Epidural vs. Spinal Anesthesia for Labor

  1. Hi everyone,

    I was wondering if anyone could help me out on understanding the differences between using an epidural vs. a spinal (sub arachnoid) for labor and delivery pain.

    I understand how they are both inserted and potential complications like Hypotension, forceps delivery, etc. but I guess I don't quite understand why you would use one over the other. I know that the spinal is easier/faster to insert but it can cause a "spinal headache" and the epidural will not, that is the only difference my book lists between the two.

    I also don't quite understand how much "feeling" a woman is left with. My book says that with an epidural she will not feel pain from labor contractions, but will have pain at birth but that she won't feel the urge to push however I was observing during a labor where mom had an epidural and she could feel contractions and push with them.

    I have read these descriptions from my book over and over again and it just doesn't go into much detail. If anyone can help clarify these two for me I would really appreciate it.
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  2. 18 Comments

  3. by   klone
    My understanding (from being a mom, rather than from schooling) is that a spinal actually blocks all feeling from the waist down. I'm not sure about how this is done. An epidural is injected into the fluid around the spine, and dulls feeling, but doesn't totally block it. There are also such things called "walking epidurals" which are lower dosages and the mom can walk around and has more feeling.

    WHen it works as it should, mom doesn't feel pain, but will feel pressure. They're not always totally effective, though.

    I opted against it during birth. The idea of having a catheter in my spine gives me the heebie-jeebies.
  4. by   MaggieJo
    I can also give more information from being a mom. I haven't had OB rotation yet, (can't wait for it though!!) from what I understood was that with an epidural, the medicine is in the fluid around and beneath the spinal cord. It is given continously through a catheter, where a spinal block is like a shot. (only given once) A pro with the epidural is that it can be "turned up" if it isn't working very well, or "turned off" if it is too strong. (i.e. mother can't feel to push) Once the spinal block is given it's there, and no going back. Anyway, that's just my memory from birth classes. Hope I was able to help some. I'm envious because I want to already by on my OB rotation. The reason I'm in nursing school is because I want to be a L&D nurse. Good luck. Let me know if you find out anything different or contradictory to what I said.
    Maggie
  5. by   SpudID
    Hello, I am supposed to start nursing school in March, but I work for two large area hospitals in Portland, OR teaching childbirth education and leading a doula program. I have witnessed over 60 births personally and I will tell you what I know anectdotally and have learned through reading.

    About the epidural it is delivered in the dura space and it is absorbed vascularly. That is why it takes longer for the effect (15-30 minutes. The spinal is delivered directly to the spinal fluid and can have the fast effect (2 minutes). Many times if a mom is in a lot of distress the anesthesiologist will give a combo spinal epidural. The puncture and deliver the meds to the spinal space giving quick relief, back the needle out to the epidural space and thread in a catheter. Then mom can be on a drip and receive meds during the whole labor itself.

    With a walking epidural the meds person usu has a cocktail of narcotic and caine meds that allow movement without the dead weight caused by caine meds. The narcotic can have a side effect though of causing some itching that some women find irritating.

    As far as numbness, it seems that it is the same. Some women have epidural during cesarean birth and some spinals. It usually has more to do with time element of the care providers and how the mother is faring. One women I witnessed had a spinal for a scheduled cesarean birth because the doc was in a hurry and couldn't wait for the epidural numbness.

    Hope that helps,

    Lani in Oregon
  6. by   shortsteph12
    I have also not done my OB rotation yet, and am also interested in being a LD nurse. I can say from my experience that the Epidural blocked pain from about a little below the breasts to the knee and also had the unusual and unfortunate reaction of having the cathetor fall out of my back the nurse said she has never seen that. With the spinal (for my second child a planned c section) I had no feeling from below my breasts all the way down. It lasted quite a long time and I didnt get a headache but, was had N&V from the meds which may have been a combo of several. With the Epidural when they did the surgery, I could feel pressure when they cut. With the spinal I felt absolutely nothing.... Hope that helps a little
  7. by   Traveler
    I have never worked in L and D as a nurse but also have had a spinal. It is quicker to do than an epidural. In my case it was done for fetal distress as an emergency. I was one of the unfortunate ones who ended up with a spinal headache and our first trip out was back to the hospital to have an epidural blood patch.

    Epidural with the second one. They can be titrated and can also be left in. (mine was in for two days after c-section for pain control)

    Spinals are not as safe as epidurals and not as easy to control.

    Ann
  8. by   nekhismom
    Maybe you should post this ? under the Ob-gyn forum?
  9. by   mitchsmom
    Here is some info on epidurals, and describes different types:
    http://askdrsears.com/html/1/T010800.asp#T012010

    The spinal block includes abdomen and pelvic area, the epidural can be adjusted for vaginal delivery (pelvic area) or c-section (abdomen and pelvic area).
    If you google it you'll find lots of info.
  10. by   NCgirl
    Hi- try posting this under the nurse anesthesia board, I'm sure some experienced CRNA's will have your answer!
  11. by   BETSRN
    Spinals are used for TOTAL block during a c/section. They are not used for labor anesthesia. Epidurals are lighter and a patient can move and even support her weight. These are what are used for labor pain (if a person so chooses to have a regional anesthesia at all).
    Spinals and epidurals go into two different spaces in the spinal cord area.
    This isn't much of an explanation, but hope it helps.
    Betsy RNC in L&D
  12. by   nurseshawna
    lol, dumb answer here, since i am only a first semester nursing student, i know nothing really about either, but having had both, i would pick an epidural over a spinal anyday. never felt the epidural being inserted, worked great for pain, had a regular vag birth, second child i had a c-section and had to have a spinal. they had to attempt it 4 times, and it was horrible each time, i also didn't get the pain relief that i understood i would get.
  13. by   HawaiiRN
    Quote from NCgirl
    Hi- try posting this under the nurse anesthesia board, I'm sure some experienced CRNA's will have your answer!
    NC Girl,
    I sent you a PM.
  14. by   kmchugh
    Seems to be a lot of misinformation in this thread, so I will try to clear up as much as I can.

    Both spinal and epidural anesthesia work on the same principle, which is bathing nerves or nerve roots at or in the spinal canal with a local anesthetic medication to provide varying levels of analgesia or anesthesia for a number of different procedures. Neither depends on "vascular uptake" to be effective, though uptake into the vascular system is how the anesthetics are cleared, and why they wear off after a given amount of time.

    A spinal anesthetic is a "one shot" anesthetic. A very small needle is inserted through the dura until there is a return of CSF. A small amout of local anesthetic, usually (but not always) with some narcotic, is injected, and the spinal needle is removed. Spinal anesthesia provides a very dense motor and sensory block. Depending on the volume, baricity, and type of agent injected, it can provide complete lack of feeling from about the nipple line down. (It can even go higher, but that is considered a bad thing, because respiratory muscles begin to be involved.) However, it is a one shot thing. Depending on the agents chosen for injection, duration can range from about 30 - 45 minutes, up to 90-120 minutes, and sometimes even longer. If it wears off before delivery, your only options are to deal with it, get another spinal injection, or use IV medications.

    In epidural anesthesia, a special needle is used to identify the epidural space just outside of the dura. A very thin catheter is then threaded into this space, and again, local anesthetic, usually with narcotics, is administered. Again, we are attempting to block sensation at the nerve roots where they enter the spinal canal. Much higher volumes are used in epidural anesthesia. Additionally, the catheter is left in the back, so a continuous infusion of the local anesthetic medication can be administered to the catheter. Also, we can administer additional bolus doses of medication as labor progresses.

    Generally, there is a greater degree of control with epidural over spinal anesthesia. I can vary the rate of infusion, and change medications to give greater or lesser levels of blockade, and by choice of medication administered, retain a greater degree of motor control, so mom can more effectively push. However, I can use epidural anesthetics to achieve a block as dense as spinal, so that surgery, to include c-section can be done on the patient with little or no discomfort. (It's not unusual to feel pressure, as when the surgeon pushes on the belly to help push the baby out, but it should NOT be painful.)

    So, why do we sometimes choose spinal over epidural? Well, there are a lot of reasons. For example, I choose to give spinal anesthetics to patients having c-sections, because spinal is better for the baby than general, and mom gets to be awake when the baby is born. Additionally, time of onset is much faster with a spinal anesthetic. Generally, once I have an epidural in, I tell moms that it is going to take two to three contractions before they really start feeling any relief. With spinal anesthesia, the patient feels relief in about 10-30 seconds.

    Generally, if the patient is going to have a procedure of known duration, and pain management post operatively is not going to be anesthesia's concern, we will use a spinal anesthetic. If we cannot predict the duration, or the duration is expected to be longer than can be achieved with spinal anesthesia, then epidural anesthesia is the way to go.

    Having answered your question, allow me to step on my soapbox for a moment. As a CRNA, one of my pet peeves is a prejudice some nurses, physicians, and (most commonly) nurse midwives feel towards epidurals for labor and delivery. They believe (and convey to their patients) that they are somehow less of a woman if they need an epidural for labor. It is an antiquated idea, and one I believe harms women. Yes, I know, women had babies for thousands of years without epidurals. But then, we extracted teeth for thousands of years without anesthesia as well. Does it make a dental patient somehow less of a person for demanding local anesthesia before the dentist drills on their tooth?

    I've actually been told by a nurse midwife that, with proper breathing and concentration (as she taught her patients) she could achieve the same level of pain control that I could achieve with an epidural. Nonsense. I don't care how much concentration or breathing you work on, you will never be able to make an incision without pain by this method. However, I can do so with an epidural.

    I'm not suggesting that every woman must or should have an epidural. In fact, with I discuss them with my patients, one of the first things I say is that "I'm not here to sell you anything." I simply provide information, answer questions, and allow the mom to make her own decisions, and I respect her ability to do that. If she chooses not to have an epidural, great. That is HER choice. By the same token, it is unfair and unethical for others to allow their prejudice to color how they talk to patients. Present patients with options, and allow the patient to make a choice, unsullied by your preconceived notions.

    Kevin McHugh, CRNA

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