Types of Delivery

Anesthetics during childbirth

Anesthetics

Drugs that produce a loss of sensation are called anesthetics. These medications interrupt the pathway of nerves that carry sensations of pain to the brain. In effect they "block" pain messages and are commonly called "nerve blocks." During delivery your doctor can choose a nerve block that will completely numb you from the waist down or one that numbs a smaller vaginal area.

The most frequently used blocks are the epidural, pudendal, spinal, and caudal. Let's look at each in turn:

• The epidural block affects only the sensory nerves to numb you from the waist down, leaving you with full muscle movement. It can be given before the cervix is fully dilated and it provides excellent anesthesia during the entire active phase of labor, vaginal delivery, forceps delivery, or cesarean delivery. The medication is administered by inserting a long, fine needle into the space between the vertebrae of the lower back. A small plastic tube is threaded and left in the space right before the spinal cord. With the tube in place, medication can be administered throughout labor as needed. Initially, it can take up to 30 minutes to feel the effect. The epidural is rapidly becoming the most widely used type of nerve block for relief of pain during labor.
• The pudendal block is administered through a needle inserted in the vaginal area. The numbness is localized and reduces pain in that area, but does not reduce the pain caused by uterine contractions. The pudendal block is frequently combined with a tranquilizer for added pain relief.
• A spinal block is administered at the end of labor, immediately before delivery. A full spinal block affects the sensory and motor nerves; it instantly numbs the body from the waist down and causes loss of voluntary leg movement and the inability to use abdominal muscles. It is usually used for cesarean deliveries. Because the spinal blocks feeling in the part of your body that comes in contact with a saddle, if you were riding a horse, it has become known as a "saddle block." It is often used for forceps-assisted delivery. Because the saddle block interferes with the normal movement of the baby's head into the birth canal, a saddle block is not usually administered until the cervix is completely dilated and the baby's head is deep in the pelvis. The spinal block is administered by inserting a long, fine needle into a space between the vertebra of the lower back.
• A caudal block was once a very popular method of delivering pain relief during labor and delivery. Today, it is less popular than the epidural for a number of reasons. The caudal does not cover as wide an area as the epidural. It requires a larger dosage, and it is difficult to administer correctly. In addition, the increased pelvic and abdominal muscle relaxation produced by this technique might slow the progress of the second stage of labor. Like the spinal block, the caudal block is administered by inserting a long, fine needle into a space between the vertebra of the lower back.