stadol can be given either in the I.V. or as a shot to take the edge off the contraction pain. This is called analgesia because it just dulls the pain and doesn't remove it completely. This also allows more rest between contractions, but can make the patient drowsy. This medicine is avoided immediately before delivery to avoid the baby being born with this medicine in their system, which can make the baby a little sleepy at birth. The risks of this form of pain relief are that and allergic reactions to the medications.

This is currently the most popular form of pain relief in labor. It is a "regional" anesthesia because only a region of the body is affected. The numbing medication is placed outside of the spinal cord with a catheter that is left in place. It takes about 15-20 minutes to take effect. The degree of numbing can be controlled by the dosage of the medication given. With a lower dose, contractions can be detected by the patient, but they are not as painful; the legs feel heavy, but they can be moved. With a stronger dose of anesthesia a cesarean can be performed. The problems with epidurals are: they can slow labor so it is often best to wait until labor is well under way and the patient is dilated to around 4-5 centimeters, there is also an increase in the need to use forceps because pushing can sometimes be impeded. Occasionally, skip areas in pain relief can occur (Hot Spots). Also, decreases in blood pressure, allergic reactions to the medications and rarely a severe headache after the delivery can occur. These are some of the reasons that it can be too late for an epidural. If one is almost ready to push, the risks of an epidural may not be worth taking if the time of benefit will be limited.

This is similar to an epidural, but the medication is place directly into the spinal fluid. This causes an all or none effect. There is no sensation in the lower body and no ability to move the legs. You do remain awake throughout this. I do not use this for routine delivery, but it is sometimes used for cesarean delivery, if it is indicated. The risks of spinal anesthesia are the same as with epidural anesthesia.

This is also a regional block because the pudendal nerve which runs down to the vaginal opening is numbed. This is done with a needle injecting into the vaginal wall. This doesn't make labor less painful, 'but it decreases the discomfort of the vaginal stretching with the delivery of the babies head. The risks here include: allergic reactions to medications and bleeding into the vaginal sidewall.

This is the injection of numbing medicine just in the area of injury for pain relief. It is used generally in the area where an episiotomy is to be cut or where tears have been caused by delivery and stitches are required. This does not, however, decrease the pain of contractions. The risks here include: allergic reactions to medications and local bleeding.

I receive many varied request about pain relief in labor. I think it is interesting that the range of request go from being completely put to sleep to having no medications what so ever. There was a time, years ago, where "twilight sleep" was used for delivery. This "sleep" was really a drug induced amnesia with the patient awake, and sometimes in very poor control of herself, but unable to remember the experience because of the drugs blocking the memories.

Currently, being put to sleep is avoided in labor and delivery because the epidural has been shown to be safer. General anesthesia, or being put to sleep, doesn't allow you to take any part in the birth process in the operating room and precludes the husbands presents there as well can expose the baby to the medications used. Now, the only time one is put to sleep, in general, is if a cesarean section needs to be done so rapidly that there is no time to place an epidural. The most significant risk of being put to sleep is the loss of the body's natural ability to keep food and acid from coming back up and being inhaled into the lungs. The anesthesiologist tries to control this with pre-operative antacids and careful control of the patient's windpipe. THIS IS WHY YOU SHOULD NEVER EAT OR DRINK ANYTHING AFTER YOU BEGIN YOUR LABOR.