Abstract: or not to use anesthesia during the


2100 Cadet: Mahmoud
fares samir

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When a woman finds out she is pregnant, she
will begin the internal debate about whether or not to use anesthesia during
the labor process. Many women feel that natural childbirth is the only way to
go until they begin labor and realize
just how painful the birthing process can be. It is important to weigh all of
your options when it comes to pain relief during labor. There are safe and
effective methods of pain relief that allow motto focus on pushing rather than
the pain of the baby moving out of the body through the birth canal.

 Keywords: -anesthesia for
labor-general anesthesia-regional anesthesia-local anesthesia-complication of


Not all women will need relief from the
pain of labor. Many times this is helped by support from the baby’s father or
another family member. This may be all the “anesthesia” they need. Other women
may need a combination of support and medications. Fear is one cause of pain,
and it has been found that women who have attended childbirth classes and are
given enough information about the whole process need less medication.

Each woman is different. Each person’s
labor and delivery is different. It is difficult to decide in advance what pain
relief will be needed. Therefore, it is best to know about different choices,
and then wait and see how the labor progresses and decide with your doctor what
medications, if any, will be needed.

There are several types of drugs that may
be used during the birth of your child. They are: pain killers (narcotics),
general anesthesia, and regional anesthetics. Pain killers or analgesics reduce
the feeling of pain. General anesthesia allows the mother to sleep during
delivery. Regional anesthetics make certain areas of the body numb while the
woman remains fully awake.



 Types of anesthesia:

General anesthesia, regional anesthesia
or a local anesthesia are available. They work by causing you not to feel any
sensation in all or part of your body. You and your doctor will discuss which
of these anesthesias are appropriate.


1- general anesthesia:

General anesthesia is one where the woman
sleeps during delivery. Sleep is caused by a special medication given to her
through a needle that has been placed in one of her arm veins. Soon afterwards,
certain gases are given to her to breathe, which circulate throughout her body,
to keep her asleep. She, then, wakes up when the delivery is all over.

This type of anesthesia is usually only
given if there is an emergency and not a moment to waste. Because it takes only
a short time to give and is effective almost immediately, it may be your
doctor’s choice should a problem occur. In that case, you should be prepared to
accept this decision.

2- regional anesthetics:

Regional anesthetics cause a specific area of the body
to become numb. The types most often used are: spinal, epidural, caudal, saddle
block and pudendal anesthesia.

spinal anesthesia:

Spinal anesthesia
is a blocking pain reliever often used in cesarean sections. The spinal
anesthesia numbs the entire lower half of the body and can numb all the way to
the neck in certain cases. There is no feeling in the lower half of the body
which leaves mom unable to feel when she should push during vaginal labor. The
spinal anesthesia is placed directly into the spinal cord and relieves all pain
immediately. The spinal is a onetime pain reliever that is injected with no
continuous relief. However, the pain relief will only last at full strength for
about 1 hour before it starts to wear off.


How is it given?

A numbing
medication, something similar to novocaine, is injected into the lower portion
of the back which gradually causes the mother’s lower part of her body to feel
tingly, heavy, and numb. She is then unable to move her legs. She feels no pain
during delivery, but in an hour or so the feeling gradually returns.

b- epidural

An epidural
anesthetic is given in the same area of the back as the spinal, but the
medication is injected into the space just short of the spinal canal, called
the epidural space. For pain relief during of labor, a small plastic tube is
then inserted into the space, and taped to the mother’s back. This allows more
numbing medication to be added as needed without any other needle sticks. This
tube is usually not uncomfortable for the woman. As one dose wears off, another
can be given. It usually takes effect in five to ten minutes and continues
until after delivery. She will feel numbness and tingling in the lower portion
of her body, but she still is able to move.
The advantage of this method is that it can be used not only for delivery but
during labor as well. Therefore, very little discomfort is experienced during
both labor and delivery.

For injection of
a spinal, epidural or caudal, the mother will be asked to lie on her left side
in a curled up position or possibly sitting and curled over. For a saddle
block, she will be asked to sit up. This position may be uncomfortable at her
stage of labor but is in no way harmful to her or the baby.


Advantages and


• Can be topped, should the surgery be

• Can be used for good postoperative


• More likely than spinal anaesthesia to
produce patchy or unilateral


• Takes longer to
establish an adequate block.

• Can be technically
diffi cult, with a higher incidence of headache in

the event of
inadvertent dural puncture.

• The catheter can
migrate into the subarachnoid or subdural

resulting in
unpredictable and possibly fatal complications if large

doses of local
anaesthetic are administered.

• Larger doses of local anaesthetic
agents are required, leading to the

possibility of toxicity if the catheter
has migrated intravenously


c- combined spinal epidural:

Combined spinal
epidural (CSE) anaesthesia combines the advantages

of spinal
anaesthesia, i.e. speed of onset and dense block, with the ability

to prolong the
period of anaesthesia and analgesia via the epidural route.

Advantages and disadvantages:


• The epidural component can be used to
top-up the block.

• A smaller volume of local anaesthetic
can be used intrathecally and

the block extended gradually with the
epidural component (this may

cause less cardiovascular instability and
be useful in women with

cardiac disease).

• The epidural component can provide
postoperative analgesia.


• There is a
higher risk of failure of the intrathecal component.

• Possible higher
risk of meningitis than with either spinal or epidural


• The epidural
component of the technique is untested and any

local anaesthetic
agents must be given in small boluses, in case the

catheter is in
the subarachnoid space


d- caudal anesthesia:

Caudal anesthesia
is an epidural anesthesia in which the medication is injected into the lower
part of the spinal canal near the tailbone. This causes the lower part of the
belly and legs to become numb. The woman may still feel some pressure but not
pain. She will still be able to help push the baby out during delivery.

This anesthesia
can also be started during labor and continued throughout delivery


e- saddle block

A saddle block or
low spinal is given just before the baby is about to be delivered. The
medication is injected in the lower spine. This type of anesthesia causes
numbness only in the area of the body that ordinarily would come in contact
with a saddle while riding horseback. The medication produces a numbing
sensation usually long enough only for delivery and to repair an episiotomy.

f- pudendal

This anesthesia
provides for numbing of specific nerves (called pudendal nerves) in the lower
part of the body near the birth canal. A needle is carefully inserted into the
vagina and is injected along both sides of the vagina. This makes the area
between the mother’s legs feel numb. This feeling usually lasts for as long as
it takes for delivery and repair of the episiotomy.

3- local anesthesia:

Local anesthesia
is made possible by injecting the medication directly into the skin that needs
to be made numb (much like what a dentist does).

For delivery, the
medication is injected into the perineum (the space between the vagina and
anus) just before the baby is born. This allows the area to be pain-free when
the episiotomy is performed and later repaired.

Local anesthesia
does not help with contraction pains.


complication of

a-on the baby:

If the woman gets
a general anesthetic, the baby may be made sleepy also. Because of this, the
mother is usually not given any of the anesthetic until just before the baby is
to be born. That way, the baby is less likely to be affected.

A small amount of
the medications used in the regional anesthesias may get to the baby but
usually there is little effect. Overall, their use is considered safe.


b-on the mother:

All of the
anesthetics are considered quite safe for the woman, but there is always a
small risk. When a general anesthetic is given, the woman may vomit and breath
some of the stomach contents into her lungs. This is usually prevented by not
allowing the mother to eat or drink anything after labor begins. If she needs
liquids, an IV (needle into a vein) will be used so fluids may be given.

When a spinal or
epidural anesthetic is given, there is a chance that low blood pressure may
occur. This is best treated by extra fluids and special medications.

There is also a
chance that a headache may occur after a spinal or epidural anesthetic. This
headache is worse when you sit or stand up and gets better when you lay down.
It is treated with plenty of fluids and pain medicine until it disappears.
Sometimes your anesthesiologist will treat this with a simple spinal injection.

Women given
epidurals run a higher chance of having low level fever during labor. This can
lead to your baby needing to have tests and antibiotics to cover the
possibility of infection. Generally, the babies of mothers with this fever do
not have an infection, but the babies sometimes need special tests and
medicines to check for the possibility that they might have an infection.

Remember, no
anesthesia is perfect. Each one has its advantages and disadvantages, as well
as possible risks and side effects. But with well-trained doctors, the chances
of a safe and pleasant delivery are likely.

You may want to
discuss your feelings regarding pain relief and anesthesia with your doctor
before the time of delivery. That way, the two of you may plan together the
best way for you to have the type of childbirth experience you desire.