Editor’s Note: This article is written from the perspective of a medical provider and does not encompass all possible scenarios and outcomes. All providers have their own methods, and you should always ask your own doctor or anesthesia provider for specific information on how medical procedures will be approached during your labor and delivery.
Spinal anesthesia, in its simplest explanation, is an injection of local anesthetic (numbing medicine) into the spinal fluid, creating a motor and sensory blockade (you will be numb and you will not be able to move). A spinal anesthetic can be given in a variety of settings for a variety of surgeries, but here we are discussing it in the context of a cesarean section (C-section).
Though I personally have never had a C-section, I’ve done the anesthesia for many as a nurse anesthetist. C-sections can be performed on a spectrum from planned to emergent and these are all very different experiences. In an emergent C-section situation, if you have an existing, working epidural catheter, the anesthesia provider may use your existing epidural catheter to administer an increased volume of local anesthetic to relax your muscles enough to allow your OB to perform a C-section.
After the spinal anesthetic procedure, you should not feel any sharp pain or be able to move from your armpits to your toes. This sounds scary, but the feeling is temporary and allows you to be awake for the birth of your baby. A C-section is one of the few surgeries where the patient is completely awake, and the whole process is actually quite amazing.
In a routine, planned C-section, you will likely walk back to the operating room, sit on the OR bed, and the anesthesia provider will administer your spinal anesthetic. Those who have had emergent/urgent C-sections and those who have had planned/scheduled C-sections can vouch that these are drastically different experiences. Monitors measuring your oxygen levels, blood pressure, and heart rate will be placed accordingly. You will also receive oxygen through a nasal cannula (a little piece of plastic with prongs that sit inside your nostrils – it can be very annoying or itchy, and that’s normal).
It is important to maintain a slouched posture during the procedure — tucking your pelvis under in a scooping motion — because it stretches out the lumbar spinal spaces (lower back) and provides a better opportunity to find the correct location. It’s best to relax your shoulders and drop your chin to your chest. I often tell patients to think about a “mad cat” or “curled shrimp” posture.
After I assess the space in which the spinal needle should be placed, I tell patients that they will feel the “cold and wet” — the antiseptic soap used to clean off the skin. If you are allergic to topical iodine, please make sure that is in your medical chart (it never hurts to remind the anesthesia provider as well). Then, a “big sticker,” or sterile drape, will be placed on your back, isolating the area from the risk of infection.
Next, you’ll feel a “pinch and a burn,” or something similar to a bee sting, as the local anesthetic used to numb the skin and tissues is delivered underneath the skin. The burning, stinging feeling dissipates quickly. This numbing medicine provides more comfort as the needle passes through the layers of tissue and bone until it reaches the spinal fluid.
Once I see spinal fluid in the needle, I inject the small amount of local anesthetic needed to numb you from your armpits to your toes. After this injection, everything is removed from your back. Unlike an epidural, the only thing left inside of you is the medication.
After the spinal is placed, you will quickly lay on your back and the operating room staff will start to prep you for surgery. Once the drapes are up and the surgeon tests to make sure the spinal is working properly by pinching your skin, your support person will be allowed to come into the operating room. During the C-section behind the drape, it’s just you, your support person, and me.
As an anesthesia provider, I’m constantly monitoring my patients’ vital signs and the status of the surgery. I love this job – I love supporting my patients through this transition, and I love seeing babies being born and watching people become parents.
As with any medical procedure, there are certain risks and misconceptions about spinals. The following are the common concerns, questions, and pieces of information that I talk about with my patients, as well as a few things I wish people would understand a bit better about the procedure itself.
10 Things to Know About Spinals
1. If your spinal is not working or you are uncomfortable, you may need general anesthesia, but this hardly ever happens. If you need a general anesthetic, there is an increased risk to the mother, but no additional risk to your baby.
2. Most women want to know if they will feel anything during the C-section — yes and no. You should not feel sharp pain (like the scalpel or stitching sutures, etc.). You WILL feel tugging and pulling as your OB retracts your uterus and takes the baby out. I always warn the moms this is coming. It can be very uncomfortable, but it only lasts a few moments, and immediately after, your baby is born!
3. Nausea, vomiting, and shivering are all common and expected. If you are someone who has vomited your way through your C-section, you can attest to how uncomfortable it is to throw up while laying on your back. Your support person can be extremely helpful in suctioning out your mouth during this time.
4. The amount of local anesthetic left in your spinal fluid is small, and the baby doesn’t get any.
5. The curve of your spine changes as you get older. It may take a few extra minutes or tries to find the right spot. That doesn’t mean anything is wrong, and each time you have a spinal will likely be a slightly different experience.
6. The higher your BMI, the harder it can be to find the right spot. (But people with a low BMI can present challenges too.)
7. You will not be paralyzed if you move while the spinal is being placed. It just takes longer and makes it harder to find the right spot. We’re more likely to stick ourselves, as well.
8. This is what I tell my patients regarding risks: “Risks include bleeding, infection, and nerve damage, but these are rare. You’re more likely to have a nerve injury from the retractors in your abdomen than my needle. The space I’m looking for is several centimeters lower than where the average spinal cord ends. Headaches and backaches are possible, but there is a low chance. More serious risks can affect your heart and lungs, but anesthesia providers know how to manage those situations and they’re unusual.” You will always find someone or hear a story about someone having a horrific experience, and while I feel bad for them, you should know they are in the small minority.
9. When you lay down, it can be hard to breathe because your ribs aren’t used to being numb. That’s a common feeling that can be anxiety-provoking, but staying calm and trusting your body and your doctors helps. Take slow, deep breaths.
10. We will give you oxygen in your nose, but if it’s not enough, we have a plastic mask that delivers more.