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Let’s face it: There’s probably a tinge of anxiety in the excitement that you’re feeling as you approach childbirth. Knowing more about your options for pain management can make it easier for you.

Here, we’ll compare two of the most common forms of pain medication for labor — an epidural and a spinal block.

Both an epidural and a spinal block (often shortened to “spinal”) give you good pain relief during birth. Whatever you and your medical team decide is best for you, the start of the procedure is the same:

  • You can choose to lie on your left side or to sit up. Either way, you’ll be asked to arch your back to make it easier to insert the needle effectively.
  • Your anesthesiologist will wipe your lower back with an antiseptic solution to minimize the chance of infection.
  • They then use a fine needle to administer a quick-acting local anesthetic. You may feel discomfort similar to the bite of a mosquito, but the area numbs quickly.
  • Your anesthesiologist then guides a thicker needle into the spinal area.

Whether you have an epidural or a spinal, you’ll probably also receive sedatives or analgesics intravenously or together with the anesthetic to relax you.

Before we move on to the differences, let’s take a closer look at the structure of the spine.

Think of the spinal cord and nerves as wires suspended in a long tube (called the dural sac) filled with cerebrospinal fluid. The space around the cord is the epidural space. It’s filled with spinal nerve roots, tissue, fat, and blood vessels.

Back to epidurals and spinals: The main difference is the placement. With an epidural, anesthesia is injected into the epidural space. With a spinal, the anesthesia is injected into the dural sac that contains cerebrospinal fluid. The direct access means that a spinal gives immediate relief.

That’s the main difference, but not the only one. The following lists give you the other differences.

The basics on epidurals

  • The anesthesiologist inserts a needle into the numbed area on your lower back to reach the epidural space.
  • Placing the epidural typically takes about 10 minutes. Give it another 10–15 minutes and you’ll have good pain relief.
  • A catheter is then threaded through the needle. The needle is removed and the catheter is taped to your back to keep it in place.
  • Thanks to the catheter, you can receive either a continuous flow or periodic doses of anesthesia.

The basics on spinals

  • A spinal block is a single shot into the dural sac.
  • You’ll feel immediate pain relief.
  • The relief lasts for an hour or two.

Today, as medicine becomes more exact, epidurals are more likely to be used.

If you’re heading into your first birth, your medical team may opt for an epidural. Here’s why: First births can last for 12 to 18 hours. Whereas a spinal gives you pain relief for an hour or two, an epidural offers you the option of pain relief for a longer period of time.

Learn more about the pros and cons of epidurals.

There are births where a spinal has advantages over an epidural. If you experience any complications during birth or are having a cesarean delivery, also known as a C-section, your OB may advise you to opt for a spinal. In these cases, you want immediate relief.

In addition, by injecting anesthetics directly into the dural sac that contains cerebrospinal fluid, lower doses of medication can be used.

Know that there’s one thing that you don’t have to consider when it comes to epidurals and spinals — a difference in risk factor.

Both epidurals and spinals share the same amount of risk. Your medical team will monitor you closely, as the anesthetics that you receive also affect the central nervous system (CNS), cardiovascular system, and respiratory system.

Here are some questions that you can ask your OB-GYN:

  • What combination and dosage of drugs will be used?
  • What size needles are used for an epidural? One study suggested that the use of a thinner needle seems to reduce the chance of developing a headache.
  • What are the hospital’s policies about staying in bed, walking around, and eating?
  • How could the medications affect my baby?
  • Does the hospital offer the option of combined spinal and epidural (CSE) anesthesia? This block combines the best of both worlds: immediate relief from the spinal part and continued relief from the epidural part.

As you approach labor day, you’ll have plenty of things on your mind. Don’t hesitate to start a conversation with your doctor about the type of pain relief you want for labor. Together, you make an informed decision. Just know that plans can change.

Bottom line: Epidurals and spinals are both effective, but what’s best for you may be different than what’s best for someone else.