Spinals Versus Epidurals Versus Natural

03.25.11: What's the best way to deliver?

Kim commented on a recent blog, “It was only during my pre-admittance paperwork appointment that I found out an epidural means a catheter is left in your spinal column/spinal membrane for the whole delivery.” The idea of a foreign object being attached to Kim’s spinal column “scares the bejeezus” out of her. Kim, countless women share your sentiment.

Alex wonders, “What’s the difference between an epidural and spinal anesthesia?” She described a spinal as “the shot that made me numb for my cesarean.” She’s hoping for a VBAC with her next baby, but doesn’t want to go through labor “naturally.” Alex asks, “Can I get a spinal instead an epidural because, “that tube creeps me out?” Alex, it creeps a lot of women out.

Before I tackle “the creeps” and “bejeezus” let’s break down the difference between spinal and epidural anesthesia. Both numb your abdomen, uterus, genitals and legs so you don’t feel pain during labor, birth and surgery. They’re both given through shots in the area around the spine and both allow you to be awake (but feel free to take a nap) while you deliver. General anesthesia totally knocks you out and isn’t commonly used for deliveries unless there’s a huge screaming emergency. It can make babies sleepy too.

Spinals are a single shot (OK, two shots – one to numb the skin and the next to administer anesthesia) of strong medication that works faster and makes patients more numb than epidurals do, but for a shorter period of time; usually a couple hours or as long as it takes to do a c-section. They’re also used occasionally for vaginal deliveries when the doctor knows the baby will be delivered quickly. They’re inserted using a very similar technique as an epidural but don’t require the insertion of tubing into the spinal space.

Can Amber have a spinal instead of an epidural? Probably not. Spinals don’t last long enough for most labors. If the medication wears off the pain comes back.

Epidurals are administered through a tube called a catheter that’s inserted near the spinal column. That tube is attached to a pump that delivers a continuous dose of numbing medication to keep you comfortable throughout your entire labor and birth no matter how long it lasts. If you need a c-section during labor, the epidural can be used to deliver surgical-quality numbing medication.

It’s that darn needle and epidural tube that freaks patients out. We’re conditioned to think anything that touches our spine could cause paralysis or a brain infection. Epidurals are overwhelmingly safe and do their job well. Only very rarely are there any complications. I know, the tube is creepy, but epidurals aren’t all that different from IVs.

Kim worries the tubing will be dislodged when she’s “rolling around trying to deliver.” Kim, don’t worry about that. If you have an epidural, you won’t be rolling around because your legs and butt will be numb. Your nurse will help you move from side to side. Plus, we use lots of tape to hold epidurals in place. Many women say the most difficult part about getting an epidural is when birth is over, the epidural can come out and it’s time to pull the tape off.

Kim says, “it doesn't seem like there are any really good options when it comes to pain management during delivery.” She wants my perspective as a nurse and mother. Kim, the best options for pain management are the ones you have available. If you don’t want or have access to pain medication, use warm baths, frequent change of position, massage, deep breathing and relaxation techniques. If you’re delivering in a modern American hospital, you have other options. I’ve had three epidurals and one un-medicated birth – all vaginal deliveries. I’d pick an epidural again in a heartbeat.

I really wanted an un-medicated birth with my first baby. I was 100 percent against having an epidural. In fact, I was pretty judgmental about it in a “real women go natural” kind of way. I spent months practicing natural childbirth techniques. After 25 hours in labor though, all my deep breathing, meditation and relaxation techniques were spent and I begged for an epidural. Baby number two came too quickly and at my midwife’s office so I went all-natural by default. Babies three and four – epidural and epidural. Loved them.

Labor is a highly individualized experience. Many first time mothers go into labor absolutely committed to “no epidural no matter what.” Plenty get their wish and have lovely births. Plenty go au-natural, but have horrendous, out-of-control births too.

Many women opt for epidurals because labor is intense and lasts a lot longer than they imagined. They start with a little IV medication, just to take the edge off. When that wears off about an hour later, they get another dose. That second dose usually doesn’t last as long as the first dose. Contractions get stronger as labor progresses and an epidural is their next best pain management tool.

Usually, women discover the “dreaded epidural” wasn’t as difficult or creepy as they anticipated. Their pain goes away, they get some rest and before they know it, it’s pushing time. They deliver in relative comfort and few women say they regret it.

Are epidurals better than going natural? Not necessarily. Some women guilt-jerk themselves for “caving in” and getting an epidural. Others kick themselves for not getting one sooner. As long as you have a safe delivery and healthy baby, why kick yourself at all? Birth is challenging enough. Do what you have to do and don’t beat yourself (or other mothers) up about it.

