StorkNet interview with
Sanjay Datta, MD
Author of
Childbirth and Pain Relief, An Anesthesiologist Explains Your Options

Dr. Sanjay Datta is the immediate past Director of Obstetric Anesthesia at Brigham and Women's Hospital, a Harvard Medical School affiliated hospital, a position he held for eight years. His department oversees and manages the delivery of more than ten thousand babies per year, and is one of the busiest academic departments in the country. Under Dr. Datta's leadership, it is also considered one of the best in the world. In addition, Dr. Datta is currently a Full Professor in Anesthesia at Harvard Medical School. He completed his preliminary training in England, followed by an obstetric anesthesia fellowship at McGill University in Montreal.

During his twenty-five-year medical career, Dr. Datta has also served as a Visiting Professor at many of the world's leading medical schools including the Mayo Clinic, Yale University School of Medicine, Navy Hospital in Bethesda, Columbia University, McGill University in Canada, University of Toronto, University of Basel (Switzerland), and the University of Sao Paulo (Brazil).

He resides in Massachusetts with his wife and daughter.

We invite you to read StorkNet's review of Childbirth and Pain Relief, An Anesthesiologist Explains Your Options.

StorkNet interview with Dr. Sanjay Datta

Dr. Datta, author of Childbirth and Pain Relief, An Anesthesiologist Explains Your Options recently took questions from StorkNet members regarding issues related to pain relief and childbirth. We hope this discussion helps you gather important information before your labor and delivery. In his book, Dr. Datta presents a balanced approach to informing expectant parents about labor pain and their options for handling it. We encourage you to read our review of his book, then enjoy our interview!

Dama: Dr. Datta, For my first birth, I intended to go natural, but ended up having an epidural because of a long labor and lack of support/training in pain management. One of the reasons I wanted to go natural was that I knew of the risks associated with epidurals, and was afraid especially of a drop in blood pressure.

My question is, given the fact that I have been under general anesthesia three times with no ill effects, and the fact that I have had an epidural with no significant side effects, is my risk for a dramatic drop in blood pressure lower should I decide to have an epidural in future births? Dama

Dr. Datta: Absolutely not! For labor, delivery and cesarean section the regional anesthesia is safer compared to general anesthesia because of full stomach as well as difficulty in intubation issues. Regional anesthesia includes epidural, spinal and combined spinal/epidural. The chance of a drop in blood pressure following an epidural is extremely low and if it does happen it is easily treatable.

Becki: I am pregnant with my first child and probably do not want to have a natural birth. I have a problem though... I cannot stand pain medication. I do not like to feel fuzzy or disoriented at any time. I have had major surgeries before and refused to take after-care painkillers because of how they make me feel. Will an Epi make me feel like other pain meds? If so what is my best option? I do have an fairly high pain threshold, but prefer not to suffer in pain during labor. What is your suggestion?

Dr. Datta: The majority of obstetricians wait for the cervix to dilate 4-5 cm before the epidural is requested. So if possible, you can wait until the time the epidural comes. There are several pain-killing medications available at the present time; some of them will cause less fuzziness as well as disorientation. Finally if you have severe pain during early part of labor you can request an early epidural for pain relief.

Amy: I had an emergency c-section with my first. I was put to sleep. I am due with my second on May 20th. It will be a scheduled c-section. Will I have the option to be put to sleep? I am very afraid of an epidural. I was told you get "pockets" or periods of time where you feel everything with the epidural. Is this true? I am very scared I will feel everything.

Dr. Datta: You can always request a GA (general anesthesia) for your anesthetic options. However, the GA is associated with more complications, that's the reason why anesthesiologists prefer regional anesthesia. The options of regional anesthesia are spinal, epidural or combined spinal epidural. Most of the time epidural works without problems and there is no reason why you should feel everything. Finally, spinal anesthesia is very popular for cesarean section. You should talk to you anesthesiologist about that. Good luck.

Heather: Pudendal block vs. Epidural? I was in hard labor, five weeks early, and complete. There was no time to get an epidural, plus they didn't want to give any narcotics to me. They did give me a pudendal block, which was GREAT! (I think, I delivered 20 min. after I got to the hospital) What is it? Why was it "so great" and if I need one again, is it complete enough to have with pitocin?

Dr. Datta: Pudendal block is only effective during the second stage of labor. Hence, there are significant differences between epidural and pudendal. Epidural anesthesia gives you total pain control that is both in 1st stage as well as 2nd stage of labor. Pitocin related contraction pain during 1st stage could be helped by epidural.

Brenda: I had an epidural with my last child who is now 10 months old and got a spinal headache where I needed a blood patch. What are the chances that this will happen again with my current pregnancy? I am due in May.

Dr. Datta: The chances of getting another accidental dural tap causing headache is rare.

Sheila: Hi, I had a baby 22 months ago, now I'm due any day now, my question is, do you think the labor will be quicker this time? It was 10 hours the last, and I'm having an epidural. They turned it off last time when I started to push. Can I have it on the whole time? Thank you.

Dr. Datta: Labor is usually shorter in multiparous parturients (multiple birth patients). In some hospitals it is usual to shut off the epidural infusion during the 2nd stage of labor, so that the pregnant women push more effectively. On the other hand, pushing without proper pain relief can be uncomfortable. You should talk to your obstetrician as well as anesthesiologist regarding this.

Rita: How does Pitocin work? What exactly is it and is it true that the contractions become more painful when pitocin is used? Thank you.

Dr. Datta: Pitocin (Oxytocin) is a hormone secreted by posterior pituitary gland. Sensory stimulation from uterus, cervix and vagina promote oxytocin secretion from the posterior pituitary directly into the circulation. Oxytocin acts mainly on the uterus and on the lactating breast to stimulate milk ejection. Late in the pregnancy there is an increased amount of oxytocin receptors. By the end of the pregnancy, receptor concentrations have increased 80 fold to 100 fold over those in the nonpregnant uterus. The highest concentrations occur in early labor, increasing the number of contractile units that respond, thus - augmenting the force of contraction causing pain.

Elise: How much of pain medications reach the baby during labor and delivery?

Dr. Datta: An extremely small amount.

Jennifer: Why is an epidural not given in the last stages of labor? The pushing is what scares me. Thank you for talking to us.

Dr. Datta: Epidural can be and is given in the last stage of labor. If the pushing part worries you, talk to your obstetrician as well as anesthesiologist.

Lisa: I chose an interthecal for pain relief with the birth of our daughter this past November. With the regular interthecal meds, the hospital's new ingredient included Marcaine.

I asked for just a very small amount of the Marcaine, because I didn't want my legs to be numb. Well my legs were rather numb, and I could feel a terrible amount of back labor. I know it doesn't matter now, but could the anesthesiologist have mixed the dosages? The nurse saw him only put a very small amount of the Marcaine in. Could he have done it wrong? Is that why I felt so much labor, and had numb legs? I also had no itching this time. I had an interthecal with my first born, and had severe itching. They didn't have the Marcaine then. Thank you for reading my question. Lisa

Dr. Datta: If I understand you correctly, you probably had a combined spinal epidural for your labor and delivery pain relief. With this technique, a very small amount of local anesthetic (Marcaine) and pain killing medication are used. Because of back labor, the anesthesiologist had to walk in a fine line. Too much medication can cause numbness in your leg; on the other hand, your back labor needed proper amount of medication. Back labor is associated with more pain.

Tina: Yesterday I went to an "open house" at the local hospital that claims a natural childbirth is possible. I asked the nurse if women were allowed to eat or drink and she said "only ice chips." I questioned her on that and said that labor takes energy and if you are not hooked up to an IV then you need to keep hydrated and sometimes have access to a snack to boost your energy level. She went on to explain that in the case of an emergency c-section, the woman's stomach needs to be empty so that the anesthesia can be given. She went on to say that the women would have to wait for two hours otherwise for the food to digest. This seems ridiculous to me. What if she is an accident victim or happens to progress very fast and has food in her stomach. I believe we were being misinformed. Can you explain to me the real reasons nothing is given by mouth. I ate/drank consistently through my labor and can't imagine not being able to boost your energy in that way.

Dr. Datta: In the majority of hospitals solid food is discouraged as soon as active labor is started. The main reason is presence of solid food in the stomach, which may be problematic when general anesthesia is given in a hurry. The stomach may be full, if so, the incidences of a difficult intubation and inability to intubate are higher. Delayed gastric emptying is one of the important physiological changes. In my hospital, clear fluid is given during labor, Gatorade is one of the popular drinks.

Jennifer: I have a ruptured disk in my lower back, if I need an epidural for labor could I still get one?

Dr. Datta: In our hospital this problem will not be contraindicated for epidural analgesia or anesthesia, unless there are acute and neurological problems. It is important to consult you anesthesiologist to get the final answer.

Florence: What is the difference between a spinal block, epidural and receiving demerol? I am concerned about pain management during labor (I am due in two weeks.) and I want to be informed of my options. How is a Demerol administered?

Dr. Datta: Epidural and spinal techniques involve injection of medications in the epidural and spinal space. For labor and delivery, epidural is the ideal technique, as it provides complete pain relief during the 1st and second stage of labor. Demerol is given intravenously; the quality of pain relief is not as good as an epidural or spinal.

Elena: I am planning on having an epidural at some point during labor, but I have really bad anxiety, which affects my breathing and staying in control. Is there anything you can recommend that I can take while waiting for the epidural that won't affect the baby or cause tremendous side effects? I'm currently taking 10mg of Paxil daily. Thanks.

Dr. Datta: You first need a good support person who will work with your bad anxiety. You can also get some medications like nalbuphine and Demerol If your anxiety is still significant you can ask for midazolam which is an effective anti-anxiety medication. You should see an anesthesiologist in your hospital for a consult.

Jenny: Did they change the name of a saddle block to an epidural? And what is an epidural called now? My mother said she had an epidural, only all it was, was a local anesthetic. I've only heard an epidural to be what she called a saddle block. Thank you.

Dr. Datta: Saddle block consists of pain relief in the saddle part of the perineum (crotch). It is done by positioning the pregnant woman in the sitting position and giving a minimal amount of local anesthetic via the spinal route. Epidural block is associated with administering the medication in the epidural space. Extent of the block is wider in case of epidural. Both saddle block and epidural block are done by using local anesthetic.

Christina: I had my son two years ago. I was given an epidural, which was "topped up" at least two times during labour as my labour was 36 hours long and ended in C-section. Other than that the epidural seemed unremarkable. However within a few days after the birth, I began to experience (what I can only explain as) shocks up my spine to the base of my neck. It would last less than a minute but took my breath away as it progressed up the spine. I went back to the hospital and was examined by my OB who found no reason for concern and stated my spine healing after the epidural. I tried to contact an anesthesiologist but they do not speak to patients once they are released. They are referred to the OB.

Would you agree that it was my spine healing that caused this sensation? We are trying for our second child and have been told to expect another c-section. I am concerned to have another epidural as this sensation was very scary to me, as it concerned my spine. One last note... I had to have a cervical cerclage in my 14th week and they gave me a "spinal" shot for this and I did experience severe headaches after this experience. Is it possible that I have some sort of sensitivity to the spinal/epidural procedure? I understand you don't have all my history to answer and I will of course revisit this topic with my OB. Thank you in advance.

Dr. Datta: The cause of the shocks up your spine is not well understood. Spine healing could be one of the causes. Spinal anesthesia given for the cerclage was associated post dural puncture headache. This is also not common. I do not think you have any sensitivity towards spinal, epidural procedure. For you next cesarean section spinal anesthesia may be an ideal option.

Shelley: Why do women have to wait until they are 4 cm dilated before they can get an epidural? I go very fast from 4 to 10, so I was unable to get the epidural in previous pregnancies. However, getting to 4 is very painful. When I had my last baby, I talked the Dr. into giving me the epidural before he even started the induction. It went perfectly. What are your thoughts on this?

Dr. Datta: This came from one study that showed that if epidural is provided before 5 cm the incidences of cesarean section was higher. Although other studies did not agree with the first study's results. I believe if the pregnant woman is in severe pain the epidural should be provided independent of the cervical dilation.

Alesia: I had a spinal tap about five months ago and now I am having a baby in July. I say I want any epidural, but will it be as painful as my spinal tap was?

Dr. Datta: Providing a fair amount of local anesthetic in the area of epidural needle placement, it should not be that painful.

Chris: I've heard that epidurals can slow down my labor and increase my risk for a C-section. In your experience, have you found this to be true?

Dr. Datta: Several studies have been done regarding these questions. They showed that the epidural analgesia minimally affect the length of labor and did not increase incidences of cesarean section.

Kyra: Is it true that an epidural can leave you paralyzed? What is the difference between a spinal and an epidural?

Dr. Datta: The chances of this major complication are extremely rare. Spinal anesthesia is the technique where the needle is inserted inside the spinal space, full of spinal fluid, whereas in the epidural technique the needle remains superficial to the spinal space. The area of the block will depend upon the amount of local anesthetic used. The amount of local anesthetic used is smaller in case of spinal compared to epidural. Epidural block is ideal for labor and delivery analgesia, whereas spinal anesthesia may be preferable for cesarean section.

Sarah: I have a bad back, am I still allowed to have an epidural? And if so, can an epidural make my back pain worse? Also, do epidurals cause back pain?

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Dr. Datta: In case of chronic back problem, we do not feel epidural should be contraindicated. There are several studies which show that during pregnancy there are no differences in back pain between epidural and non-epidural groups. The hormone relaxin is a major factor of back pain during pregnancy.

Stefani: Will the epidural effect my being able to nurse my baby immediately after delivery? Will there be drugs in my system that I have to worry about?

Dr. Datta: Absolutely not! The amount of medication is extremely small and the amount in the breast milk will be a very small amount if any at all.

Alice and Jim: Our hospital offers a "paradise" epidural. How does this differ from a regular epidural?

Dr. Datta: I never heard of "paradise" epidural. I am eager to learn from you.

Louise: I am having a planned C-section. Will I be offered a spinal or an epidural? Will I be allowed to choose?

Dr. Datta: In most of the places spinal anesthesia has become the popular technique for cesarean section unless contraindicated where epidural anesthesia will be used. You can talk to the anesthesiologist before a final decision is made.

Marianna: My hospital does not offer epidurals. What alternatives are available?

Dr. Datta: The next best alternative would be patient controlled intravenous anesthesia, where you can inject pain control medication via a button depending upon your needs.

Rudi: During my last delivery, the nurses told me I couldn't have an epidural because I was too far into my labor. Is that true? If this happens again, what are some alternatives to help me through the final stages of labor?

Dr. Datta: It is true, because epidural works slowly, it might not be a proper technique if you have advanced too far. In such a situation combined spinal epidural or one-shot spinal will be ideal techniques.

Natassja: When would they knock me out for a C Section? If I were to be put under general anesthesia, could my husband come in the delivery room with me? How long after getting general anesthesia can I breastfeed my baby?

Dr. Datta: In general anesthesia they will put you to sleep once everybody is ready for the surgery. We only allow the husband to come in when the baby is delivered and if the baby does not have any problem he can take care of the baby outside.

StorkNet would like to thank Dr. Datta for his participation on our site as a very special guest.

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