FAQs: Epidurals and Spinals during Labor

The following are some common question and answers about epidurals and spinals during labor.

Q: What is an ideal epidural anesthesia?
A: Anesthesiologists aim to provide good pain relief without impeding your ability to move your legs or push the baby out during childbirth. In other words, you will be pain free but you will be able to move your legs during epidural analgesia.

Q: What is a combined spinal-epidural?
A: A combined spinal-epidural (CSE) can combine the advantages of each technique. It involves a spinal injection followed by the insertion of an epidural catheter. Quick onset can be achieved with the spinal part. Further maintenance of the anesthesia is achieved through the epidural catheter.

Q: What's the difference between a spinal and epidural and a combined spinal-epidural? 
A: The spinal cord and the nerves are contained in a sac of cerebrospinal fluid. The space around this sac is the epidural space. Spinal anesthesia involves the injection of numbing medicine directly into the fluid sac. Epidurals involve the injection into the space outside the sac (epidural space). Spinals and epidurals have the same effect – they both numb a large region of the body – but because the spinal injection is more direct, the effect is immediate.

Q: How do I know what’s best – an epidural or a spinal?
A: Spinals are usually the first choice of anesthetic for women who are not in labor but need a Cesarean delivery. 
Epidurals are the primary way of relieving pain in women who request analgesia for labor. Epidural anesthesia takes a little longer to establish desired effect. But because a small tube (catheter) can easily be placed in the epidural space, repeated doses of medicine can be given to maintain anesthesia as long as needed.

Q: How is a spinal anesthetic given?
A: The procedure for spinal anesthesia is similar to epidural anesthesia for labor or for cesarean delivery. The difference is that medicine is injected directly into the spinal sac. A thin needle is used to reduce the chances of a spinal headache.

Q: How will I know if a spinal is working?
A: Many women describe an immediate feeling of warmth and tingling in the feet which extends up their legs and torso as the spinal anesthetic takes effect. The legs will then begin to feel numb and heavy. It is normal for the body to feel numb from the lower chest down to the feet. This is considered the right amount of anesthesia to keep you comfortable. Although your ability to breathe is not changed, the spinal does numb the chest area as well, so the sensation of breathing will feel altered with a subjective sensation of feeling short of breath. Always remember that the anesthesiologist is monitoring and watching your breathing, oxygen levels, blood pressure, heartbeat and other vital signs.