American Medical Association Family Medical Guide - American Medical Association [298]
Pudendal Block
Vaginal pain can be relieved by an anesthetic called a pudendal block, which is injected into the tissue of the vagina. A pudendal block is often used just before a forceps delivery (see page 534), or before an episiotomy (see next page), in which an incision is made in the perineum (the skin between the opening of the vagina and the anus) to allow the baby to pass through the vagina more easily.
Epidural and Spinal Anesthesia
If your pain is severe, the doctor may recommend epidural (see below) or spinal anesthesia for pain relief. For an epidural, the doctor or an anesthesiologist injects an anesthetic into the space surrounding the spinal cord at the base of the spine (epidural space). The anesthetic is infused through a thin, flexible tube (catheter) to provide small doses of the anesthetic as needed during labor and delivery. An epidural numbs the body from the waist down.
Spinal anesthesia is similar to an epidural except that it is given in one injection, and it paralyzes, not just numbs, the body from the waist down. Spinals are used mostly for cesarean deliveries (see page 534) because vaginal deliveries require the mother to be able to help push the baby through the birth canal.
Epidural anesthesia
Epidural anesthesia during pregnancy is given between contractions, with the pregnant woman lying on her side. The needle (which is attached to a catheter) is inserted between the vertebrae of the spine into the epidural space surrounding the spinal cord. An epidural causes numbness from the waist down, but the woman is fully conscious.
Complications from epidurals are rare. An epidural may prevent a woman from feeling when to push with contractions, possibly making labor longer. Sometimes an epidural relaxes the pregnant woman’s blood vessels, causing her blood pressure to drop, which may slow the baby’s heart rate. To prevent this potential problem, women are given intravenous fluids before and during administration of the epidural.
Techniques Used to Aid Delivery
Doctors can use a number of techniques and procedures to assist women during labor and delivery. These techniques can help ensure that childbirth is as comfortable as possible for the woman and safe for the baby. Doctors are able to continuously monitor the fetus’s health throughout labor, if necessary, and ease delivery using instruments such as forceps.
Fetal Monitoring During Labor
Fetal monitoring is performed routinely during labor when there is some reason to evaluate the fetus’s health more closely than usual. In external fetal monitoring, two belts are placed on the woman’s abdomen, one to measure the fetus’s heartbeat and the other to measure the length, frequency, and relative intensity of uterine contractions during labor. If complications such as bleeding occur during labor, a doctor may recommend internal fetal monitoring, which can be done only after the membranes of the amniotic sac have been broken.
Internal monitoring of uterine contractions
If complications develop, internal monitoring is sometimes performed during labor to evaluate uterine contractions and the health of the fetus. In internal monitoring, an electrode is inserted through the vagina and attached to the fetus’s scalp to measure the fetus’s heart rate. Usually, a long thin tube (a pressure-sensitive catheter) is also inserted through the vagina into the uterus to measure the actual intensity, length, and frequency of the contractions.
To perform internal fetal monitoring, the doctor inserts an electrode through the woman’s vagina into her uterus and attaches it to the