Epidurals vs. Spinals: A Boca Raton Birth Photographer's Insider Scoop
Questions to Ask your OBGYN/Midwife during first/second and third trimesters (clickable link)
As a birth photographer in Boca Raton, I've had the privilege of witnessing countless mothers navigate the incredible journey of childbirth. Over the past 9 years and 200+ births, I've seen firsthand the diverse choices women make for pain management, including epidurals and spinals.
While most epidurals I've witnessed involve an Anesthesiologist entering the labor and delivery room and asking everyone but the birthing mother to leave, some allow the spouse/partner to stay. Lately, in 2024, I’ve had the opportunity to stay for several epidural administration procedures along with my birth photography client’s birth doula. Occasionally, my birth photography client’s doula will even be able to hold/hug my client while the Anesthesiologist does the epidural procedure, especially here in Boca Raton. Every birth photography client I’ve witnessed receive an epidural, I have noticed the effects have ranged vastly from woman to woman, and even from pregnancy to pregnancy in the same woman. Epidurals, from every birth I have attended, are not intended to act like a spinal tap, completely numbing the lower half of your body where you literally cannot move your legs at all. Instead, with an epidural, you should still have some movement of your legs, though depending on how powerfully it affects you, it is possible to be more numb.
Though in nearly every case of spinal taps, every single spinal tap procedure I have seen has been my birth photography client going into the operating room, and once me and her spouse/partner are allowed to enter the operating room following the spinal tap procedure, every mother is completely numb nearly instantly following the spinal tap. Clearly I have witnessed spinal taps to provide a much more powerful effect, which would make me think spinal taps would not work for a vaginal delivery as all my clients have lost full mobility of their legs while the spinal tap is in effect, but those are just my observations.
I have heard over and over the same words at the start of each of my birth photography clients c-sections:
“You should not feel pain and you should not feel temperature (hot or cold) but you can still feel the sensation of pressure, though it should not hurt.”
Below are some guidelines of differences I have observed over time between an epidural and a spinal tap, based off information available online, as well as insights of my own experiences. Please note, obviously I am not a doctor nor a medical expert. Reading my blog should not be taken as medical advice. This blog serves only to share what I have observed over the years as a birth photographer and mother who had two c-sections with two spinal taps myself and you should always speak to your own medical care provider before making any medical decisions in your life.
Key Differences between Epidurals and Spinals and getting them:
Epidurals: The Procedure from Start to Finish:
When my birth photography client feels ready for an epidural, she first needs to receive two bags of fluids. I observed the information that the medication in epidurals (commonly fentanyl but I hear that in some hospitals they use sufentanil) can make your blood pressure drop, hence the fluids help to raise your blood pressure enough to counteract this. So knowing that you’ll need two bags of fluids, you’ll want to time asking for an epidural correctly. If you wait too long, your pain level may be so high it can make staying still to get an epidural harder for you (I am not sure what would happen if you just can’t stay still, would general anesthesia be required? I’ve never seen this situation occur so I just can't speak to it, only speculate) but even more so, if you wait too long, your pain level can become exorbitant and then you will have to feel that way until the entire process is complete.
Once she’s received the two bags of IV fluids, the Anesthesiologist will come into the labor and delivery room, wheeling a medical ‘cart’ with several drawers into the room, and begin the procedure.
Before the Anesthesiologist begins, the mother in labor needs to be sitting in an upright position, off the side of the labor and delivery hospital bed, with her feet hanging off the bed, holding a pillow to her chest and belly and curling around the pillow, creating a circular shape of her spine to provide more room for the Anesthesiologist to access her spinal cord for the procedure. Now this being said, during a delivery in 2024, I observed an Anesthesiologist permit my birth photography client in Boca Raton continue to lay horizontal on her side while the Anesthesiologist seamlessly administered the entire epidural procedure flawlessly, without the need of her sitting in an upright position. I have never seen this done before, it amazed me, and the epidural proved beautifully functional and effective for my client! It did make me wonder why more Anesthesiologists do not offer this as an option, as women in labor would be far more comfortable receiving an epidural in this position. I wondered whether it is a lack of experience administering it in this position or a lack of desire to have to work around a laboring woman, in the masculine-world-mentality of you need to come to me. I do not know the answer at this time. If I encounter this Anesthesiologist in the future, I will be sure to ask, and I will ask if I can photograph a horizontal epidural administration. Received permission to photograph is so important to me.
To administer the epidural or spinal, local anesthetics are used to numb the area, blocking pain signals so the Anesthesiologist can later go in with a very tiny catheter tube that will be the delivery system to you for the medication that will provide you with pain relief. I’ve read that the local anesthetic is administered with smaller needles and the medication is often bupivacain, lidocaine or ropivacaine.
I’ve read that other medications such as epinephrine can help prolong the epidural’s effect while clonidine can help manage blood pressure, but I have not observed either medication administered in my years as a birth photographer in south Florida (maybe I did not notice, especially if they were not formally announced, as often unless the patient asks for specific drug names to be told to them, they usually are not named in my experience).
Majority of the time, my Birth Photography clients delivering in a labor and delivery room will receive an epidural. Sometimes, when the epidural is not effective enough to provide enough relief to my client, I have had a handful of clients need to get their epidural redone (the entire process), and some of my clients get a “top off” of medicine (also referred to as a bolus), but I’ve never had a client who ends up having a vaginal delivery have to get a spinal tap. So I can’t speak to whether it is possible to do that.
Once my client has received the epidural, I’ve heard every Anesthesiologist mention a somewhat different time frame as to when the epidural’s full effects will be felt by the patient. Some have said 10 to 15 minutes, others have said 30 minutes or more. I don’t know if the difference is due to provider approach or the type of medication used, but knowing this answer could vary may help you mentally prepare to give yourself more time before you feel relief.
Spinals and How the Procedure Differs from Epidurals:
For spinals (also known as spinal blocks or spinal anesthesia) and c-sections, the procedure takes place in the operating room, with the anesthesiologist typically positioned behind the mother.
In my experience, spinals tend to result in near-instantaneous numbness, (while the effects of epidurals can vary significantly from woman to woman, and even from one pregnancy to another. Epidurals aren't meant to completely numb the lower body like a spinal, but they can offer substantial pain relief.)
During a Spinal, the mother is usually sitting on the operating room bed facing the door where the window is, all you can see is the Anesthesiologist standing behind her during the administration procedure, so I am not actually sure how different it will appear from the epidural photo I captured you can see below.
With my C-Section birth photography clients delivering in the operating room, majority of the time they get a spinal tap once they enter the operating room, with the exception of clients who already had a good epidural (strong enough for surgery) in place prior to going into the operating room for their c-section, such as a client who was planning a vaginal delivery in a labor and delivery room but unexpectedly needed to go to the operating room to have a c-section.
Important to Remember:
Epidural and spinal taps are both medical procedures involving the administration of anesthesia or pain relief by an Anesthesiologist, but they have distinct differences in their administration, purpose, and effects.
Epidural:
Administration:
Purpose:
Pain Relief: Epidurals are commonly used for pain relief during labor and delivery, surgery, or certain medical conditions causing chronic pain. (Alternatives: Nitrous Oxide Therapy During Childbirth)
Effects:
Area of Effect: Epidurals provide pain relief to a broader area of the body, such as the lower abdomen and pelvic region.
Duration:
Duration of Action: Epidurals can be used for extended periods, providing continuous pain relief if needed.
Spinal Tap (Spinal Block):
Administration:
Location: The spinal canal, directly into the cerebrospinal fluid.
Purpose:
Anesthesia: Spinal taps are primarily used for surgical anesthesia or specific medical procedures requiring lower body numbness.
Effects:
Area of Effect: Spinal taps provide a more localized and intense form of anesthesia. They affect a smaller, specific area, leading to more profound numbness.
Duration:
Duration of Action: Spinal taps are often used for shorter durations compared to epidurals, making them suitable for procedures with a quicker timeframe.
Key Differences between an Epidural and a Spinal Tap / Spinal Block
Site of Administration: The primary distinction lies in the location where the medication is injected. Epidurals are administered in the epidural space outside the spinal cord's membrane, while spinal taps are directly injected into the cerebrospinal fluid within the spinal canal.
Area of Effect: Epidurals provide a wider area of pain relief, making them suitable for procedures or conditions that require a broader coverage. Spinal taps, on the other hand, offer a more localized and intense form of anesthesia.
Catheter Use: Epidurals often involve the placement of a catheter for continuous administration, allowing for prolonged pain relief. Spinal taps typically involve a single injection for a specific procedure or surgery.
In summary, while both epidurals and spinal taps involve the administration of anesthesia or pain relief in the spinal region, the choice between them depends on the medical context, the required duration of action, and the specific area of the body that needs to be affected.
As a gentle reminder, I do not provide and do not promise any medical advice nor medical assistance and this is information easily accessible on google to anyone who searches. Any information written on my blog as a non-professional and no-medical advice capacity and assumes no responsibility for the choices a person makes with regards to their pregnancy, labor, birth, baby and/or post partum.
Other Questions to ask your OBGYN during your third trimester before you give birth
If you are planning to discuss epidurals and spinal taps with your OBGYN or Certified Nurse Midwife, here is a list of other questions worth asking during your first, second and third trimester to be sure your OBGYN / Midwife’s plan for your birth is in-line with what you feel comfortable with as well as what your and your spouse/partner’s preferences for you and your baby may be, link is clickable:
Questions to Ask OBGYN/Midwife during initial consultation (clickable link)
(these are a list of questions to ask when you are interviewing various doctors and midwives and practices to choose who will be your delivery team)
Questions to Ask your OBGYN/Midwife during first/second and third trimesters (clickable link)
(these are a list of questions to ask when you are already working with a specific doctor or midwife during your pregnancy)
Obviously I am not a doctor nor a medical expert. Reading my blog should not be taken as medical advice. This blog serves only to share what I have observed over the years as a birth photographer and mother who had two c-sections with two spinal taps myself and you should always speak to your own medical care provider before making any medical decisions in your life.
