Epidural vs. Spinal Anesthesia for Labor

klone, MSN, RN · Feb 17, 2004

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.

MaggieJo · Feb 17, 2004

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

SpudID · Feb 17, 2004

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

shortsteph12 · Feb 17, 2004

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

Traveler · Feb 18, 2004

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

nekhismom · Feb 18, 2004

Maybe you should post this ? under the Ob-gyn forum?

mitchsmom · Feb 18, 2004

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 lady partsl delivery (pelvic area) or c-section (abdomen and pelvic area).

If you google it you'll find lots of info.

NCgirl · Feb 18, 2004

Hi- try posting this under the nurse anesthesia board, I'm sure some experienced CRNA's will have your answer!

BETSRN · Feb 18, 2004

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

nurseshawna · Feb 18, 2004

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.

HawaiiRN · Feb 18, 2004

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.