Epidural/Spinal Blocks 

Nerve blocks such as epidurals and spinals are commonly used for  cesarean sections. These will make you numb from your breasts to your toes. You will feel pressure and movement during the surgery, but nothing sharp. You can still breath comfortably on your own and you will be awake for the birth of your baby.

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Epidural Analgesia

If your doctor decides it is safest for you and baby to have a cesarean delivery, an epidural tube that was placed during labor may be used to make you numb for your surgery. Stronger medicine is given through the epidural to make you numb from your breasts to your toes. You will still be able to feel pressure and tugging sensation during surgery, but nothing sharp. It takes about 10-15 minutes to make you numb for surgery if you already have an epidural tube in place. To learn more about epidurals for vaginal delivery, click below.
 
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Spinal Analgesia

For women who don’t have an epidural tube already placed, spinal anesthesia is the most common technique used for cesarean delivery. A spinal anesthetic is a small dose of pain medication that is placed in the lower part of the back. It is injected into the fluid that surrounds the nerves in your spinal cord. The spinal anesthetic will make you numb from your breasts to your toes. You will feel pressure and movement during the surgery, but no sharp sensation. You can still breath comfortably on your own and you will be awake for the birth of your baby.

Procedure:

To place the medicine, you will first sit on the edge of the operating room table with your legs dangling over the side. Your blood pressure and oxygen levels will be monitored. The lower part of your back is cleaned with a soap solution. This helps prevent infections. You will round your back like the letter “C” to open the spaces between your back bones. Next, a small dose of local anesthetic is injected into the skin to make you more comfortable during the procedure. This will feel like a poke and a burn. After this, most people only feel pressure. Once the correct location is found, the numbing medication will be injected, and everything will be removed from your back. You will then lie down on the table, a tube will be placed to drain your bladder, and your belly will be cleaned for surgery.

Benefits

  • You will be awake and comfortable for the birth of your baby.
  • Pain relief is very fast (within 5-10 minutes) after administration of the spinal anesthetic.
  • A support person is allowed in the room during the cesarean delivery.
  • There is no risk of long term back pain with the placement of a spinal.
  • Some women can do "skin-to-skin" with their baby in the operating room while the doctors finish surgery.

Risks

  • The common side effects of a spinal include low blood pressure, nausea, vomiting, or itching.
  • Rare risks of a spinal include bleeding, infection, injury to a nerve or tissue in the area, allergic reaction, or difficulty breathing.
  • Some women feel a bruise at the site of a spinal for a couple days.  
  • Sometimes nerve blocks cause changes in the baby’s heart rate.
  • Although uncommon, a headache may occur after the placement of the spinal (1 in 100 times), called a spinal headache. This headache may require further treatment prior to going home with your baby.
  • Surrounding nerves or tissues may be injured during the procedure (1 in 20,000 times). A nerve injury may feel like numbness or tingling, or a nerve may not work appropriately.    

Combined Spinal & Epidural

This technique combines the rapid onset of spinal anesthesia with the ability to give more medicine through an epidural tube if the surgery is prolonged. A combined spinal & epidural may be used if a woman has had prior cesarean sections or other abdominal surgery.

Procedure:

To place the combined spinal and epidural, an anesthesiologist will have you sit on the edge of the operating room table or lay curled up on your side in the fetal position. You will be asked to relax and round your back like the letter “C” to open up the spaces between the bones in your spine. Your lower back will be cleaned with a soap solution and the doctor will wear sterile cap and gloves to help prevent infections. You will be given a small dose of numbing medication in the skin to make you more comfortable during the procedure. This may feels like a bee sting. After the numbing medication, you will feel pressure as the anesthesiologist finds the correct location to place the spinal and epidural tube using a special needle. The needle will be carefully inserted between your back bones into a space outside your spinal cord, the epidural space.

Once the correct location is found, a special needle is inserted through the hollow needle and the spinal anesthetic is administered. The medicine is injected into the spinal fluid and coats nerve roots, providing quick pain relief (5-10 minutes) and numbness from breasts to toes.

The spinal anesthetic needle is removed and a small plastic tube is inserted through the epidural needle into the epidural space. The epidural needle is then removed, and the tube is taped to your skin. While nothing sharp stays in your back, the tube will remain in place during surgery.

Benefits 

  • You will be awake and comfortable for the birth of your baby.
  • The spinal medication works in 5-10 minutes to provide pain relief and numbness for the surgery
  • The epidural can be used to give more numbing medicine during surgery if it is required.
  • There is no risk of long term back pain with the placement of a combined spinal & epidural.
  • An epidural can also be used after surgery for pain relief in some special situations.

Risks

  • The common side effects of a combined spinal & epidural include low blood pressure, nausea, vomiting, or itching.
  • Rare risks of a combined spinal & epidural include bleeding, infection, injury to a nerve or tissue in the area, allergic reaction, or difficulty breathing.
  • Some women may need an epidural adjusted or replaced if it isn’t providing as much relief as expected.
  • The epidural tube may slip into a blood vessel or the spinal fluid, so careful tests are done after the placement to make sure it is in the right spot.
  • Some women feel a bruise at the site of an epidural for a couple days.
  • Sometimes nerve blocks cause changes in the baby’s heart rate.
  • Although uncommon, a headache may occur after the placement of the combined spinal & epidural (1 in 100 times). This headache may require further treatment prior to going home with your baby.
  • Surrounding nerves or tissues may be injured during the procedure (1 in 20,000 times). A nerve injury may feel like numbness or tingling, or a nerve may not work appropriately.
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