Epidural vs Spinal: Which is best for you?

What are the differences between an epidural or spinal anesthesia? Today we’re going to give into what the differences are, and when each is used. Possibly most important is what type of pain relief to expect from each one.

But first, how the heck do I know all about all this (a great questions to ask about serious topics like this)???

Hi — I’m Hilary — The Pregnancy Nurse 👩‍⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺​ I have helped thousands of families have either a spinal or an epidural… so I think I can adequately answer your questions today.

Of course, you should talk with your own provider about your specific needs, but this article will just be an overview about what to expect with each one.

What is an Epidural and What is a Spinal?

An Epidural:

– Is given in the lower back, and numbs the nerves that travel to the uterus, vagina, and legs.

– Is given by an anesthesiologist or a nurse anesthetist (I have a whole post on who gives the epidural).

– Is most often used during labor, but can also be used for pain after surgery, or pain relief without surgery

– Usually takes about 15 minutes to work. The anesthesiologist will insert a needle into your back to reach the epidural space and place a small tube, called a catheter, into the space.

– You will be awake and able to push when it’s time to deliver your baby, but you shouldn’t feel too much pain.

– It is aimed to really take away about 80% of the pain, so you can still move and feel the baby descend into the birth canal and push properly.

And yes, if you have lots of questions about the epidural or your pain mangement options I have an entire chapter in here on it. People love that chapter!

The Spinal:

– Is given in the lower back and numbs all nerves below the block.

– Is most often used for surgery on the feet, legs, abdomen, or pelvis.

– Takes about 5 minutes to work and is shorter lasting than an epidural. The anesthesiologist will insert a needle into your back to reach the spinal canal.

– A small amount of medication is injected into the cerebrospinal fluid that bathes the spinal cord.

– For pregnancy, this is most often given in the operating room for a cesarean section.

How Are They Administered?

To you, the placement will seem very similar between the two. They are given while you’re sitting or lying on your side (based on doctor’s preference). You’ll be asked to curl forward so your back is rounded around the baby. This makes it easier for the anesthesiologist to see the appropriate area and insert the needle.

Much of the procedure is them preparing the medications, and the site (to prevent infection). With both procedures they advance the needle little bit, by little bit until they reach the right spot. Then, medication is injected.

With an epidural, they will place a tube in the space to run medication into that area continuously.

Most often with a spinal the shot is just done once, and then everything is removed, and it will wear off naturally.

I actually have a youtube video where I share how an epidural is placed in Raggedy Anne:

What Are the Benefits of an Epidural?

The main benefit of an epidural is that it can provide continuous pain relief during labor. It’s also the most effective pain relief option available.

Other benefits include:

– You’re able to remain awake and alert during the birth of your baby.\

– You are able to get some rest during labor

– Epidurals can help you avoid other pain medications, such as opioids, that may have more side effects.

What Are the Benefits of a Spinal?

The main benefit of a spinal is that it provides very effective, rapid pain relief. It can also be used in combination with an epidural (known as a combined spinal-epidural, or CSE) to provide both immediate and continuous pain relief.

Other benefits include:

– You’re able to remain awake and alert during the birth of your baby.

– Spinals can help you avoid other pain medications, such as opioids, that may have more side effects (even as you recover from your surgery as they last quite a while to numb the surgery site)

What are the risks and side effects?

Both epidurals and spinals are generally safe procedures. The most common side effect is a drop in blood pressure, which can make you feel lightheaded or dizzy. This is why you’ll be monitored closely after the procedure is done.

Other potential side effects include:

– Nausea and vomiting

– Itching

– Headache

– Urinary retention (the inability to urinate)

– Fever

– Shivering

– Backache

– Difficulty moving your legs

– Epidural hematoma (a collection of blood near the epidural site)

– Spinal cord injury

– Maternal or fetal death (rare)

Which one is right for you?

It really depends on what you’re using it for.

During labor an epidural is given. Some doctors will do a CSE (I’ll explain that in a bit) but you will have an in-dwelling epidural catheter to help you remain comfortable.

If you are having a cesarean section and already have an epidural infusing, they can give extra mediation in that tube and numb you that way, or they can give you a spinal quickly and efficiently in the OR.

If the cesarean is being done emergently, they may also have to use general anesthesia, but unless it is an emergency, it not as safe for you or for the baby, so check out my post about cesarean section anesthesia.

What is a CSE (combined spinal epidural)?

A combined spinal epidural (CSE) is a combination of an epidural and a spinal. It’s sometimes used to provide both immediate and continuous pain relief during labor.

With a CSE, the anesthesiologist will insert a needle into your back to reach the spinal canal. A small amount of medication is injected into the cerebrospinal fluid that bathes the spinal cord. This provides immediate pain relief.

The anesthesiologist will then place a small, flexible tube (catheter) into the epidural space. Medication can be injected through the catheter to provide continuous pain relief.

I love these, but not all doctors are trained on how to do them. Also, if you aren’t in a great deal of pain initially, it may be too much in the beginning. In general the anesthesiologist will decide if it is your best option (and their best skill) for what is going on.

It is put in, essentially the same way other than that medication is injected into the cerebrospinal space, then, the needle is pulled out a bit and a catheter (a tube) is inserted in the epidural space where you can have a continuous infusion of medication and pain relief for your labor.

I hope that helped to clear up some questions between the two. If you’re looking for good quality pregnancy information, I’d recommend taking a prenatal class so you don’t miss any important parts.

This one covers everything you need to know from third trimester through your first months home with baby. The reviews speak for themselves. I love that it…

• Can be done in just 3 hours
• Is aimed for partners to be involved too!
• Can be done entirely on your own timeframe, it’s on demand — just what you need!

I hope you’ll come join me inside. I guarantee it will prepare you.

And, if you’re not quite sure you’re ready for that whole thing, check out my free prenatal class. It’s your first step toward getting in the driver’s seat of your birth.