Let’s talk through spinal blocks vs epidurals! Because even though they are similar, many people don’t realize that there are actually quite a few differences. And trust me, I didn’t realize this either before I became an L&D nurse.
In this article, I’m going to break it down for you! How are spinal blocks and epidurals similar and how do they differ?
Rest assured that you will have a much better understanding of the two after reading this article. Which will help you have a better understanding about your birth!
Ready mama? Let’s get started!
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What is a spinal block?
Spinal blocks, aka spinal anesthesia, are most commonly used to numb mamas prior to a C-section.
Basically, a spinal block is a procedure that involves a member of the anesthesia team injecting anesthetic below the spinal column, directly into the spinal fluid.
This provides pain relief for up to 2 hours.
When are spinal blocks used for birth?
In the labor and delivery world, spinal blocks are most often used for scheduled and routine C-sections.
Placing a spinal block takes a little bit of time, so if mama or baby’s condition is deemed unstable and your provider is requesting an emergency C-section, there likely wouldn’t be enough time for a spinal.
Are spinal blocks used for emergency C-sections?
In the case of an emergency C-section, and in some urgent C-sections, the fastest and safest anesthesia option is general anesthesia. General anesthesia puts you fully asleep.
With an urgent C-section, it truly is situational. It really depends on exactly what’s going on with mom and baby, and how much time we have until we need to deliver.
I have seen it go both ways with urgent C-sections. Some women are able to have a spinal placed and remain awake for the delivery while others, unfortunately, are put under general anesthesia.
Speaking of general anesthesia, it’s also used as a backup method if spinal anesthesia is unsuccessful.
What is an epidural?
It seems that an epidural is a more familiar term when it comes to birth. Maybe it’s because the majority of U.S. births are vaginal deliveries (source). Maybe it’s just that mamas don’t talk about their spinal blocks as frequently. Or maybe it’s just a personal assumption on my end.
But let’s get down to business, what exactly is an epidural? If you have taken or are taking my Birth It Up: The Epidural Series course, this should be a review for you.
An epidural is a type of regional anesthesia that blocks pain in a particular part of the body. The goal of an epidural during birth is to provide pain relief, rather than completely eliminating all feeling and sensation.
With an effective epidural, you should not feel sharp contraction pain, but you might still feel pelvic and rectal pressure as your baby gets lower into your pelvis.
It typically takes about 20 minutes to feel the full effects of the epidural once it’s placed.
Over the course of those 20 (ish) minutes, you should notice that your contractions begin to feel shorter and less painful.
When are epidurals used for birth?
An epidural is used for a woman in labor that is anticipating a vaginal delivery. I say anticipating because we can’t predict how a woman will end up delivering – because a C-section can happen unexpectedly.
If a laboring mama has an epidural and ends up needing a C-section, we can usually convert her epidural into a spinal block. An anesthesia team member does this by administering certain medications through the epidural catheter.
Spinal block vs epidural: similarities and differences
Now that we have covered exactly what spinals and epidurals are, let’s move on to how they are similar and how they differ.
Similarities between epidurals and spinal blocks
- Both provide pain relief for childbirth
- Both work by blocking the transmission of pain signals
- You will be in the same position for the placement of both
- Both are placed by a member of the anesthesia team
Differences between epidurals and spinal blocks
- Onset: epidurals take about 20 minutes to provide relief whereas with a spinal block, it’s almost immediate
- Catheter: with an epidural, a catheter remains in your back to deliver continuous medication until delivery. With a spinal block, the needle is immediately removed once the medication is administered – nothing remains in your back
- Mode of birth delivery: epidurals are most commonly used for anticipated vaginal births, while spinals are used for C-sections
Spinal block vs epidural: advantages and disadvantages
Both spinal blocks and epidurals have advantages and disadvantages. As the birthing person, I highly recommend you familiarize yourself with both in case your delivery plans change!
If there’s one thing that we know for sure about labor and birth, it’s that it can be unpredictable. In my online birth classes, I make sure to provide enough overlapping information to cover you if plans change!
Related Reading: Birth It Up: The Epidural Series – Every Question Answered
What are the advantages of using an epidural vs a spinal block?
An epidural offers pain relief for a longer period of time. With a labor epidural, a catheter is threaded into your epidural space. Once the anesthesia provider determines the catheter is in the correct place, they administer a test dose of medication to confirm.
If all is well, they will leave the small catheter in your back, tape it down really, really well, where it remains until you deliver your baby. This option allows the other end of the epidural catheter to be connected to a pump that administers pain medication throughout delivery.
In less words: a big advantage of an epidural over a spinal block is that the relief doesn’t have a set “end time”.
How does this compare to a spinal block?
With a spinal block, we place a needle into your back, administer the numbing medication, and then remove the needle.
This is because we typically expect a C-section to take 2 hours or less, so we don’t necessarily need the medication to work for hours and hours.
If there are known complications and we anticipate that the C-section will be longer, then you may receive something called a combined spinal epidural (CSE).
While this might be perceived as a disadvantage, it’s also the intention – you just don’t need the pain relief for as long as a mama in active labor!
What are the disadvantages of using an epidural vs a spinal block?
One disadvantage of an epidural over a spinal is that the catheter remains in your back. The placement is done under sterile conditions so it’s not so much that it’s an infection risk as it just a nuisance.
But keep in mind, that pesky little tube that’s taped to your back provides you with pain relief for labor, so most people don’t have an issue moving past it.
Another disadvantage is that an epidural takes longer to start working. Typically, an epidural takes about 20 minutes to work to its full capacity.
This is 20 minutes (give or take) from the time the test dose is administered. A spinal begins working pretty much immediately after the medication is administered.
Keep in mind the two aren’t used interchangeably!
Again, the intended purpose of each is different, making it somewhat difficult to compare the two too closely, but those are what I would consider the big disadvantages of an epidural over a spinal block.
Spinal block vs epidural FAQs
Which is more commonly used during labor?
An epidural is more commonly used for labor. This is something that might vary depending on where you deliver, but rarely, if ever, have I seen a spinal block placed for someone that’s laboring and anticipating a vaginal birth.
The good news is that an epidural can be converted to a spinal block pretty easily if needed. What did I say before? The only predictable thing about labor is that it’s unpredictable.
As your labor and delivery nurse, I’m going to do everything in my power to help you have a safe, vaginal birth, if that is your plan. Sometimes though, situations present themselves during labor that make a vaginal birth unsafe and contraindicated.
Can you convert an epidural to a spinal block?
Should you have an epidural in place and you need a C-section, there’s a good chance that a member of the anesthesia team can give you medication through your epidural catheter to convert it to a spinal.
Why is this a good thing for you? I touched on this earlier but a backup anesthesia plan for someone needing a C-section is general anesthesia. With general anesthesia, you lose consciousness and won’t be awake for your baby’s birth – and that’s just plain unfair!
Let’s say you are laboring, planning for a vaginal birth, and something happens in the labor process that prompts you to need an urgent or emergent C-section.
With a functioning epidural in place, there might be enough time for the anesthesia team to give you the appropriate medications, turning your epidural into a spinal – which would mean…yep, you got it – you can remain awake for the birth of your baby!
This isn’t a guarantee and truly does depend on the situation and how urgent or emergent the C-section is, but it definitely can be an option!
Which is more commonly used during C-sections?
A spinal block is more commonly used during C-section births. I know you were paying attention earlier in the article, but I’ll do a little recap for you, just in case!
Remember, C-sections don’t take longer than a couple hours. This probably sounds like a looong time but I’m referring to the entire procedure, from beginning to end, not just the getting baby out part.
If your provider anticipates needing longer than 2 hours to complete the C-section then a combined spinal epidural (CSE) would probably be the better choice. This would a catheter to be placed and the anesthesia team to administer additional medication if needed.
To make it short and sweet: epidurals are most commonly used for laboring women anticipating a vaginal birth and spinals are typically used for scheduled or routine C-sections.
Do spinal blocks or epidurals have more side effects?
The side effects of a spinal block and epidural are actually quite similar. Probably the most common side effect of both is hypotension (low blood pressure).
Another pretty common side effect of both is nausea and vomiting. This is typically a direct result of an abrupt drop in your blood pressure. Often you will feel symptomatic before we are able to see the blood pressure drop on the monitor. Luckily there are a lot of interventions we can do to bring it back up!
Itching is another side effect that can happen after a spinal or epidural. Itching is actually a common side effect of opiate-based drugs, which you will receive with both a spinal and epidural. Once the opioids are out of your system, the itching should resolve.
Another, far less common side effect (thank goodness) is a headache. I’m not just talking about any kind of headache; I’m talking about possibly the worst headache of your entire life. This particular kind of headache is rare, as in a 1% chance rare. Known as a spinal headache, the symptoms typically appear within 48 hours after the anesthesia has been administered.
Related Reading: Epidural Side Effects and Facts You Need to Know!
Which is better: spinal block vs epidural?
When it comes down to whether an epidural or spinal is better, I would have to say that it truly just depends. You have probably learned by now that spinal blocks and epidurals have different purposes.
Knowing that they are used for different things makes it pretty tough to say that one is better than the other. I’ll leave you with this:
- Spinal blocks are better and more appropriate for a woman planning a C-section birth
- Epidurals are the more appropriate and better option for laboring mamas that intend on having a vaginal delivery
Where can I learn more about epidurals for my birth?
Between my Birth It Up: The Epidural Series online birth class, my Instagram page, and all the free resources on my website, you will not be hurting for knowledge about epidurals when you finish reviewing the resources below!
You could spend hours skimming through all my epidural resources. To save you some time, I’m posting some of my very favorites below.
Cheers to an even better birth, mama!
- Birth It Up: The Epidural Series – Every Question Answered
- How Does an Epidural Work? When to Get an Epidural? The Entire Epidural Process Explained!