Spinal Block vs. Epidural – What is the difference?
It’s easy to confuse a spinal block and epidural since the terms are so often used interchangeably. Other times, it’s not communicated clearly which one we are receiving.
What is the main difference between them?
Where they put the medication and how long it takes to work once it’s there.
Epidural
They use an epidural “to produce loss of sensation below the waist”. The word “epidural” refers to the space around the spinal cord where the medication is infused through a small catheter tube. They leave the catheter in your back to deliver the medications throughout your labour.
To get an epidural:
In the beginning, they’ll put an IV into your arm. This is for fluids, to control your blood pressure, and because you won’t be eating or drinking anything- except a little water.
When the Anesthesiologist gets to your room, they will ask you to lean forward over a pillow, or lean on your partner for support, and stay still through the contractions by breathing through them. That way, the needle can be inserted safely.
A small amount of local anaesthetic (freezing) will be injected into the skin of your lower back.
Then, they’ll insert a needle between the bones of your spine into the space around your spinal nerves.
Your anesthesiologist will insert the epidural needle when your contraction stops. It is important that you tell them when you have a contraction.
They’ll insert a small, soft, plastic tube and remove the needle. That tube (catheter) delivers the anaesthetic medication that will numb your pain.
This whole process usually takes about 15-20mins and the medication will take about 10-15 minutes to start working.
Epidurals are excellent for removing the pain sensation from your contractions, but the contractions will continue to happen. Some people are able to have a rest or a nap after receiving it- which can sometimes be the relaxation needed to progress labour.
Depending on your hospital, the anesthesiologist, and the type of epidural given- you may not be able to move the lower half of your body. “Low-dose” or “walking Epidurals” usually allow you to be able to move and push your baby out in multiple positions on the bed. If you have a long labour, it can allow you to sleep and recover your strength.
Also depending on your hospital and when the doctor is available, you might only be able to get an epidural at certain points. Commonly, I hear stories of people being told “now or never, the Doctor is going into another surgery” or even that they have progressed too far in labour to get one. Check out the post on Stages of Labour and read about Transition to understand why people ask for an epidural commonly.
If a C-Section becomes necessary, they can “top-up” a properly working Epidural and use it for the C-Section. But you should know that epidurals do not always work. That is a tough thing to prepare for or cope with.
Labouring and Pushing With An Epidural
It is a common misconception that you are only able to push on your back (in the Lithotomy position) when you have an epidural. Or that there are no gravity-assisted positions to help increase your success of vaginal birth and decrease the length of labour.
Using tools like a Peanut ball, Birthing Bar, dropping the bottom of the bed, or changing your positions regularly can all increase your odds of an uncomplicated vaginal birth, even with an epidural!
You will still be able to feel the pressure as baby descends through the birth canal during the Second Stage (Pushing Stage). However, it might take a little longer to get the hang of activating muscles you can’t completely feel.
Spinal Block
A spinal block is an “injection of a local anaesthetic or opioid into the subarachnoid space (inside the dural sac which contains cerebrospinal fluid), through a fine needle that numbs the nerves that supply the tummy, hips, bottom, and legs.”
The start of the procedure is similar to that of an epidural, but they do it in the operating room where you will be having a C-section. Also, you are not typically in labour. There is no catheter with a spinal block. Instead, they will inject the medicine directly into the dural sac with a single shot.
It provides an immediate block of nerves below the waist, so there is no delay in pain relief. The spinal block lasts for several hours with one dose of medication. It can be an effective way to manage surgical pain after a C-section. The downside is that it completely immobilizes your lower body until the medication wears off.
Your provider may suggest a spinal block if you decide on pain relief late in labour since they use it for scheduled c-sections, as well as urgent and emergency.
Is the level of risk the same?
Both procedures have the same risk in the form of a “spinal headache.” It may affect your baby as well by making them sleepier. It could also cause a slight delay in normal newborn activities (ie: breastfeeding). We also see this in babies whose mothers received any narcotics during later labour. Rest assured your medical team will monitor you and baby closely. It’s best to talk to your health care provider and discuss the option that is best for you.
As you approach labour day, you’ll have plenty of things on your mind. Don’t hesitate to start a conversation with your health care provider about the type of pain relief you want for labour. Keep in mind that plans can change.
I hope that you’ve learned a little bit about pain relief. I would love to answer any questions! If you have some, please drop them in the comments below and let me know if there’s anything you need!