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What is a spinal?A spinal is a single painkilling injection that gets to work faster than an epidural. It's a regional anaesthetic, which means that it can numb a large area of your body. It is injected by the anaesthetist through the small of your back, into the fluid surrounding the spinal nerves, using a very fine needle.
Spinals and epidurals are the most effective methods of pain relief for labour (Jones et al 2012) and must be given by an anaesthetist. About 30 per cent of women have a spinal or type of epidural during or after labour (CQC 2010).
How does it work?During a spinal the drug is injected around the nerves supplying your uterus (womb) and cervix. These are the nerves that carry signals from the part of your body that feels pain in labour.
This will prevent you from feeling your contractions, or prepare you for a caesarean, if you need one. Your tummy will feel numb and you'll receive effective pain relief.
When are spinals used?You can have a spinal during the first stage of labour, as part of a combined spinal epidural (CSE). The spinals used in CSEs are called mini-spinals and use a low dose of painkilling drugs (NCCWCH 2007: 137, Simmons et al 2007).
Full-dose spinals are only given in an anaesthetic room or operating theatre. They can be used if you haven't got an epidural in place already, or if your epidural needs boosting (NCCWCH 2011).
You may need a spinal if:
- You need to have an assisted birth, when your obstetrician will use instruments such as forceps or ventouse to help your baby to be born.
- Your obstetrician thinks that your baby may not be able to be born vaginally and may need to be born quickly by caesarean (RCOG 2011, 2012).
- If you are having a planned or emergency caesarean birth.
- If you had a third or fourth degree tear or an episiotomy and need extra pain relief while you're being stitched up after your baby is born (NCCWCH 2007:193).
- If you need a manual removal of the placenta, or if you have a retained placenta (NCCWCH 2007: 247).
What are the advantages of a spinal?If you have a caesarean section, a spinal avoids the need for a general anaesthetic. You will then be awake for the birth of your baby and your birth partner can be with you in the operating theatre.
You will also be more alert, have better pain relief, and be less likely to feel sick than if you'd had a general anaesthetic. After he's born, you can hold and feed your baby straight away. Your baby will also be more alert than if you'd had a general anaesthetic.
Other benefits of a spinal in labour are:
- It provides rapid pain relief, as it works in just five minutes to 10 minutes (RCOA 2008:5, Hughes et al 2003). This is faster than an epidural (Jones et al 2012, Simmons et al 2007).
- Unlike an epidural, it can be given in a single injection, so there is no tube left in your back.
- You are likely to need a urinary catheter for a shorter time than you would with an epidural (Jones et al 2012).
What are the disadvantages?Most of the disadvantages are the same as those for epidurals, as well as:
- It is short-acting. Mini-spinals last between an hour and an hour-and-a-half, and full-dose spinals last about two hours (RCOA 2008b: 20).
- Unlike an epidural, a spinal can't be topped up, and is rarely given more than once (RCOA 2008b: 20).
- It may make you feel more itchy than an epidural would (Jones et al 2012, Simmons et al 2007), especially in areas such as your nose and lips. The opioid drugs used in CSEs, such as fentanyl, can cause itchiness, particularly if given in high doses (NCCWCH 2007: 116, RCOA 2008).
- During a spinal the needle deliberately punctures the fluid-filled sac that protects your spinal cord. If there is a leak of some of the fluid you may get a severe headache.
However, the risk of you getting a severe headache is only about one in 500 (OAA 2008), as very fine needles are used, so less fluid leaks. Headaches are more common after accidental puncture during an epidural (about one in 100). This is because the needle used for epidurals is much larger.
What else should I know?
- Keep as still as you can while you are having the injection. You'll be asked to either lie on your side, or sit on the side of the bed and curl over. Concentrate on breathing deeply and evenly. Sigh out and keep your shoulders relaxed. Maintain eye contact with your birth partner.
- Tell your anaesthetist immediately, but try to stay still, if you feel pain or pins and needles in your legs. This may be a sign of nerve damage and that the needle needs repositioning (RCOA 2009).
- It can take up to four hours, or even longer for full-dose spinals, for feeling to completely return to your lower body. It's normal to feel some tingling in your skin as sensation returns (RCOA 2008).
- Not everyone can have a spinal (OAA 2012). The anaesthetist will ask you questions about your health, and if you have any medical conditions, before performing a spinal. This may affect whether or not you can have one.
Last reviewed: July 2012
CQC. 2010. National NHS patient survey programme: survey of women's experiences of maternity services 2010. London: Care Quality Commission www.cqc.org.uk [pdf file, accessed July 2012]
Jones L, Othman M, Dowswell T, et al. 2012. Pain management for women in labour: an overview of systematic reviews. Cochrane Database of Systematic Reviews (3): CD009234. onlinelibrary.wiley.com [pdf file, accessed July 2012]
NCCWCH. 2007. Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Centre for Women's and Children's Health, Clinical guideline. London: RCOG Press. www.nice.org.uk [pdf file, accessed July 2012]
NCCWCH. 2011. Caesarean section. National Collaborating Centre for Women's and Children's Health, NICE Clinical guideline. London: RCOG Press. www.nice.org.uk [pdf file, accessed July 2012]
OAA. 2008. Epidural information card: Epidurals in labour – what you need to know. Obstetric Anaesthetists Association www.oaa-anaes.ac.uk [pdf file, accessed July 2012]
OAA. 2012. Pain relief for labour. Obstetric Anaesthetists Association www.oaa-anaes.ac.uk [pdf file, accessed July 2012]
RCOA. 2008. Your spinal anaesthetic The Royal College of Anaesthetists. www.rcoa.ac.uk. [pdf file, accessed July 2012]
RCOA. 2009. Risks associated with your anaesthetic. Section 11: Nerve damage associated with spinal or epidural injection The Royal College of Anaesthetists. www.rcoa.ac.uk [pdf file, accessed July 2012]
RCOG. 2011. Operative vaginal delivery. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 26. London: RCOG press www.rcog.org.uk [pdf file, accessed July 2012]
RCOG. 2012. Information for you: an assisted vaginal birth (ventouse or forceps). Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk [pdf file, accessed July 2012]
Simmons SW, Cyna AM, Dennis AT, et al. 2007. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database of Systematic Reviews (12): CD003401. onlinelibrary.wiley.com [pdf file, accessed July 2012]