Epidural or Spinal in Labour, Which is Best?

epidural vs spinal

Pain relief in labour is something you need to think about prior to the event actually occurring. The reason is control. Of course, there are certain events which may occur during labour which you have no control over, and you have to submit to whatever your midwife or doctor deems best for you. Some things however, you can decide beforehand. Pain relief is one of them.

Some women choose to have no pain relief whatsoever. Some women choose to try having no pain relief, but give themselves the option if the pain becomes too difficult to bear. Two pain relief options which you need to think about are epidurals and spinal anaesthesia.

Of course, in order to be able to make an informed choice, you need to know as much information about each one as possible.

Epidural

An epidural allows painkilling drugs to be given you via a tube which goes into the small of your back. This is a regional type of anaesthetic, so it will only affect that part of your body, e.g. your lower back, belly, etc. The rest of your body will be unaffected.

A specially trained anaesthetist must come to give you the epidural, as the procedure is quite complex, and you must hold still during the epidural being sited. The tube goes into the spinal nerves, which carry directly to your brain. The injected drugs which go through the tube, therefore, affect the brain. How? By affecting the pain signals which your brain will send to your womb and to your cervix during the course of your labour. This effectively works to numb the area, and provide good quality pain relief for you.

You might be wondering what drugs are contained within the epidural procedure. Typically this is a mixture of a local anaesthetic drug, and an opioid to numb the pain further. Most likely this will be Bupivacaine or Levobupivacaine, and Fentanyl. These are given in a low dose and are controlled by the anaesthetist to ensure you aren’t given too much.

The plus point of an epidural is that you should be able to move around a little, although you will have the tube in your back so you will need to be careful how far you go, and you will need to have a member of staff with you. You can change position, which is useful for women in active labour. Your epidural may be given as a continuous type of pain relief, or one which is topped up.

Of course, epidurals may not be suitable for every woman and your anaesthetist will carry out a health background consultation before they decide whether this is the right choice for you. If suitable, you can have an epidural at any stage of labour, however most women want this when the contractions are starting to become very strong. The epidural will remain in place until after your baby is born and the placenta has been delivered. If you require stitches, the epidural can give you pain relief for that procedure too.

Spinal

A spinal anaesthetic has some major differences to an epidural but still needs to be performed by an anaesthetist. A spinal is one single injection which goes into the small of your back. This works faster than an epidural, but it is a regional type of anaesthetic, and therefore it will numb a larger part of your body.

A spinal anaesthetic works quite similarly to an epidural, i.e. it works to affect the pain signals that the brain sends to the womb and cervix during labour. The difference is that you won’t be constantly attached to a tube in your back, as you would with an epidural.

Within around 10 minutes your belly will be numbed. This is often given as preparation for a caesarean section also. As with the epidural, you will need to sit as still as possible whilst the spinal is being performed.

Another difference is that a spinal can’t be used at any stage of labour. You can have the spinal during the first stage, or you can have a full-dose spinal for a caesarean section. Again, your anaesthetist will ask you questions prior to deciding if the spinal is for you, as although most women are suitable, not all are. The most common reasons for needing a spinal over an epidural are:

  • You are going to have a planned C section (caesarean), or your doctor or midwife thinks this might be necessary
  • You are about to have an instrumental birth, e.g. forceps or ventouse
  • You have a severe tear
  • Your placenta needs to be removed by hand

These are all situations in which you need pain relief to be faster acting, which is what a spinal would give you. By going down this route, you also avoid the possibility of a general anaesthetic for a caesarean, and you will be more alert generally.

The down side of a spinal is that it doesn’t last as long as an epidural, and lasts for up to two hours. It cannot be topped up like an epidural can, and you usually only have one injection. It can also take a little while for full sensation to return to your body after a full-dose spinal (for a caesarean), sometimes up to four hours.

Which is Best?

Every woman is different, and every labour is different. Now you know the pros and cons, as well as the differences between epidurals and spinals, you’re in a better position to make a decision. It may also be that you are advised by your doctor or midwife in terms of which route to go down. In that case, always go with medical advice.

If you require a caesarean section or an instrumental assisted delivery, spinal will most likely be the option you are given. If however you are in the midst of a normal delivery and you find the pain too much to deal with, an epidural could be a good option for you.

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