Global Pain Relief - Narcotics, Gas & Air, & General Anesthesia and Your Birth Plan

By: Aunt Doula (11/26/2022)

One of the most widely ranging applications of anesthesia is known as "General Anesthesia" and belongs in the category of global pain relief. Global anesthesia can have mild effects from dulling pain throughout your body to extreme sedation that requires a tube to be inserted into your airway to maintain your breathing. During labor and delivery, this spectrum of general anesthesia may occur at multiple points and be administered depending on the circumstances of your birth, your health, and what your facility provides.

Narcotic Based Global Anesthesia

Global anesthesia that reduces pain during labor without causing you to become unconscious is usually narcotic based - you may recognize names such as morphine, demerol, oxycodone or fentanyl. It depends heavily on the facility you are in as to which drug(s) you may be given or what is available to your anesthesiologist. It is of note that an epidural uses narcotic based medications.

The narcotics used in labor and delivery are processed by the laboring persons body, and a certain amount of the dose will make it through the placenta to the baby. The term global means that the effects are felt throughout the entire body - globally - including the baby. It is important to know that while the baby may experience side effects, efforts are made so that you will not be given these types of medications if you are expected to give birth within a short time (~2 hours) so the baby is not drowsy or being affected by the possible side effects that could impact their ability to breathe.

Global narcotic pain relief that is given as an injection in the muscle or a one-time dose through your IV (depending on your facility) is typically given to allow short term relief from labor pains. This may facilitate a window for the laboring person to rest and regain strength to continue laboring and may be used to delay or prevent getting an .

Gas & Air (non-narcotic) Global Anesthesia

Global non-narcotic pain relief that is used during labor, often called "gas and air," is slowly being adopted across the United States and is used widely in the UK, Canada and Australia. "Gas and air" is a combination of nitrous oxide (gas) and oxygen (air), sometimes referred to as "laughing gas" in dentistry. The administration of the gas in labor vs dentistry differs in that during labor it is controlled by the laboring person; In dentistry, the dentist (with consent) administers the gas to the patient to a point of altered consciousness so dental procedures are performed without pain. During labor, the hand held mouth piece is typically required to be only held by the laboring person so that the dose is naturally mediated by the ability to maintain a relatively clear mind while feeling adequate pain relief. The goal of gas and air during labor is not to reach the point of altered consciousness as it is important for the laboring person to be a primary participant in their labor.

The primary benefits to gas and air are that the pain relief can be applied when at its peak intensity, controlled by the laboring person, and the side effects clear almost as quickly as the pain relief sets in, with no tolerance built up for the time frame it is used. This means that a laboring person can use the gas and air, take a break, and then return to it throughout the active stages of labor without needing a higher dose. The side effects to the baby do not seem to be significant and pass as quickly for them as the laboring person. This means that gas and air can be used through the complete delivery of the baby.

Gas and air can be used instead of narcotics for a number of reasons, and when compared gives similar relief with fewer impacts to the baby while increasing perceived control for the laboring person. Perceived control is an important part of empowerment in the birthing space, and while gas and air is not equivalent to the relief of an epidural, it does ensure a focus on breathing, takes the focus away from the pain and the gas relaxes the body. With all of this in combination, midwives believe that this increases the overall efficacy of the pain relief and labor experience.

To date, there have been no severe adverse outcomes to the use of gas and air for the laboring person or babies. The primary side effects noted for laboring people with its use are dizziness, nausea/vomiting and a sense of detachment. It can be discontinued if side effects are too unpleasant, or pain relief isn't effective enough.

Gas and air can be a very effective way to delay or prevent the need for an epidural if that is a goal for the laboring person. Depending on your hospital, even within the same city, you may or may not have access to this pain relief option. However, the more people who request the option, the more likely a hospital is to consider adding it to their unit.

Global Anesthesia that causes an Unconscious State

In less than 10% of emergency C-sections, or rare cases when a spinal epidural cannot be administered, a laboring person may need to be put under "General Anesthesia" where they become unconscious and do not feel pain or have any awareness of their surroundings. Depending on the circumstances, you may or may not need a breathing tube while the surgery happens, however this would happen after you were unconscious. There are a number of drugs that may be used to keep you unconscious and unaware of pain for the duration of your surgery. An anesthesiologist will be present regardless of if you have an epidural, spinal, or general anesthesia and it is their entire focus to ensure that you remain pain free and your body stays stable. They are extremely good at their jobs, and highly specialized just like your surgeons.

It is an uncommon situation to need general anesthesia that requires unconsciousness, however it is an important possibility to be educated about. In the unlikely event you require an emergency c-section things can move extremely quickly, so awareness of and therefore preparation of being put under general anesthesia will put you a step ahead and hopefully lower your anxiety.

++++++++++++++++++++++++++++++

The most common types of global anesthesia used in labor and delivery are listed here, however it is not comprehensive - when making your birth plan it is important to state if you want to be offered global pain relief options such as the narcotic or non-narcotic options. During your tour of your chosen facility, be sure to ask what options are available to you. In an emergency situation, it may not be something you are asked about to be put under general anesthesia, however if you have had poor reactions to general anesthesia in the past it is extremely important to list this on your birth plan and inform your labor team when you are admitted so that it is in your chart should things need to move quickly.

Just as you can designate a code word for requesting an epidural, you can use a code word for these global options, it's entirely up to you. Be clear on your plan that you have a code word you will use to indicate you wish to proceed with whichever pain relief option you state with the code word. "Kumquat - I want a dose of narcotic pain relief" "Kumquat - I want Gas and Air." "Kumquat - I want an epidural."

Does it sound silly? Maybe. Is it clear and effective? Yes! And most importantly it puts a deep emphasis on your empowerment. The right to choose when you will receive pain relief is powerful. Knowing what your options are gives you the cards to request what you want, when you want it - and hold firmly to the reins of your delivery.

No matter what you choose or refuse, the value of being educated and prepared can make the difference between a scary or panicked delivery and a calm empowered one.