All about epidurals & spinals.

What do you know about epidurals and spinals? I want to know more. This is my understanding so far as a non-medical person who's never had either.

- An epidural takes a lot longer to put in than a spinal. It goes into a different space and is more fiddly to insert the thing.

- If you might need an epidural for pain relief, it's good to get it in early on, before your contractions are so strong it's hard to sit still for it, and to make sure the anaesthetist is there and has time to do it.

- You can have the epidural in, but not have any drugs put into it. This means you are not attached to anything and can move around freely, (can you still go in the bath?) and it's quite quick and easy to put the drugs in. You can have the canula thing in your hand, ready for saline drip, but nothing attached to it.

-Once drugs go into the epidural you can't move around, and they'll want to put the saline drip in and hook you up to monitors.

-The epidural drugs lower your blood pressure and do affect the baby. It can affect the progress of your labour.

-It takes about 15 to 20 mins for the epidural drugs to take effect, and they can vary the amount of drugs they put in it.

-For a C/section they usually prefer a spinal to a GA these days, and a spinal is much quicker and easier to do than an epidural. A spinal cannot go in the same thing as your epidural, it's a separate procedure because they're going into a different space in the spine.

I want to know more in case I need either this time. What else can you add? I'll post any extra info I find.

Yvette - I asked about an epidural in the very early stages of labour after my waters were broken. Mum laughed at me but I was only asking because I didn't want to miss out on one when it became too unbearable. I was induced due to high blood pressure so the midwife said that if I wanted an epidural, it would be better for me to have it early because it can help to lower BP.
When it was administered I felt no pain at all as I was having contractions and was breathing through them with the gas. I would not hesitate having another one again (although I will probably have a c-section again so it may not even be an option).
When it came to having the emergency c-section, they were able to just numb me more via the epidural.
The IV in my hand actually hurt more (sometimes more than the contractions had!).

I have heard and this was from medical students that were doing surveys on ppl that had an epidural ( 2 days after I had one) that the bigger you are the harder it is to get an epidural in cause they have trouble feeling for the spine if you are overweight, and i know with my SIL it took a few goes and she was overweight at the time

I had an epidural in within 5 mins in my labour with Kam no dramas with it at all. Not sure about adding drugs to it etc though as mine were added straight away and yep it ties you down to the bed you can't go anywhere. Wouldn't be able to feel the floor to walk anyway LOL.

Love

My epidural went in after 5 hours of labour on the first go (didn't feel a thing) and they used the same port (medico term) for the spinal block when I went in for the c/s. So they don't have to put it in a different place, I was under the impression that it did different things to the CNS (central nervous system) in that an epidural dulls the pain but you can acknowledge that it is going on, and a spinal block does just that, blocks everything from that point on down the spinal cord. Please if anyone else has more correct information share, I just was under this impression. :)

Debbie & Christy, this is what a woman from AMBA said to me yesterday, that they had just topped up her epidural to do the c/s. This had me really confused, as DH (ex-nurse) is quite sure you couldn't do a c/s with just an epidural.

Have just had another diagram drawn for me. There are meninges, which are membranes surrounding the spinal cord. To get to the spot for an epidural, they have to go through 2 meninges but not through the 3rd, and the meninges are next to each other without a space in between, so it's tricky to get to.

To do the spinal, they DO/CAN go in the same hole they've made for the epi, but they're not just topping up the epi, they go through the NEXT meninge into the sub-arachnoid space where the spinal fluid is. It is easier for them to find this space because it's actually a space, whereas the epidural one is into the extra-dural space which is trickier to find.

So it SEEMS as if it's still the same thing, in fact it's the same drug, but in a different space, making you paralysed from the chest down quite quickly, whereas with epidural the level of anaesthesia can be varied.

Hi Mymagenta. That's interesting that your epi worked straight away. I wonder if it varies with different people or how much of the drug they put in. With the spinal, did it hurt having it put in? I've heard sometimes they can use a local first. Are you expecting your 4th child now or just planning? I agree re preparation, but howling rather than breathing works for me, lol.

Does anyone know if they were given a local first, how big the needle was etc? Did the anaesthetist explain what they were doing. How long did it take to work for you?

I'll see what I can get from the doctor about all this on Wednesday, I hope I'm understanding it correctly. It's so confusing really isn't it.

Hi Yvette,

With my labour, I was induced, and my BP was rising, so they recommended I have an epidural... though I was just about to ask for one anyway.
They did numb the spot it first with a local anaesthetic, and putting the big needle in really did not seem to hurt much at all. It was hard to stay in a hunched over position, but at the same time, it was good to have something to concentrate on and distract me from contractions - being that I had to keep myself still.
The anaethetist actually had to do it twice, cause apparently he missed it the first time or something... but that didnt bother me too much.
The pain relief started working in around 5-15 minutes I think.
I guess the only bad thing was that I couldnt feel when it was time to push. The midwife kept asking me if I felt any pressure, and I said no. But I was feeling pain breaking through... so I assume thats what it was, cause when she finally checked to see how dilated I was, I was already at 10cms, and I think I must have been like that for a while.
The actual pushing was easy though... even though I coudlnt feel it, I still knew what to do, and the midwife told me exactly when to push. So we managed to get Aidyn out in less than 20 mins, with no intervention (forceps or venthouse) needed.

With the birth of my DD I had an epidural at about 5-6 hours into labour after trying the gas and pethedine and finding they didn't help the pain at all.

It was definatly hard to sit still while they put the needle in. I could vaguely feel it going in but it wasn't painful as they had put the local in first. I didn't see the needles (i can't stand them) but my boyfriend said it was really big. The doctor said he hit blood vessels twice and then got it in on the third time.

I then didn't feel anything for about 4-5 hours and then the pain started coming back slowly. I had a button to press if i needed more pain relief but I think they turned it off at a certain point. I could feel the pressure and contractions so I knew when to push and she was out with 15 minutes of pushing.

Yvette - not sure if you remember but I had both an epi and a spinal block done. I asked for an epi about 4 hours into active labour and m/w agreed as I was 3cm and not coping with the pain. I also had to be induced with the drip due to high blood pressure. It took an hour for the aneathist to come in and he put the needle in straight away, I didn't see the needle he used. It worked straight away and took all the pain away. There are differing amounts of drug they use and it wore off after about 3 hours and it made me really drowsy. I was tied to the bed, as I had the epi thing, the drip for the contractions, cathider (sp) for waste and a fetal scapal monitor. They upped my dosage but that didn't work. They called the ob for advise as to want to do and he examined me and I was fully dialated but had no urge to push, although all the epi had worn off.

As Matty was getting distressed, ob gave me the option of a spinal block in thearte and deliver with forceps, or a c/s. I opted for the forceps and he promised if anything went wrong he could do the c/s straight away due to the spinal block.

The spinal took ages to put in it seemed but in reality it didn't really as I was in so much pain and the contractions were almost over the top of one another. I think you are spot on about the different places it goes in the spine. You have to curve your back for both the epi and spinal but the spinal was harder as he wanted me curled more, hard to do while having painful contractions and a big tummy! I had to have the nurses help me. The relief was instaneous. I am pretty sure they do the local first. I don't remembering feeling it, but remember them telling me that I probably would. Three pushes and he was out - thanks to the forceps!

HTH's.

Have been Googling epidurals & have seen my midwife. Still need to know much more, but have found out:

- you can have a c/section by topping up an epidural, but spinal is preferred. If you have one in anyway, they may just top it up.

-spinal works straight away, epi takes 5- 15 minutes. So I guess for some people they can work pretty quickly.

-headaches & back pain are common side effects.

-the epi is more inclined to slow your labour the earlier you have it.

-epi can be topped up but a spinal wears off after a couple of hours.

Mymagenta - yes Obs & midwives are in danger of losing skills such as delivering breech babies by relying so much on c/sections. I'm told I will get a consultant no matter what, so hopefully that equals experience. I'm public, so money has nothing to do with it, but for private patiients, especially in the US, I gather it does (see Misconceptions by Naomi Wolf).

Thanks for everybody's posts. Nell, that's weird how your epi couldn't be got going again with a top up. I know you had such a hard time. Was it the timing or something, like maybe it takes longer to work after the initial dose? Did they talk to you about it afterwards so you could get an understanding of why it happened that way?

Has anyone had side effects?

Has anyone been able to remain upright, sitting, standing, kneeling or squatting with an epidural going?

wow I had two top-ups with my epi before they did the c/s and one time it never worked...I mean I didn't feel any different from the top up, and when they did the c/s it wasn't blocked completely because I felt what they were doing. I felt the initial incision and pulling of the abdomen, and I could walk within the 12 hours, go to the loo and other stuff...so maybe I only had a top-up of the epi and not a block? hmmmm....

I was under the same impression as you Christy, that the epidural and spinal block could both go in the same place (i.e. one needle spot IYKWIM).

I had the epidural first, and then because of having to have the emergency caesarean, I distinctly remember the anaesthetist saying that I had to have a spinal block. The spinal block worked REALLY quickly (and I didn't have another needle......he told me it would go in the same spot as the epidural) but the epidural took closer to half an hour to work I think, and I was able to still move my legs etc, but with the spinal, I couldn't move from the boobs down!

yeah I don't remember having a second needle, and I certainly could still move my legs during the c/s [-X

Christy that does sound like it must have been an epidural doesn't it. How freaky being able to feel the incision. Was it painful or just uncomfortable? So I wonder why sometimes they choose to top up and epi & other times to do a spinal.

I totally want an appointment with an anaesthetist if they want me to even consider this epidural. Now! Reading on the internet I've seen talk about different kinds of epidurals with different kinds of drugs in them too. They can just use local anaesthetic or a combo of local and opiates. The opiates apparently are what causes itdhiness as a side effect.

Still reading.