Below is a Patient information video about Obstetric Anaesthesia and Maternal Weight
Obstetric Anaesthesia and Maternal Weight
Hello, I’m Dr. Joanna Ferdier, one of the obstetric consultants here at Leeds. Joining me is Dr. Ella Bilson, a senior anaesthetic trainee. We are here to provide you with guided information and recommendations regarding your care.
Who Are Obstetric Anaesthetists?
Obstetric anaesthetists are medical doctors specializing in anaesthesia and pain relief, with specific training and knowledge about the changes your body undergoes during pregnancy. This includes care before your baby is born, during labor and delivery, and postpartum (after your baby is born). We work closely with obstetricians, midwives, and other healthcare professionals to ensure you receive the most appropriate care tailored to your needs during labor and delivery.
An anaesthetist may provide pain relief through various techniques, such as an epidural or a spinal block, which target specific parts of the body. This approach is known as regional anaesthesia and is considered the safest type of anaesthesia for both you and your baby. Overall, our role as obstetric anaesthetists is to ensure your safety and comfort during childbirth while collaborating with the rest of the medical team.
Why Specific Information is Important
If you are pregnant and have obesity, we will plan the delivery of your baby in more detail, as complications are more likely for both mother and baby. Your Body Mass Index (BMI), calculated by your midwife at your first appointment using your height and weight, is a crucial factor. As your BMI increases, particularly above 40, the likelihood of certain pregnancy-related complications also rises. While many births will be uncomplicated, it is important to prepare for the possibility of unforeseen emergencies. The following anaesthetic information is intended to help you make informed decisions about your antenatal care, including pain relief options and understanding specific challenges and recommendations.
Labour and Delivery Options
There are three potential outcomes for the birth of your baby: vaginal delivery, assisted vaginal delivery (using tools such as a vacuum suction cup or forceps), or an unplanned caesarean section. Various options for pain relief during labour are available, including non-medication methods (such as TENS and water birth) and medications (such as gas and air, opioids, and epidurals). We advise against relying solely on internet searches for information, as much of it can be misleading. Instead, we recommend visiting trusted sources backed by medical evidence, such as labour pains.org
There is a well-documented association between obesity and an increased risk of complications during labour. For this reason, national guidance recommends placing an epidural early in labor to prepare for any unanticipated issues. The reasons for this are twofold: administering an epidural catheter can be challenging and may take longer to establish, so doing this before strong contraction pain starts increases the likelihood of success and safety. Additionally, if your baby requires an assisted or surgical delivery, having a working epidural allows for a smooth transition to stronger pain relief, which reduces risks for both you and your baby.
Advantages of an Epidural
An epidural is the only option that can provide complete relief and adapt to the changing pain levels of labor. It makes examinations more comfortable, reduces your body’s stress response, helps you stay alert and less nauseous during labor, decreases blood loss during surgery, and lowers the risk of blood clots in the legs (DVT). Historically, there have been many scary stories surrounding epidurals, but they are now considered safe, well-tolerated procedures. Like any medical procedure, epidurals can have side effects and complications. We provide information leaflets outlining the risks of regional and general anesthesia, designed to offer clarity on how likely or unlikely certain issues are to occur.
One in three women may experience itching, and one in twenty may require further intervention to optimize the epidural. Occasionally, we may need to address a drop in blood pressure once the epidural is in place. Severe headaches may occur in about one in every 100 women, necessitating follow-up with an anaesthetist.
By recommending early epidurals, we aim to avoid the need for general anaesthesia in emergencies, as general anaesthesia poses increased maternal risks, especially for individuals with obesity. Disadvantages of general anaesthesia include the inability of birth partners to be present during delivery, increased grogginess and sleepiness in the mother, poorer initial bonding with the baby, worse postoperative pain relief, higher rates of nausea and vomiting, increased bleeding and postoperative breathing issues, and exposure of the baby to anaesthesia.
Scheduled Caesarean Sections
If you are scheduled for an elective caesarean section, the safest and calmest form of anaesthesia is a spinal anaesthetic. While it involves a needle in your lower back, it is often faster and easier than an epidural. However, if additional time is needed for positioning or surgery, we may recommend a combined spinal-epidural approach. This combines the rapid onset of spinal anesthesia with the flexibility of an epidural catheter to extend pain relief if necessary, allowing you to remain awake throughout the procedure.
Conclusion
We want to assure you that for any procedure during your pregnancy, you are in safe hands. Medical staff are highly trained and prepared for unexpected situations. We will routinely visit you upon your arrival in the delivery suite, but it is essential for you to be informed and have access to all relevant resources. This will empower you to understand your options and make informed decisions about the birth of your baby.
Thank you for watching this video. If you have any unanswered questions or would like to speak with an anaesthetist before arriving in the delivery suite, please ask your midwife to contact our department.