Epidural/Spinal Blocks

Nerve blocks such as epidurals and spinals are the most commonly used pain relief options for women in labor.  Medicine can be given in the lower part of the back to numb the nerves that are causing contraction pain.  These techniques allow you to be awake and comfortable for the birth of your baby.

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Epidural Analgesia

Epidural analgesia is the most reliable and effective option for reducing pain during labor. A tube is placed in the lower part of the back and is used to provide pain relief continuously throughout the labor process. This is achieved through low dose anesthetic medications that are given through the epidural tube. This procedure makes you numb in your belly and legs while still letting you move your upper body. Epidurals can be placed any time during the labor process up until the baby is coming out. There are some women who may not be able to receive an epidural due to medical conditions such as high risk of bleeding, previous back surgery, heart problems, or difficulty sitting still for the procedure.

Procedure:

To place the epidural tube, an anesthesiologist will have you sit on the edge of your bed 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 caps 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 feel like a bee sting.

After the numbing medication, you will feel pressure as the anesthesiologist finds the correct location to place the epidural tube. A needle will be carefully inserted between your back bones into a space outside your spinal cord, the epidural space. Once the needle is accurately placed, a small plastic tube is inserted through the hollow space in the needle. The 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 labor. Next, the anesthesiologist will make sure the tube is in the correct place by doing some tests. You will given an initial dose of local anesthetic through the epidural tube to make you comfortable, which may take 15-30 minutes to work completely. After this, the epidural tube is hooked up to a pump that gives medicine continuously. You and your baby will be closely monitored throughout this process.

Benefits

  • You will be awake and comfortable for the birth of your baby.
  • Pain relief is fast. It takes about 15-30 minutes for the medication to work.  
  • Recent studies have shown no increased risk of cesarean section with the use of epidural anesthesia.
  • An epidural can help you rest and relax before delivering your baby.
  • Some studies have shown decreased postpartum depression when epidurals are used for delivery.
  • There is no risk of long term back pain with the placement of an epidural.
  • An epidural can be used to make you numb and comfortable for surgery if you need a cesarean section for the health or safety or you or your baby.

Risks

  • The common side effects of an epidural include low blood pressure, nausea, vomiting, or itching.
  • Rare risks of an 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 block (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.

Spinal Analgesia

A spinal analgesic is a small dose of numbing medication that is placed in the lower part of the back in the fluid that surrounds the nerves. Spinals are most commonly used for cesarean delivery to make you numb from your breasts to your toes. A lower dose spinal analgesic may be given for a vaginal delivery if you are very close to pushing the baby out and the anesthesiologist does not think there is enough time for an epidural. The medicine works quickly because it is administered directly into the spinal fluid. It usually takes about 5-10 minutes to feel pain relief.

Procedure:

To place the medication, the anesthesiologist will have you sit on the edge of your bed or lay 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 caps and gloves to help prevent infections. 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 patients will 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 and allow the medicine to take effect. You and your baby will be closely monitored throughout this process.

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.
  • There is no risk of long term back pain with the placement of a spinal.
  • To learn more about a spinal for cesarean sections, click here.

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 Analgesia

This technique combines the rapid onset of spinal anesthesia with the continuous infusion of medicine given through an epidural tube.

Procedure:

To place the medication, the anesthesiologist will have you sit on the edge of your bed or lay 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 caps and gloves to help prevent infections. 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 patients will only feel pressure.

Once the correct location is found, a special needle is inserted through the hollow needle and the spinal analgesic is administered. The medicine is injected into the spinal fluid and coats nerve roots, providing quick pain relief (5-10 minutes). The spinal needle is removed and a small plastic tube is inserted through the epidural needle into the epidural space. The 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 labor. After this, the epidural tube is hooked up to a pump that gives medicine continuously. You and your baby will be closely monitored throughout this process.

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.
  • A combined spinal & epidural can help you rest and relax before delivering your baby.
  • There is no risk of long term back pain with the placement of a combined spinal & epidural.
  • An epidural can be used to make you numb and comfortable for surgery if you need a cesarean section for the health or safety or you or your baby. To learn more about nerve blocks for cesarean sections, click here.

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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