There are three types of regional anaesthesia: spinal, epidural and combined spinal-epidural. In all these, a healthcare professional injects local anaesthetic (a pain relief medication) into your back. This numbs your tummy and lower body. You remain awake and comfortable during the birth. Your anaesthetist will discuss with you which anaesthetic they feel is best for your caesarean birth.
A spinal anaesthetic is the most common type used for a caesarean birth. It involves an injection of local anaesthetic into the lower back to numb the lower half of your body. The nerves that carry feeling from your lower body sit in a sac of fluid inside your back. The anaesthetist uses a fine needle to inject the anaesthetic into this fluid. It works quickly and you stay awake, but won't feel pain from the waist down.
An epidural anaesthetic involves placing a thin tube near the nerves in your back to deliver pain relief. It's often used during labour with a mild anaesthetic to ease contraction pain. For a caesarean birth, a stronger dose can be given through the tube to fully numb the lower body.
A combined spinal-epidural anaesthetic is when you have both a spinal and epidural. The spinal anaesthetic makes you go numb quickly. The epidural gives more anaesthetic, if needed.
You will have a cannula (a thin plastic tube) inserted into a vein in your hand or arm to give you fluid and medicines. The theatre team will place monitors for your blood pressure, heart rate, and oxygen level. The anaesthetist will prepare the equipment for your anaesthetic.
You will be asked to sit up or lie on your side. Getting in the right position helps the anaesthetist find the small space in your back. They will ask you to curl up over your bump.
The anaesthetist will start by feeling the spaces in your back with their hands. They will then put some local anaesthetic in your lower back to numb the skin. From this point, most people just feel some pushing in their back. If you feel any tingling or pain, please tell the anaesthetist as it can help them to find the correct space. The procedure usually only takes a few minutes. It may take longer if it is difficult to find the small space in your back.
When the injection is finished, you will lie on your back, with a tilt on the bed. The anaesthetic will take effect within a few minutes. At first, your skin will feel warm. You may then feel pins and needles before becoming numb to the touch. Your legs will feel heavier and more difficult to move. When the injection is working fully, you will be unable to lift your legs or feel any pain in the lower part of the body.
While the anaesthetic is starting to work, you will have a catheter (plastic tube) inserted to keep your bladder empty during the operation. This stays in until the heaviness in your legs wears off so you don’t need to worry about getting to the toilet.
The anaesthetist will do simple tests to check the anaesthetic is working. These include asking you to lift your legs, touching your skin with something soft, sharp or cold and asking what you can feel. The anaesthetist will only allow the obstetrician to start the caesarean birth when they are satisfied the anaesthetic is fully working.
You shouldn’t feel any pain during the operation but it is normal to feel pressure and pulling. Some people describe it as ‘feeling like someone is doing the washing-up’ in their tummy. If you experience any discomfort, or anything is worrying you, tell your anaesthetist. You may be given extra pain relief. Occasionally, the anaesthetist may recommend changing to a general anaesthetic.
Everyone is different and it is not possible to know who will experience a side effect or risk.
Knowing about risks can help you discuss options with your healthcare team and make decisions about your care.
The risks in this leaflet are averages obtained from research studies. You can find out about the research that we used in our spinal anaesthesia and risk evidence table.
Your risks might be higher or lower than these numbers. If you are thinking about having a spinal anaesthetic, your anaesthetist will discuss with you the risks that are more likely or significant for you.
Since labour can be unpredictable, you may require a caesarean birth with a spinal even if you hadn’t planned to. Reading this leaflet and others on the LabourPains website can help you prepare for the unexpected and think about any questions you might have.
According to the latest evidence, spinal anaesthetics:
Most spinal anaesthetics work well. They usually take about 10 minutes to work. The anaesthetist will do checks to make sure that your spinal is working well enough for surgery. If it is not, they may:
5 needed additional pain relief – 95 did not
2 needed a general anaesthetic – 98 did not
These numbers are out of every 100 people who had a spinal
| What happened? | For how long? Can it be treated? |
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Headache (post-dural puncture headache)
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It can happen between one day and one week after a spinal anaesthetic. It can be mild and get better within a few days with over-the-counter pain relief, or it can be severe and require treatment in hospital. You can get more information about post-dural puncture headaches on our website: Headache after a spinal or epidural anaesthetic. How many?
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Shivering
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It can happen for 2–4 hours after the spinal anaesthetic. Shivering is usually a side effect of the spinal anaesthetic. It’s not due to feeling cold, but you can have a blanket to make you more comfortable. Shivering stops when the spinal anaesthetic wears off. How many?
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Low blood pressure
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It can happen immediately and last for a few hours, soon after the spinal anaesthetic. It can make you feel sick, dizzy or drowsy. Your healthcare team can give you medicine to improve your blood pressure. How many?
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Feeling sick (nauseous)
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It can happen immediately and last for a few hours, soon after the spinal anaesthetic. Your healthcare team can give you anti-sickness medicines if it happens. How many?
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Being sick (vomiting)
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It can happen immediately and last for a few hours, soon after the spinal anaesthetic. Your healthcare team can give you anti-sickness medicines if it happens. How many? Out of every 100 people
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Itching
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It can happen immediately and usually wears off after a couple of hours. Your healthcare team can give you medicine to treat the itching. Out of every 100 people
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Difficulty passing urine
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You might not be able to feel if you need to go to the toilet after a spinal. The healthcare team sometimes recommends a urinary catheter, a thin tube to drain the urine directly from your bladder. This might stay in until the next day. |
These numbers are out of every 20,000 people who had a spinal
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What happened? |
For how long? Can it be treated? |
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Weak, numb, tingly
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Temporary damage: (days or weeks) and normally gets better by itself. How many? About 10 did – About 19,990 did not Permanent damage How many? About 1 did – About 19,999 did not You can get more information from the leaflet Nerve damage after a spinal or epidural anaesthetic. |
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Loss of consciousness or cardiac arrest (when the heart stops beating)
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The anaesthetist will treat you immediately and give you a general anaesthetic if this happens. How many? 1–7 did – 19,993–19,999 did not |
These numbers are out of every 50,000 people who had a spinal
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What happened? |
For how long? Can it be treated? |
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Meningitis symptoms
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Meningitis infection can happen days or weeks after the spinal. This can be treated with antibiotics. How many? 1 did – 49,999 did not Permanent damage How many? About 1 did – About 19,999 did not You can get more information from our leaflet. Nerve damage after a spinal or epidural anaesthetic. |
These numbers are out of every 200,000 people who had a spinal
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What happened? |
For how long? Can it be treated? |
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Infection in or around
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It happens days or weeks after the spinal. It is treated with antibiotics or sometimes surgery to drain the abscess. How many? 2 did – 199,998 did not |
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Blood clot around the spine (vertebral haematoma)
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This is a serious complication which may require emergency surgery. It can cause leg paralysis if not treated quickly. How many? 1–2 did – 199,998 did not |
These numbers are out of every 500,000 people who had a spinal
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What happened? |
For how long? Can it be treated? |
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Becoming paralysed
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How many? 2 did – 499,998 did not |
We try very hard to keep the information in this leaflet accurate and up-to-date, but we cannot guarantee this. We don’t expect this general information to cover all the questions you might have or to deal with everything that might be important to you. You should discuss your choices and any worries you have with your medical team, using this leaflet as a guide. This leaflet on its own should not be treated as advice. It cannot be used for any commercial or business purpose. 
Download an English language leaflet of spinal risk information
Please note: These questions and answers are by their nature quite general. We are afraid that the OAA cannot enter into discussions about nor answer enquiries about specific cases. If you have any questions, comments or complaints about your own care, you should take this up with the unit responsible. Please note that all hospitals have a Patient Advice and Liaison Service (PALS) who can help you if you are unsure how to go about this.
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