Epidurals vs. spinals

[AngB]

Has anyone had both? How did they compare?

I've had 2 epidurals/c-sections. (First one was a classical/vertical incision so I always have to have c-sections no later than 37 weeks before I go into labor- that part is more than okay with me.) Both times though, getting the epidural was the worst/most painful part. (Maybe because it was the same anesthesiologist both times.) The first time I was really sick and swollen and it took her 4+ times to get it in right, and even the second time when I wasn't really swollen it took at least 2 times. I don't think it was well placed though even then-it worked well enough I didn't feel anything for the surgery (it hurts so bad when they "miss" that if it feels decent I let it go.) But when my pain meds started fading afterward, my back hurt MUCH more than my c-section, I finally talked them into taking it out "early", and felt MUCH MUCH better after that.

I know my OB prefers epidurals with c-sections but I really really want a spinal instead. But maybe that part is just going to stink either way?

(I have a pretty high tolerance for pain, so if I knew I didn't need it for the surgery part, I'd be okay with not having it at all. I'm not at all worried about the spinal wearing off- I want it to wear off! I always felt BETTER/more comfortable when they take the epidural out.)

[PZMommy]

I've had 2 spinals for both of my c-sections. It only hurt briefly for a minute when they actually inserted the needle, but after that, there was no pain. With my first, a few days later I had a sore spot (felt like a bruise) where the needle had been inserted, but that was it. At my hospital it is standard procedure to do a spinal for a scheduled c-section. They only use epidurals if you had one during labor and then needed an emergency c-section.

I would ask your anesthesiologist if you can have a spinal instead. Why does your dr prefer epidurals?

Dawn

[pastrygirl]

For me, a spinal worked and an epidural didn't. ;)

I don't remember much about my spinal except that it took all the pain away. It was an emergency C-section, so I was just focused on getting Toby out alive.

My epidural was after nearly two days of unmedicated hard labor and I just needed some rest. It didn't work at all. ETA: As a result, I'd be terrified of getting an epidural for a c-section! I could even feel getting stitched up after my VBAC, with the epidural. It sucked.

[AngB]

I would ask your anesthesiologist if you can have a spinal instead. Why does your dr prefer epidurals?

Dawn

I think because they stay in and can keep giving meds for up to a couple days while recovering, whereas the spinal wears off and then you are at the mercy of oral meds, etc. Considering I had the epidural pulled out as soon as they'd let me last time, though, and she knows I have a pretty high pain tolerance since I was off all meds before I was even discharged, hopefully she will be okay with it.

(My first time was an emergency and she figured it was so bad b/c I was really swollen and sick with pre-e/HELLP. Well, the second one was even worse and I wasn't really swollen at all. Plus I'm allergic to the tegaderm stuff that they have to use to hold it in place and got a huge bright red rash where it was. So a spinal would be better for that too, I think, since I was under the impression that it's just basically like a shot.)

Thanks for sharing your experiences!

[mmsmom]

I have only had spinals so sorry I can't give you any comparative information. But I do think it is more up to the anesthesologist as to what you will get vs. the OB. If you are having a c-section you will have an IV that drugs can be administered through so being able to give more meds should not be a reason to have an epidural. I had 2 planned c-sections at 2 different hospitals and had spinals for both. I did not find them to hurt at all, they numb first with lidocaine & that's the only part I felt. I did get a headache with the 2nd one that was pretty rough and they could not administer the drugs to make it go away until the baby was out but after that it went away and it was all fine.

I'm sure this can be different depending on hosptial but I was told from surgery until 24 hours after surgery (or when the IV comes out) the anesthesologist is in charge of pain management, after that the OB is in charge.

[PZMommy]

I think because they stay in and can keep giving meds for up to a couple days while recovering, whereas the spinal wears off and then you are at the mercy of oral meds, etc. Considering I had the epidural pulled out as soon as they'd let me last time, though, and she knows I have a pretty high pain tolerance since I was off all meds before I was even discharged, hopefully she will be okay with it.

(My first timpe was an emergency and she figured it was so bad b/c I was really swollen and sick with pre-e/HELLP. Well, the second one was even worse and I wasn't really swollen at all. Plus I'm allergic to the tegaderm stuff that they have to use to hold it in place and got a huge bright red rash where it was. So a spinal would be better for that too, I think, since I was under the impression that it's just basically like a shot.)

Thanks for sharing your experiences!

I had an IV and was given pain meds via that for 24 hours. Then the IV came out and was just given oral meds. I have a low pain tolerance, but that was good enough. Both times I was only on Advil when I was released.

Dawn

[Green_Tea]

I've had three c sections - one with an epidural (after 18 hours of labor), and then two with spinals.

c/s #1 with an epidural was completely fine.

c/s #2 with a spinal was a disaster because the meds did not take quickly. They had to wait to start the surgery and tip me so my feet were elevated and it took about 30 minutes for me to be sufficiently numb. About 30 minutes before they finished closing me up, the spinal stopped working and I felt a lot of the final parts of the surgery.

c/s #3 was also with a spinal. And anesthesiologist was kept in the OR with me to monitor the situation to avoid a repeat of section #2. I was give considerably more of whatever they use in the spinal. It was fine.

I think it's possible that your OB has seen one or more patients who have had their spinal meds wear off during surgery. A second or third section can take much longer, and once a spinal is administered and the needle is removed, adding more meds is not an option (there are other types of meds that can be used, of course - like IV meds, or general anesthesia - but they won't leave you feeling as alert and ready to nurse/hold the baby.) An epidural makes it possible to add more meds as necessary.

[SkyrMommy]

I had an epidural with DD, induced labor that went awry & ended up with an emergency section, I don't remember it hurting and it was effective for a time, and then they had to adjust the meds as labor went on it wasn't as effective.

With DS I had a scheduled section and had a spinal. It was very uncomfortable as it was administered, but effective immediately and I felt so much less with DS than I did with DD. I didn't have any sort of reaction headache, but both the epidural and spinal caused me to throw up and I had to have additional meds to control my stomach.

In recovery, the spinal wore off so much quicker and I was on my feet and home so much sooner, but I did feel more of the bruise at the insertion spot from the spinal than I remember from the epidural.

[TxCat]

The decision between a spinal or an epidural is often a decision made in concert between your anesthesiologist and OB, or at the anesthesiologist's discretion, obviously taking into account the patient's past medical history and surgical history and patient preference (to a certain extent).

Unless there is a specific medical reason to avoid a spinal, it's pretty rare to get an epidural specifically for a planned c-section. Not saying that it can't happen, but it's pretty unusual, and something that would surprise me. For a planned c-section, the vast majority of patients get a spinal block or a combined-spinal-epidural. The benefit of the combined-spinal-epidural (also known as CSE) is that the main, or initial, anesthetic is the spinal shot, which tends to be a denser block than an epidural block and takes effect much more quickly. However, by placing an epidural catheter at the same time, the anesthesiologist can use the epidural catheter to augment pain relief/anesthesia if the surgery takes an especially long time, if the spinal block fails for some reason (ie, bad batch of medication), or the epidural catheter can stay in for post-operative pain control, typically up to 24-36 hours after surgery. In my personal practice, I place a CSE about 90% of the time for a planned c-section for the following reasons: 1) repeat c-sections typically take longer than primary c-sections due to increased scar tissue, 2) if a patient has a high BMI, that typically increases the length of surgery, 3) a lot of OB's I work with like using the epidural for post-op pain control, 4) I personally like having the epidural as my "back-up" anesthetic in case there is a problem with the spinal. It is one more way to minimize the chance of converting to a general anesthetic for c-section.

AngB, I'm sorry that you had such a rotten experience with both epidurals - that's terrible! Out of curiosity, did your anesthesiologist ever mention if you have scoliosis? I only ask because that's one of the things that typically increases difficulty with placement. If you were having a lot of back pain with the epidural catheter, it also makes me wonder if it was in the "right" location at the time - it's not unusual for them to migrate from their original position, and that could cause discomfort. I would definitely discuss your concerns with your next anesthesiologist and let them know about the difficulty in placing the epidural on both occasions. The only other thing I would add is that your positioning during the spinal or epidural placement can help tremendously. By arching out your lower back as much as possible, it helps open up the spaces between the spinous processes of your back, creating more room for the anesthesiologist to maneuver and find the epidural or spinal space.

For those of you who have had non-functional epidurals in labor, always let the anesthesiologist or nurse anesthetist know. Depending on the situation, they may be able to take out the epidural, and place a new one. I always counsel my patients that one of the risks of an epidural is that it might not work the way we expect it to, and if that is the case, I will be more than happy to replace it for them. In my mind, if you have gone through the process and potential risk of having an epidural, there is no reason for it not to work the way it should.

[AngB]

The decision between a spinal or an epidural is often a decision made in concert between your anesthesiologist and OB, or at the anesthesiologist's discretion, obviously taking into account the patient's past medical history and surgical history and patient preference (to a certain extent).

Unless there is a specific medical reason to avoid a spinal, it's pretty rare to get an epidural specifically for a planned c-section. Not saying that it can't happen, but it's pretty unusual, and something that would surprise me. For a planned c-section, the vast majority of patients get a spinal block or a combined-spinal-epidural. The benefit of the combined-spinal-epidural (also known as CSE) is that the main, or initial, anesthetic is the spinal shot, which tends to be a denser block than an epidural block and takes effect much more quickly. However, by placing an epidural catheter at the same time, the anesthesiologist can use the epidural catheter to augment pain relief/anesthesia if the surgery takes an especially long time, if the spinal block fails for some reason (ie, bad batch of medication), or the epidural catheter can stay in for post-operative pain control, typically up to 24-36 hours after surgery. In my personal practice, I place a CSE about 90% of the time for a planned c-section for the following reasons: 1) repeat c-sections typically take longer than primary c-sections due to increased scar tissue, 2) if a patient has a high BMI, that typically increases the length of surgery, 3) a lot of OB's I work with like using the epidural for post-op pain control, 4) I personally like having the epidural as my "back-up" anesthetic in case there is a problem with the spinal. It is one more way to minimize the chance of converting to a general anesthetic for c-section.

AngB, I'm sorry that you had such a rotten experience with both epidurals - that's terrible! Out of curiosity, did your anesthesiologist ever mention if you have scoliosis? I only ask because that's one of the things that typically increases difficulty with placement. If you were having a lot of back pain with the epidural catheter, it also makes me wonder if it was in the "right" location at the time - it's not unusual for them to migrate from their original position, and that could cause discomfort. I would definitely discuss your concerns with your next anesthesiologist and let them know about the difficulty in placing the epidural on both occasions. The only other thing I would add is that your positioning during the spinal or epidural placement can help tremendously. By arching out your lower back as much as possible, it helps open up the spaces between the spinous processes of your back, creating more room for the anesthesiologist to maneuver and find the epidural or spinal space.

For those of you who have had non-functional epidurals in labor, always let the anesthesiologist or nurse anesthetist know. Depending on the situation, they may be able to take out the epidural, and place a new one. I always counsel my patients that one of the risks of an epidural is that it might not work the way we expect it to, and if that is the case, I will be more than happy to replace it for them. In my mind, if you have gone through the process and potential risk of having an epidural, there is no reason for it not to work the way it should.

Thanks so much for taking the time to share all of that info!

I am delivering at a different hospital this time and will have to talk to my OB about the options and if we can do a CSE instead possibly. I think part of the issue with my epidural, at least the 2nd time, was that I'm allergic to tegaderm and since it was on my back and I was leaning against it, it aggravated the possibly not well placed epidural even more. Or something. All I know is that when I was recovering, where it was in my back when the meds started wearing down bothered me more than my c-section pain, and once I finally talked them into taking it out (they really tried to talk me into leaving it in longer, saying they don't like to take it out "so early"), I felt much much better and recovered quickly and easily with just tylenol and motrin. I have never been told I have scoliosis and passed the screening they did in middle school, etc., so I'm not sure that's it. In my first pregnancy, I was sick with HELLP and pre-e and barely made the cut off for platelet levels to even get an epidural, so I can understand the swelling and stuff may have made the placement more difficult. (And I was pretty stoned out on magnesium sulfate for the next 3 days after so I don't even remember that they had left the epidural even in or them taking it out, or problems with it beyond getting it placed.) But the second time...no idea what the deal was. Thanks for the tips about trying to arch out my lower back as much as possible. I don't remember them ever saying that, but if nothing else, I'll definitely try to do that much at least.

[123LuckyMom]

I far preferred my spinal to my epidural!!! I'd request a spinal.