Combination of Pain Relief Techniques Improves Labor and Delivery

Jackie Johnson-Kruse, RN, a labor and delivery nurse at Sauk Prairie Memorial Hospital (SPMH) and mother of three, used a new combined epidural method of pain control for the birth of her third child.

"Trends in pain relief for mothers in labor have run the gamut from natural, with no pain relief, to surgical interventions with the mom 'knocked out.' Somewhere in the middle is where most women like to be," explains Jay Ironside, CRNA, a nurse anesthetist at SPMH. "Today in our birthing unit, we can offer a variety of techniques for pain relief, including the combined spinal epidural and patient-controlled epidurals"

Epidurals, while effective at combating labor pain, are often mis-characterized as deadening the labor experience, numbing the mother-to-be so much that she can't participate in labor, reveals Ironside. But, advances in determining the amount of anesthesia to administer and the combined use of epidural and spinal anesthetic delivery techniques allows finely tuned pain control that is tailored to the wishes of each woman and uses less medication. "Our goal is to have the patient feel comfortable, not numb" says Ironside.

Epidurals deliver a very low dose of anesthetic medication to the outer layer of the spinal cord membrane, the epidural layer. Intrathecal administration places narcotic medication one layer deeper into the spinal canal, the dura, providing instant pain relief that lasts 10 to 12 hours. The use of this combined technique eliminates the pain, but allows sensation and movement.

The patient-controlled epidural is the newest technique available in managing pain at SPMH. This technique allows the patient to control the amount of pain medication by pressing a button that activates a pump connected to the epidural catheter. "We set a low-level of continuous medication, but patients can add medication as they anticipate increased pain, such as with a contraction. The pump, set and controlled by the anesthetist, prevents an overdose, but puts the patient in charge of her own relief," explains Ironside.

With both techniques, the CRNA stays to monitor vital signs and help manage the pain sensations. By being readily available, the anesthetist can answer questions and tailor the pain management for each woman's best possible labor experience.
"Combined spinal epidurals are one of the most effective new tools in the obstetrician's armamentarium to help patients during the birth process," says Todd Schad, MD, an obstetrician/gynecologist who has delivered nearly 200 babies at SPMH since arriving in 2002. "Very few hospitals in our area offer this advanced level of pain management."

"I had my first baby without any pain medication, my second by C-section and my last one with a combined epidural," says Johnson-Kruse. "The epidural made the most sense for me this time because I had been in labor for 15 and one-half hours and was only three centimeters dilated. I knew if I could just relax and rest, things would begin to progress. And sure enough, three hours and 21 minutes after I was given the combined epidural, McKenzie was born."

As a professional on the other side of the bed, Johnson-Kruse was aware of the various methods available to mothers-to-be and had seen how effective the combined spinal and the patient-controlled epidurals were for patients. She says, "Labor and delivery are easier - even more enjoyable - for both the patient and the staff when the patient's anxiety is reduced through adequate pain control and she can actively participate in the delivery."

Ironside recommends that pregnant women talk with their doctors about pain relief. "There are so many options, and patients really do have a choice. Knowing what's available and what to expect in pain relief is a critical part of a satisfying birth experience."