Regional anaesthetic

Spinal anaesthetic

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.

Epidural anaesthetic

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.

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. 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.

• 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 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 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.