OB questions

Jolie, BSN · Aug 15, 2005

I will be a first time mom and will be meeting with the anesthesiologist next week. B/c of past addictions and concerns, I want to use lidocaine w/out epi. Is this possible? I use lidocaine for my dental procedures and it works well for me. I was wondering how lidocaine would be if I needed a c-section since the doseage would me greater.
Another question I have is: I am doing research on general anesthesia and epidurals/spinals. To be honest, I don't know which one I would choose. I want to be ovjective and do what is best for me with looking at the pro's and con's of each. Epidurals seem to have long term effects. Where can I research this a bit more? Can you give your opinions on both considering my concerns and not which one may seem easier.
TIA,
Jenn

Unless there is a medical contra-indication to regional anesthesia, (low platelets in mom, or need for STAT C-section), general anesthesia is typically not offered to OB patients. There is the potential for side-effects in the newborn, as well as a more difficult recovery for mom.

Best wishes for a safe and uneventful delivery!

kmchugh · Aug 15, 2005

1. General anesthesia is not an option for a mom in labor expecting a normal lady partsl delivery. As a rule, GA is the last option we choose for c-section. There are a lot of reasons for this, but suffice it to say it is safer for both mom and baby to have the section done under some type of regional anesthetic where ever possible.

2. There are a lot of myths out there about epidural anesthesia in general, and specifically for labor. Some are based on a small kernel of truth, while others are purely wrong. As an anesthesia provider, I would not offer any type of procedure to any patient having a baby if I thought there was a significant chance of injury. Not to say that epidurals are completely risk free, they are not. But in the final analysis, it comes down to a risk/benefit analysis, with you making the final decision. Go over the risks with your anesthesia provider. Then make an educated decision about how you want your labor to go. It is, after all, your day.

3. Your post seems to indicate that you are planning for a section. Is that the case? As a rule, I don't generally do spinal anesthetics for labor patients. They are a "one shot" deal, and once they have worn off, there are only two options. Do another intrathecal injection, or deal with the pain until delivery. With epidurals, we leave a small, flexible (usually 20 gauge) catheter in the back, that can easily be redosed. We can also start a continuous infusion into the epidural catheter. On the other hand, I like doing a CSE (combined spinal-epidural) for my patients having a scheduled section. I get the advantage of the dense block of the spinal for the section, and leave an epidural catheter for post operative pain management.

4. For labor patients, I generally don't use lidocaine. Though it produces a dense sensory block, it also produces a pretty dense motor block, leaving the laboring patient almost entirely unable to push. OB docs get a bit testy when that happens. Where I am currently practicing, I use marcaine, generally 0.25%, in the initial bolus dose, then run an infusion of 0.1% marcaine with 2 mcg/cc fentanyl. It works nice, and leaves the parturient able to push when the time comes. I have also used ropivicaine, which has some motor sparing properties, but is VERY expensive.

5. A word about spinal/epidural narcotics: As a rule, when administered to patients with real pain, narcotics do not seem to cause any problems with readdiction. They simply treat the pain. When administered intrathecally or to the epidural space, narcotics do not have the same effect as they would if administered IM, IV, or orally. They attach to the pain receptors in the CNS, but do not seem to cause any of the euphoria associated with other routes of administration. Hence, readdiction is not a problem. However, I understand your concerns. Voice them to your anesthesia provider. It should not be a problem to completely avoid epidural or intrathecal narcotics, if that is your wish.

6. "Epidurals seem to have long term effects." It's hard to address this without knowing what you are referring to. I'd need more information to address this concern.

Kevin McHugh, CRNA

guest27716 · Aug 15, 2005

1. General anesthesia is not an option for a mom in labor expecting a normal lady partsl delivery. As a rule, GA is the last option we choose for c-section. There are a lot of reasons for this, but suffice it to say it is safer for both mom and baby to have the section done under some type of regional anesthetic where ever possible.
2. There are a lot of myths out there about epidural anesthesia in general, and specifically for labor. Some are based on a small kernel of truth, while others are purely wrong. As an anesthesia provider, I would not offer any type of procedure to any patient having a baby if I thought there was a significant chance of injury. Not to say that epidurals are completely risk free, they are not. But in the final analysis, it comes down to a risk/benefit analysis, with you making the final decision. Go over the risks with your anesthesia provider. Then make an educated decision about how you want your labor to go. It is, after all, your day.
3. Your post seems to indicate that you are planning for a section. Is that the case? As a rule, I don't generally do spinal anesthetics for labor patients. They are a "one shot" deal, and once they have worn off, there are only two options. Do another intrathecal injection, or deal with the pain until delivery. With epidurals, we leave a small, flexible (usually 20 gauge) catheter in the back, that can easily be redosed. We can also start a continuous infusion into the epidural catheter. On the other hand, I like doing a CSE (combined spinal-epidural) for my patients having a scheduled section. I get the advantage of the dense block of the spinal for the section, and leave an epidural catheter for post operative pain management.
4. For labor patients, I generally don't use lidocaine. Though it produces a dense sensory block, it also produces a pretty dense motor block, leaving the laboring patient almost entirely unable to push. OB docs get a bit testy when that happens. Where I am currently practicing, I use marcaine, generally 0.25%, in the initial bolus dose, then run an infusion of 0.1% marcaine with 2 mcg/cc fentanyl. It works nice, and leaves the parturient able to push when the time comes. I have also used ropivicaine, which has some motor sparing properties, but is VERY expensive.
5. A word about spinal/epidural narcotics: As a rule, when administered to patients with real pain, narcotics do not seem to cause any problems with readdiction. They simply treat the pain. When administered intrathecally or to the epidural space, narcotics do not have the same effect as they would if administered IM, IV, or orally. They attach to the pain receptors in the CNS, but do not seem to cause any of the euphoria associated with other routes of administration. Hence, readdiction is not a problem. However, I understand your concerns. Voice them to your anesthesia provider. It should not be a problem to completely avoid epidural or intrathecal narcotics, if that is your wish.
6. "Epidurals seem to have long term effects." It's hard to address this without knowing what you are referring to. I'd need more information to address this concern.
Kevin McHugh, CRNA

Hi kevin,

Thank you for the details you provided. I am a victim of medical malpractice and have little faith in the medical profession right now in my life. I was so drugged that I am still experiencing w/d symptoms. Alot of doctor's think I'm crazy but I know enough and seen enough people (research and addiction doctor's) to know better. Also, I am studying to become a toxicologist and when it comes down to it most doctor's don't know squat about drugs and interactions. I am getting off track here but please understand my state of mind. I am meeting the the anesthesiologist next week so hopefully that will go well. I am planning for a natural birth but want to be prepared just incase something was to happen. This would better prepare me and not make me go off the deep edge. When I am prepared, I handle things much better.

I worry about fentanyl b/c of it's strength. It is stronger than heroin. I also worry about how the drugs would affect my CNS system since it is so fragile. Our CNS systems don't heal in a linear fashion. I am 16 months off the drugs and have improved so much but still have a ways to go. I can not have benzos, neuroleptics and have read that some of these drugs can cause movement disorders. I can't take nausea meds with the anesthesia either b/c of the link to tardive dyskinesia/dystonia. Phenergan, reglan, etc.

I would like to know which ones cause the least side effects and don't have long term side effects. I know of several people who have had epi's and have permanent nerve damage and soreness for months. Thanks for listening.

Jenn

kmchugh · Aug 16, 2005

Jenn

I'm a little short of time, but will try to answer some of your main points:

I was so drugged that I am still experiencing w/d symptoms. Alot of doctor's think I'm crazy but I know enough and seen enough people (research and addiction doctor's) to know better.

I am sorry for the things you have gone through. Remember that those of us who do anesthesia for a living specialize in pain and pain management. Yes, it is possible for you to still be feeling the repercussions of addiction, and your anesthesia provider needs to be aware of that.

I am planning for a natural birth but want to be prepared just incase something was to happen. This would better prepare me and not make me go off the deep edge. When I am prepared, I handle things much better.

So do most people. Honestly, I wish I had more patients like you, willing to take the time to become educated before their labor. You are giving not only yourself time to prepare, but your anesthesia provider as well.

I worry about fentanyl b/c of it's strength. It is stronger than heroin.

Fentanyl is a very potent narcotic, no doubt. That's why it is dispensed and dosed in micrograms, rather than milligrams. As a rule, with epidurals, if I use any fentanyl, I'll put 100 micrograms (1/10th of a milligram) in with the local anesthetic dose. Generally though, I don't use it in my bolus doses. In spinal anesthetics, I use 25 micrograms as an adjunct to the local anesthetic. These are pretty small doses, and are given in either the intrathecal or epidural space. And, as I said, narcotics given in these spaces have a much narrower effect than if they were given PO/IM/IV.

I also worry about how the drugs would affect my CNS system since it is so fragile.

This is a difficult concern to address. I have never had a patient have a severe problem as a result of using spinal or epidural narcotics. I have had some patients complain of itching, but have found 4 mg of Zofran works wonders to treat it. These are tried and tested techniques.

I can't take nausea meds with the anesthesia either b/c of the link to tardive dyskinesia/dystonia. Phenergan, reglan, etc. I would like to know which ones cause the least side effects and don't have long term side effects.

I use reglan only occasionally, and phenergan never. Zofran is a much more effective drug to treat nausea, and as an H2 blocker, does not seem to have the effects related to tardive dyskinesia that the others do.

I know of several people who have had epi's and have permanent nerve damage and soreness for months. Thanks for listening.

Well, I have done literally hundreds of epidurals and spinals, and know of none of my patients with c/o long term soreness, or worse, permanent nerve damage (but I am not discounting reports you have). I have seen some soreness related to bruising at the epidural or spinal insertion site. That lasts at most a couple of weeks. Now, I have talked with patients complained of back pain weeks, even months after their first epidural, and who blamed that pain on the epidural. However, after talking with those patients, what I have found is that the pain they experience is not even near the site where the epidural was inserted. Mostly these are young women with little to no knowledge of labor or of early motherhood. On arriving home, they resumed normal activities (work, housework, laundry, caring for the new baby, etc). Owing to the fact that the mom's body is tired from 9 months of pregnancy and labor, and all the work they try to do in the immediate post partum period, they experience their first back muscle spasms, which are quite painful. Not having had these before (its amazing what a young body can do without too much damage), they attribute the back pain to the epidural.

As I hinted at before, if even one tenth of the stories floating around out there about how "my husband's sister's third cousin four times removed best friend's sister got an epidural and was paralyzed from the nasal hair down" were true, we would have stopped doing epidurals, particularly for labor patients, a very long time ago. That isn't to say there are not bad outcomes from spinal and epidural anesthesia, there are. But they are not nearly as frequent or prevalent as some people would have you believe. But again, take your concerns to your anesthesia provider, and let him/her help you sort through your options. You will come out feeling much better informed, and must more able to make decisions about what you want to do.

Let me know how it goes.

Kevin McHugh

guest27716 · Aug 16, 2005

Jenn
I'm a little short of time, but will try to answer some of your main points:
I was so drugged that I am still experiencing w/d symptoms. Alot of doctor's think I'm crazy but I know enough and seen enough people (research and addiction doctor's) to know better.
I am sorry for the things you have gone through. Remember that those of us who do anesthesia for a living specialize in pain and pain management. Yes, it is possible for you to still be feeling the repercussions of addiction, and your anesthesia provider needs to be aware of that.
I am planning for a natural birth but want to be prepared just incase something was to happen. This would better prepare me and not make me go off the deep edge. When I am prepared, I handle things much better.
So do most people. Honestly, I wish I had more patients like you, willing to take the time to become educated before their labor. You are giving not only yourself time to prepare, but your anesthesia provider as well.
I worry about fentanyl b/c of it's strength. It is stronger than heroin.
Fentanyl is a very potent narcotic, no doubt. That's why it is dispensed and dosed in micrograms, rather than milligrams. As a rule, with epidurals, if I use any fentanyl, I'll put 100 micrograms (1/10th of a milligram) in with the local anesthetic dose. Generally though, I don't use it in my bolus doses. In spinal anesthetics, I use 25 micrograms as an adjunct to the local anesthetic. These are pretty small doses, and are given in either the intrathecal or epidural space. And, as I said, narcotics given in these spaces have a much narrower effect than if they were given PO/IM/IV.
I also worry about how the drugs would affect my CNS system since it is so fragile.
This is a difficult concern to address. I have never had a patient have a severe problem as a result of using spinal or epidural narcotics. I have had some patients complain of itching, but have found 4 mg of Zofran works wonders to treat it. These are tried and tested techniques.
I can't take nausea meds with the anesthesia either b/c of the link to tardive dyskinesia/dystonia. Phenergan, reglan, etc. I would like to know which ones cause the least side effects and don't have long term side effects.
I use reglan only occasionally, and phenergan never. Zofran is a much more effective drug to treat nausea, and as an H2 blocker, does not seem to have the effects related to tardive dyskinesia that the others do.
I know of several people who have had epi's and have permanent nerve damage and soreness for months. Thanks for listening.
Well, I have done literally hundreds of epidurals and spinals, and know of none of my patients with c/o long term soreness, or worse, permanent nerve damage (but I am not discounting reports you have). I have seen some soreness related to bruising at the epidural or spinal insertion site. That lasts at most a couple of weeks. Now, I have talked with patients complained of back pain weeks, even months after their first epidural, and who blamed that pain on the epidural. However, after talking with those patients, what I have found is that the pain they experience is not even near the site where the epidural was inserted. Mostly these are young women with little to no knowledge of labor or of early motherhood. On arriving home, they resumed normal activities (work, housework, laundry, caring for the new baby, etc). Owing to the fact that the mom's body is tired from 9 months of pregnancy and labor, and all the work they try to do in the immediate post partum period, they experience their first back muscle spasms, which are quite painful. Not having had these before (its amazing what a young body can do without too much damage), they attribute the back pain to the epidural.
As I hinted at before, if even one tenth of the stories floating around out there about how "my husband's sister's third cousin four times removed best friend's sister got an epidural and was paralyzed from the nasal hair down" were true, we would have stopped doing epidurals, particularly for labor patients, a very long time ago. That isn't to say there are not bad outcomes from spinal and epidural anesthesia, there are. But they are not nearly as frequent or prevalent as some people would have you believe. But again, take your concerns to your anesthesia provider, and let him/her help you sort through your options. You will come out feeling much better informed, and must more able to make decisions about what you want to do.
Let me know how it goes.
Kevin McHugh

Hi Kevin,

Thanks so much for your input. I took some notes. I will definately let you know how it goes with the anesthesiologist. :)

Jenn

Natalieboo · Aug 16, 2005

I have a serious and honest question and really hope it doesn't get taken the wrong way. Have you considered trying for a birth with NO painkillers? Then you won't have to worry about any of that.

I mean, what if you go into labor and things work out well for you and you can handle it... it just seems from your post you are absolutely sure you are going to need something and may even have a c-section. IMO you doom yourself if you think about it like that.

I'm commenting because I did the same thing. When I had my first baby I was convinced I was going to the hospital and getting an epidural.. and I did. I had a very bad experience and later became a birth doula to educate myself as much as I could about birth. My next baby, I went for the support of a midwife and doula and had a natural childbirth. Truthfully, it was 100% better than the first, faster recovery, everything.

I know you are trying to get everything organized regarding anesthia but for your sake, I really hope you don't end up needing anything! Seems like it would just be easier. :)

EDIT:

CRIPES! I totally missed your reply to Kevin. TOTALLY! So, you are planning for a natural birth and are just getting prepared in case things go awry. Preparation is great! However, may I please suggest you find a doula in your city to HELP you achieve this natural childbirth? If money is an option there are LOTS that will volunteer and help you. And no, doulas are not anti-med nazi's. Find one that is kind, gentle, and very accepting to your plans.

guest27716 · Aug 17, 2005

I have a serious and honest question and really hope it doesn't get taken the wrong way. Have you considered trying for a birth with NO painkillers? Then you won't have to worry about any of that.
I mean, what if you go into labor and things work out well for you and you can handle it... it just seems from your post you are absolutely sure you are going to need something and may even have a c-section. IMO you doom yourself if you think about it like that.
I'm commenting because I did the same thing. When I had my first baby I was convinced I was going to the hospital and getting an epidural.. and I did. I had a very bad experience and later became a birth doula to educate myself as much as I could about birth. My next baby, I went for the support of a midwife and doula and had a natural childbirth. Truthfully, it was 100% better than the first, faster recovery, everything.
I know you are trying to get everything organized regarding anesthia but for your sake, I really hope you don't end up needing anything! Seems like it would just be easier. :)
EDIT:
CRIPES! I totally missed your reply to Kevin. TOTALLY! So, you are planning for a natural birth and are just getting prepared in case things go awry. Preparation is great! However, may I please suggest you find a doula in your city to HELP you achieve this natural childbirth? If money is an option there are LOTS that will volunteer and help you. And no, doulas are not anti-med nazi's. Find one that is kind, gentle, and very accepting to your plans.

Thanks Nat for your post. Yes, I have a doula and I am probably worrying more than I should be but if anyone went thru what I went thru the last 4 years you would be doing the same thing plus I am still in protracted w/d. My doula is a pediatric nurse practitioner and is excellent and works at the hospital I am delivering at. My doctor is super nice and believe me, everyone who takes care of me knows what my background is. So far, this pregnancy has been problem free and is going great. I am causing all the worry but never in my wildest dreams did I think 3 doctor's would ruin my life and almost kill me b/c of their negligence. I suffer now from post tramatic stress and am worse now than I was before all this mess started.

Jenn :)

guest27716 · Aug 18, 2005

Kevin,

What would be some questions to ask the anesthesiologist? I see him Monday. I don't want to go in and he tells me what they will do. I want to be listened to and I don't want his power to overpower me just because he is a doctor.

kmchugh · Aug 18, 2005

Jenn

The only way he can overpower you is if you give him that ability. Most anesthesia providers, be they MD's, CRNA's or AA's, I have met are more than willing to listen, and let you guide the direction of the discussion.

I'd suggest that you start out by telling him/her a little about your history. You don't have to go into nauseating detail, just that as a result of past medical treatment, you ended up with an addiction problem, and that you feel that you are still dealing with the after effects of that. S/he may have questions about that, but they may not. Let the anesthesiologist know that as a result, you are very concerned about receiving opioids. Ask him/her frankly what the potential for readdiction is when receiving opioids via the epidural/intrathecal route. (I know, I've already explained that the potential is very low, but my sense is that you could do with reassurance.) Finally, if you are still concerned, ask if they would be willing to do your epidural/intrathecal with local anesthetic medications only, leaving opioids completely out of the equation. I'm pretty sure they'll have no problem accommodating a request like that.

Next, briefly discussed your birth plan with the anesthesia provider. Let them know that though you plan to labor naturally, without an epidural, you want to know about your options. If you have to have an emergent c-section, there probably won't be many options except general anesthesia. However, this is not always the case. Ask the anesthesia provider what kind of anesthesia they prefer to do in the event that you need a non-emergent c-section if you don't already have an epidural. As I explained, general anesthesia is about the last choice for c-section. Also ask what is routinely done at the hospital for postoperative pain management for c-section patients. Ask whether you would be allowed to continue to use the epidural for pain management after surgery, and for how long. (Generally, 24 hours seems to be long enough.)

Next, you might want to ask when it is "too late " in labor to ask for an epidural. In most cases, if you're having a normal labor without complications, we have no problem putting in the epidural when the mother is dilated eight or nine centimeters. Of course, that can change on a case-by-case basis. If you were eight centimeters five minutes ago, and you are nine centimeters now, you're probably progressing too fast to get an epidural. I include this because I've met more than one pregnant patient who swears they want to have "natural" childbirth, only to change her mind when hard labor hits. I've also met a lot of labor patients who stuck to the natural birth plan. It's nice to know what your options are.

Let the conversation guide your questions. The day you have your baby is your day. You get to decide (within reason) how that day will go. Most of us are more than willing to try to accommodate you, so that the day of your baby's birth is as joyous and memorable as you want it to be. Just remember, medical necessity can trump patient desires. The more information you have, the better decisions you will be able to make.

Kevin McHugh

guest27716 · Aug 18, 2005

Jenn
The only way he can overpower you is if you give him that ability. Most anesthesia providers, be they MD's, CRNA's or AA's, I have met are more than willing to listen, and let you guide the direction of the discussion.
I'd suggest that you start out by telling him/her a little about your history. You don't have to go into nauseating detail, just that as a result of past medical treatment, you ended up with an addiction problem, and that you feel that you are still dealing with the after effects of that. S/he may have questions about that, but they may not. Let the anesthesiologist know that as a result, you are very concerned about receiving opioids. Ask him/her frankly what the potential for readdiction is when receiving opioids via the epidural/intrathecal route. (I know, I've already explained that the potential is very low, but my sense is that you could do with reassurance.) Finally, if you are still concerned, ask if they would be willing to do your epidural/intrathecal with local anesthetic medications only, leaving opioids completely out of the equation. I'm pretty sure they'll have no problem accommodating a request like that.
Next, briefly discussed your birth plan with the anesthesia provider. Let them know that though you plan to labor naturally, without an epidural, you want to know about your options. If you have to have an emergent c-section, there probably won't be many options except general anesthesia. However, this is not always the case. Ask the anesthesia provider what kind of anesthesia they prefer to do in the event that you need a non-emergent c-section if you don't already have an epidural. As I explained, general anesthesia is about the last choice for c-section. Also ask what is routinely done at the hospital for postoperative pain management for c-section patients. Ask whether you would be allowed to continue to use the epidural for pain management after surgery, and for how long. (Generally, 24 hours seems to be long enough.)
Next, you might want to ask when it is "too late " in labor to ask for an epidural. In most cases, if you're having a normal labor without complications, we have no problem putting in the epidural when the mother is dilated eight or nine centimeters. Of course, that can change on a case-by-case basis. If you were eight centimeters five minutes ago, and you are nine centimeters now, you're probably progressing too fast to get an epidural. I include this because I've met more than one pregnant patient who swears they want to have "natural" childbirth, only to change her mind when hard labor hits. I've also met a lot of labor patients who stuck to the natural birth plan. It's nice to know what your options are.
Let the conversation guide your questions. The day you have your baby is your day. You get to decide (within reason) how that day will go. Most of us are more than willing to try to accommodate you, so that the day of your baby's birth is as joyous and memorable as you want it to be. Just remember, medical necessity can trump patient desires. The more information you have, the better decisions you will be able to make.
Kevin McHugh

Hi Kevin,

Thanks so much for really answering my concerns. I feel more empowered. Like I said, I know a bit about drugs but am just getting started to learn more about them. I am not really worried about re-sddiction from a narcotic but more concerned of having my w/d symptoms kick up again. Like I said, I am still having w/d symptoms and after 3 years of being on 13 drugs (not my choice but my doctor's at the time) any chemical put in my body sends me into a tail spin. There is even some foods and smells that trigger my w/d symptoms. I have spoken to many professionals who specialize in addiction and w/d and my w/d may last years. Anyways, getting off track again. Anyways, you mentioned local anesthetics; what would those be for example? What is the difference btw. general and local? Instead of pain meds, I told them Motrin 800 mgs. would be good. I would rather be in pain than go thru the pain of w/d anyday. Thanks for listening.

Jenn

kmchugh · Aug 19, 2005

Jenn

As I have mentioned before, putting medications into the epidural space is an entirely different proposition than when medications are taken parentally. I cannot promise you that if fentanyl is given through an epidural, you won't have a recurrence of your withdrawal symptoms. I can tell you that I have never run into that problem, nor seen it in the literature. However, from your description it sounds as though you are still very sensitive to the effects of medications. I strongly suggest that you have a very frank discussion with you anesthetist your concerns in this area.

Motrin, when taken routinely, makes a good anti-inflammatory. It will help with pain. You might wish to discuss another anti-inflammatory with your anesthesiologist as well. We often use Toredol, which can be given IV or IM, and is a much more potent drug. It is not without side effects, and is usually given every six or eight hours for no more than three days. It can be particularly hard on the liver. But for short-term use it is a very effective non-narcotic analgesic. (Note: Neither of these is given during labor. They are used for post partum pain relief.)

There is a significant difference between general and local anesthetics. In general anesthesia we render you unconscious, motionless, and insensate. General anesthesia is induced with a large dose of a sedative-hypnotic drug, such as Propofol. At the same time, other medications, such as versed, fentanyl, and a paralytic are given. We would put in an endotracheal tube (which can be problematic, particularly with pregnant patients) and you are put on ventilator. Anesthetic gas is added to the breathing mix to keep you unconscious. The goal of local and regional anesthesia is to render a particular area or portion of the body insensate to pain, without rendering the patient completely unconscious. A dentist will use local anesthesia to numb a particular tooth or area of the mouth to fill a cavity.

Since the epidural is placed in the lumbar region of the spine where nerve roots that supply sensation for the lower portion of the body are located, these nerves are numbed. Therefore, while you continue to have contractions, you don't feel the pain of the contractions any longer. You may feel some pressure with the contractions, because we want to leave you able to push when you're fully dilated. However, if for some reason you needed a cesarean section, we could give you a larger dose of local anesthetic medication to enable the obstetrician to perform the procedure without pain. In obstetrics, we use a number of different local anesthetic medications depending on a number of different factors. These factors include anesthetist preference and purpose of the epidural.

The local anesthetic medications most commonly used in obstetrics include bupivacaine, ropivacaine, lidocaine, and procaine. If you're interested, you can ask the anesthesiologist on Monday which drugs are routinely used where you're having the baby.

Kevin McHugh