Spinal or Epidural for a C-Section? How Anesthesia for Cesarean Delivery Works
Why most cesarean deliveries are done with you awake, the difference between a spinal and an epidural, and what you will feel in the operating room.
Most cesarean deliveries are performed with regional (neuraxial) anesthesia — a spinal, an epidural, or a combination of the two. You remain awake, you can usually see and hear your baby at birth, and in most hospitals a support person may be with you. The ASA Practice Guidelines for Obstetric Anesthesia support neuraxial techniques for most cesarean deliveries in preference to general anesthesia.1
Spinal anesthesia
A spinal is a single injection of medication into the fluid surrounding the spinal nerves, given through a very fine needle in the lower back. It works within minutes and produces dense numbness from the chest down, which makes it the most common choice for a planned cesarean.2
Epidural anesthesia
If you already have a labor epidural and need a cesarean, the same catheter can usually be "topped up" with a stronger dose of local anesthetic. This avoids a new injection. A combined spinal-epidural places a spinal dose and a catheter at the same time, so the block can be extended if surgery runs longer.2
What you will feel
Before surgery your anesthesiologist tests that the block is adequate. During the operation you should feel no sharp pain, but pressure, pulling and movement are normal and expected. Nausea, shivering and a fall in blood pressure can occur and are treated promptly. Tell your anesthesiologist at once if anything feels painful; additional medication can be given.
Pain relief afterwards
A small dose of long-acting opioid such as morphine is often added to the spinal or epidural. ASA guidance favors neuraxial opioids over intermittent injections for pain after cesarean delivery, because they provide extended relief for many hours.1
Dr. Seitz is very experienced with cesarean deliveries and spinal anesthesia.
Sources
- Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016;124(2):270–300.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstet Gynecol. 2019;133(3):e208–e225.
Dr. John Seitz, MD
Board-certified anesthesiologist
This article is for general educational purposes and is not a substitute for personalized medical advice. Always consult your physician for guidance specific to your health.