Obstetric Anesthesia

The anesthesiologists with Northern California Anesthesia Associates are highly trained and experienced providers of anesthesia and pain management for the obstetric patient during labor and delivery. We provide on-site anesthesia coverage to Washington Hospital Obstetric Unit 24 hours a day, 7 days a week throughout the whole year.

Women going into labor have multiple options for pain management, including non-pharmacologic techniques, intravenous pain medications, local pain blocks (performed by the obstetrician), epidural anesthesia (epidural), and spinal anesthesia (spinal). We primarily provide pain management in the form of epidurals, and more infrequently spinals to women in labor.

What is an epidural? An epidural usually involves the placement of a very small, soft catheter into the space that is just outside the sac containing the spinal cord. The epidural catheter is usually inserted in the lower midline portion of the back while the patient is either sitting or lying on her side. The catheter is kept in place throughout the duration of labor until the baby and placenta are delivered, allowing for the continuous administration of medication without further needle sticks. Side effects may include numbness and decreased strength in the legs, itching, and decreased blood pressure. Risks range anywhere from temporary back ache, bruise at the epidural insertion site, headache, and very rarely infection and nerve damage. Compared to other methods of pain management during labor, the main benefit of the epidural (and spinal) is that the mother is able to get relatively superior pain relief while at the same time having very minimal direct medication effect on the baby.

A spinal anesthetic is another technique used for labor and delivery, although much less frequently than the epidural. In a spinal anesthetic, medication is given into what is called the subarachnoid space surrounding the spinal cord and is usually a single injection of medication without the insertion of a catheter. Spinal anesthesia may be used when placement of an epidural catheter is difficult or when more immediate pain relief is desired. Otherwise the risks and side effects of a spinal anesthetic are similar to that of an epidural anesthetic.

For women undergoing Cesarean sections (C-section), anesthesia options include the following: epidural anesthesia, spinal anesthesia, and general anesthesia. The main difference between an epidural or spinal anesthetic that is used for labor compared to that which is used for a C-section is the type and concentration of anesthetic given. A more concentrated medication that gives a stronger nerve block is used for C-sections. A general anesthetic is also sometime used for C-sections. Usually it is reserved for cases where the patient has a medical or anatomical condition where an epidural or spinal is not feasible or safe. It is also used in cases when the patient is not tolerating the C-section with the epidural or spinal anesthetic alone.

The main benefits of using either a spinal or epidural anesthetic during a C-section include the following: 1) allows the mother to be awake during the birth of the baby 2) minimal medication effects on the baby 3) allows for better pain control immediately after the C-section 4) avoids risks of a general anesthetic.