Written by:

Dr Elliott Ridgeon

BA (Oxon), BMBCh

Dr Ridgeon is an anaesthetist in the Oxford School of Anaesthesia. He studied at the University of Oxford, and has a research interest in trials in Critical Care. Elliott’s daily practice is spent on busy hospital labour wards, providing anaesthesia and analgesia for pregnant mothers, alongside general duties in the operating theatres and Intensive Care Unit.

Spinal anaesthesia in labour and childbirth

In this article:

  • What is a spinal?
  • Are spinals common? Do many women have them?
  • How is a spinal block performed? Is it painful?
  • How quickly does it work?
  • Spinal block vs epidural
  • Recovering from a spinal
  • Are there reasons I can’t have a spinal?
  • Spinal block side-effects and risks
  • Main points

Spinal anaesthesia in labour and childbirth

What is a spinal?

A spinal is an injection into the back that provides rapid anaesthesia (numbing) for surgery but can also be used to achieve quick pain relief in labour alongside an epidural. A single dose of a numbing agent is injected (a so-called “single shot”) which acts quickly to make you feel comfortable. This is different to an epidural where a plastic tube is left in place on your back so that medication can be given as needed.

Are spinals common? Do many women have them?

Spinals are the most common choice of anaesthesia for c-section, forceps delivery, and all other surgical procedures undertaken in pregnancy and childbirth. They are occasionally used in conjunction with an epidural (a combined technique or “CSE”).

Spinal block for c-section is preferred in particular as it’s a quick and reliable way to be pain-free. It also has another significant advantage in that it allows you to be awake to meet your new baby.

How is a spinal block performed? Is it painful?

A spinal is put in by your anaesthetist, a doctor with many years of specialist training in this and other procedures.

The anaesthetist will ask you some background questions about your medical history, medications and allergies, and check your notes and results to ensure a spinal is appropriate for you as there are some specific situations in which spinals cannot be done — e.g. in women who have significant problems with blood clotting – see below. Furthermore, they will explain the risks and benefits of the procedure (these are also covered below).

To have a spinal, you must be in an appropriate ward/unit in a hospital – you cannot have a spinal block at home or in a midwife-led unit or birth centre. If your spinal is for a procedure (e.g. trial of forceps, c-section, manual removal of placenta), you will be in the operating theatre. You must have a cannula in place (IV drip), and your baby must be monitored if you are pre-delivery.

A spinal is done with you either sitting up on the edge of a bed/couch (more common) or lying on your side. You will need to be in a slightly curled-up, slouched position to make the procedure easier. The doctor will find the right place on your back by feeling for your hip bones and the bones of your spine.

Your back will be cleaned with sterile liquid or spray, and a drape applied, to prevent infection. The doctor should talk the procedure through with you as it is happening – nothing should be a surprise! You should also communicate with the doctor, so if you have discomfort, or a contraction during the procedure, let them know.

You will get a small injection to the skin at the start – this is local anaesthetic, which numbs the skin – so the actual spinal needle itself won’t hurt (although it may feel like pushing, or pressure on the back). Spinals should not be painful, but may be a little uncomfortable.

The doctor then passes the spinal needle between the bones of the spine and gently through the membrane lining of the nervous system. A small amount of anaesthetic medication is then injected into the fluid around the nerves. These nerves provide the sensation to the tummy, pelvic floor and legs, so discomfort in those areas should be relieved.

This is a delicate and technical procedure that needs precision – stay as still as you can, and communicate openly with your doctor if you feel uncomfortable or have a contraction. Your midwife and birth partner can remain with you throughout, and can help you. The needle itself is removed immediately afterwards.

How quickly does it work?

The procedure takes about 5 minutes to complete, and it will be a further 2-10 minutes (approximately) before the anaesthesia takes effect.

You will notice a feeling of warmth spreading quickly across your bottom and legs within the first minute after the spinal – many women describe the feeling as being comparable to stepping into a warm bath.

Once you have received anaesthesia, your vital signs (heart rate, blood pressure, breathing) will be monitored; your baby will also be monitored if you are pre-delivery.

You will be less able to feel your bladder, and will struggle to wee as a result, so your midwife will need to put in a catheter (tube into your bladder) to help with this. You will also gradually become numb from the bra-line downwards. This numbness to your lower ribs might make your breathing feel a bit different, but you should not feel breathless. Your anaesthetist will check that you are suitably numb before any operation starts. No operation or procedure will start until you are completely comfortable.

It is very common to feel sensations of pulling or stretching during an operation when you’ve had a spinal, but you should not feel any sensations of pain, sharp, or cutting.

As a side-effect of a spinal, it is common to feel shivery, itchy, and, potentially, sick or dizzy.

Spinal block vs epidural

A spinal block is different from an epidural for a few reasons:

  • Spinals are used more commonly for surgical procedures (e.g. spinal block for c-section, spinal block for forceps), but epidurals are used more commonly used in labour for pain relief.
  • Spinals are “single-shot”, i.e. no plastic tubing is left in your back.
  • Spinals cannot be “topped up” like an epidural. This means that once the numbness starts to wear off, it can’t be increased again unless another spinal block is performed.
  • Numbness from a spinal usually comes on more quickly, and is “stronger” than a labour epidural.

However, the two techniques might feel quite similar for you, because in both cases you need to sit up, curve your back, slouch your shoulders, and have your back cleaned and draped by your anaesthetist – the preparation required for the two techniques is nearly the same.

Recovering from a spinal

There is minimal “recovery” required with a spinal. The pain relief wears off gradually which means that you won’t initially feel any pain, even immediately after a c-section. Similarly, your legs will continue to be numb for a while the anaesthetic wears off. This is usually over about 2-4 hours. Be extra careful getting out of bed after your spinal! Your catheter will need to stay in place until you are able to get up to the toilet and you have regained feeling in your bladder — this usually takes 6-12 hours.

Your anaesthetist will prescribe tablet painkillers for you so that you have pain relief readily available if you start to feel pain later on. These might include paracetamol, ibuprofen or diclofenac (which can also be given as a suppository at the end of a surgical procedure) and morphine. Your anaesthetist will check that you are not allergic to any of these drugs and that they are safe for you to have. You will also be offered anti-sickness medicine if you need it.

You should be fully recovered (able to walk, able to pass urine, and without headache or acute back pain) within 24 hours. An anaesthetist will visit you on the post-natal unit to check.
Contrary to some reports spinals do not cause backache. This sensation is usually related to pregnancy itself. However, the skin around the spinal injection site may be a bit tender for a day or two afterwards.

Are there reasons I can’t have a spinal?

The following things will prevent you having a spinal:

  • Major abnormalities of blood clotting that cause you to bleed more easily than normal (including some anti-clot medications).
  • An infection of the skin or tissue on the back in the location where a spinal would otherwise be put.
  • A serious allergy to drugs used in the spinal (local anaesthetics, opioids).

The following things will make a spinal more tricky or risky, but still possible (depending on a review by your doctor):

  • General infection elsewhere in the body (especially sepsis).
  • Significant scoliosis, or other changes to the shape of the spine.
  • Previous spinal surgery.
  • Spina bifida.

Spinal block side-effects and risks

Spinals are very safe and the overall risk of serious problems for mother or baby is extremely low. The important risks and spinal block side-effects are outlined below, and your anaesthetist should go through these with you prior to putting in your spinal.

The following spinal risk list is adapted from the Epidural Information Card (2008) available from the website of the Obstetric Anaesthetists’ Association (OAA). Your local maternity hospital may have slightly different statistics, ask your anaesthetist if you wish to discuss them.
The risks and side effects of a spinal

Main points

  • Spinal anaesthetics are a very common, safe and quick way to numb pain before a procedure or occasionally during labour.
  • An injection of anaesthetics (numbing agents) is injected through the back into the space containing the nerves which carry pain from the abdomen, pelvis and legs.
  • After the injection the needle is removed and nothing is left in the back.
  • It takes about 5 minutes to do the procedure and pain relief can be almost immediate.
  • There will be a warm sensation over your legs and soon you will feel numb from the bra-line down. You will not be able to feel any sharp pain but it is normal to feel pressure or pulling.
  • After the procedure, it takes 2-4 hours for your legs to be able to move again.
  • You will need to take tablet painkillers for any pain felt after the spinal wears off.
  • Spinals do not cause back pain – this is usually related to positioning or difficulties during labour.

Important – If you or your child are unwell you should seek medical advice from a professional – contact your GP or visit an A&E department in an emergency. While My BabyManual strives to provide dependable and trusted information on pregnancy and childcare 24/7 via our website pages, we cannot provide individual answers to specific healthcare questions.