A variety of methods can be used to control pain during labor and delivery of a baby. Two methods that involve inserting pain medication into or around the spinal cord are an epidural and a spinal.
The spine is the column of bone that runs down the center of your back. It is made up of many bones called vertebrae that interconnect with spongy discs in between to keep them from rubbing together. Each piece of bone in the spine has a hole in the middle. The spinal cord is located in the center of the spine inside the hole in each of the bones. If you think of beads strung together on a piece of string, the bones in the spine are the beads and the spinal cord is the string in the middle. The spinal cord is made up of nerves that connect directly to the brain through the bottom of your skull. The other ends of the nerves branch out from the spinal cord to every part of your body. These nerves provide the sense of feeling and allow signals to go from the brain to the muscles and organs to control them.
An epidural is an injection of pain medication that is given into the sac surrounding the spinal cord. During an epidural procedure, you will first get a shot to numb the skin on your back near the spine. The doctor will insert a large needle into the skin and between two of the bones in your spine, stopping before he reaches the spinal cord. The needle is used to insert a small plastic tube into the space around the spinal cord. This tube, which is called a catheter, can remain in place during the rest of your labor. Pain medication is injected through the tube into the lining around the spine. It usually takes between 10 and 20 minutes for the pain medication to start to work. Because the catheter is left in place, the doctor is able to give you more pain medication as you need it. This method allows your pain to be controlled for the entire time you are in labor.
A spinal is similar to an epidural in that the doctor will first numb your back and then insert a needle into your spine. But a spinal is different in that the needle used for a spinal is very tiny. The doctor will insert the needle between the vertebrae and into the spine and will inject one dose of pain medication directly into the spinal cord. This medication will take effect very quickly, but will only last a few hours, which means it is not typically used during a normal, vaginal delivery. This method of pain control is often used if the baby is delivered surgically through a cesarean section.
The advantage of both the epidural and spinal is that the mother is fully awake and alert during the delivery of the baby. The epidural allows her to be relatively pain free but still able to push to deliver her child. Potential side effects of these procedures include:
• Severe headache – if any of the fluid from the spinal cord leaks out during the procedure, the change in pressure can cause a very bad headache.
• Drop in blood pressure – in most cases, your doctor will give you IV fluids before performing either of these procedures. This is called “pre-block fluid loading”. Having extra fluid in your blood can help prevent your blood pressure from dropping.
• Nerve damage
• Infection in the spinal cord
• Allergic reaction to the medication
• Difficulty urinating
• Bleeding around the spinal column
• Seizures (these are rare)
Because these procedures are intended to block the signals passing between the brain and the nerves in your lower body, your legs will probably feel tingly or numb and you will not be able to walk immediately after the procedure. You also will not be able to control your bladder, so your doctor will need to insert a catheter into the bladder to drain urine. Once the medication wears off, these things will return to normal.
In addition to being used during labor and delivery, epidurals and spinals are also used for other medical procedures in the belly, chest, legs, or feet. Your doctor can determine which part of the body is numbed by the medication depending on how high on the spine he inserts the needle. Recovery time is typically shorter with these procedures than after other types of anesthesia.
Sources:
National Institutes of Health: Medline Plus
National Women’s Health Information Center
National Institutes of Health