Regional anaesthetic

There are three types of regional anaesthesia: spinal, epidural and combined spinal-epidural. 

Spinal anaesthetic

A spinal anaesthetic is most common for a caesarean birth. The nerves that carry feeling from your lower body are contained in a sack of fluid inside your back. The anaesthetist injects local anaesthetic into this fluid, using a very fine needle.

Epidural anaesthetic

An epidural anaesthetic is when a thin tube is placed near the nerves in your back.  This tube is used to deliver local anaesthetic. It is often used with weak local anaesthetics in labour to numb the contraction pain but can be used to provide anaesthesia for a caesarean birth by giving a large volume of stronger local anaesthetic into the tube.

Combined spinal-epidural

A combined spinal-epidural anaesthetic is when you have both a spinal and epidural.  The spinal anaesthetic makes you go numb quickly, and the epidural can be used to give 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 either 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, sometimes described like you are trying to look through your belly button, and push your lower back towards them.
 
They will start by feeling the spaces in your back with their hands, 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, but 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 begins to take effect within a few minutes. At first, your skin will feel warm, then you may feel pins and needles before becoming numb to the touch.  You will feel your legs becoming heavier and more difficult to move. When the injection is working fully, you will be unable to lift your legs up 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 that the anaesthetic is working properly.  These include asking you to lift your legs and 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 that 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 your tummy. If you experience any discomfort, or anything is worrying you, it is important to tell your anaesthetist. Sometimes you may be given extra pain relief. Occasionally, the anaesthetist may recommend changing to a general anaesthetic.

• Spinals and epidurals are usually safer for you and your baby.
• You and your partner will be able to share the birth experience together.

• You will feel less sleepy and less chance of feeling sick afterwards.
• Your baby will usually be more alert when it is born.
• You will usually be more comfortable afterwards.
• Less post operative nausea and vomiting.

You may experience some side effects, which your anaesthetist will manage. These include low blood pressure (which might make you feel dizzy or sick), itching or shivering.

Although very safe, occasional complications of spinal/epidural can include:

• Headache: most can be treated with simple pain relief. In about 1 in 200 spinal anaesthetics, a more severe headache can occur (post-dural puncture headache). There is a specific treatment for this type of headache. Find out more
• Inadequate pain relief: occasionally, the spinal or epidural may not work well enough. The anaesthetist will give extra pain relief or change to a general anaesthetic. 
• Nerve damage is a rare complication. Temporary loss of sensation, pins and needles and sometimes weakness may last for a few days or weeks, before a full recovery.
• Permanent nerve damage is very rare (approximately 1 in 50,000 spinals). It has about the same chance of occurring as major complications of having a general anaesthetic.