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What is a spinal anaesthetic?
A spinal anaesthetic is most common for a caesarean birth. The nerves that carry feeling from your lower body are contained in a sack of fluid inside your back. The anaesthetist injects local anaesthetic into this fluid, using a very fine needle.
What should I expect when having a spinal for a caesarean birth?
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 either 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, sometimes described like you are trying to look through your belly button, and push your lower back towards them. They will start by feeling the spaces in your back with their hands, 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, but 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 begins to take effect within a few minutes. At first, your skin will feel warm, then you may feel pins and needles before becoming numb to the touch. You will feel your legs becoming heavier and more difficult to move. When the injection is working fully, you will be unable to lift your legs up 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.
How will I know my anaesthetic is working?
The anaesthetist will do simple tests to check that the anaesthetic is working properly. These include asking you to lift your legs and 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 that the anaesthetic is fully working.
Who will be in the operating theatre when I have my caesarean birth?
There will be quite a few people in the operating theatre. This will include:
- The midwife who will help look after you and your baby.
- The anaesthetist and assistant.
- The obstetrician and an assistant and a scrub nurse.
- There will be another nurse who is responsible for fetching extra equipment.
- A paediatrician.
At the very least there will be seven members of staff in the theatre as well as your birth partner (if you have one).
Will I feel anything during the caesarean birth?
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 your tummy. If you experience any discomfort, or anything is worrying you, it is important to tell your anaesthetist. Sometimes you may be given extra pain relief. Occasionally, the anaesthetist may recommend changing to a general anaesthetic.
What are the advantages of regional anaesthesia over general anaesthesia for caesarean birth?
- 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.
Are there any risks of having regional anaesthesia for caesarean birth?
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 more severe headache can occur (post-dural puncture headache). There is a specific treatment for this type of headache.
- 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 for 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.
Will my birth partner be able to be with me during the caesarean?
If you have a regional anaesthetic, your birth partner will be able to join you in the operating theatre. They will be asked to sit down and to avoid certain areas of the room. This is to reduce the risk of contaminating sterile operating instruments. If you are to have a general anaesthetic (put to sleep) your birth partner will be asked to wait in another room.
What happens during the caesarean birth when I am awake?
Just before the caesarean starts, a member of the theatre team will confirm your name, date of birth and hospital number to ensure that we have the correct patient prior to the start of the caesarean birth.
A screen will separate you and your birth partner from the lower part of your body and the surgery. The anaesthetist will stay with you all the time. You may hear a lot of preparation in the background. This is because the obstetricians work with a team of midwives and staff in the operating theatre. Your skin is usually cut slightly below the bikini line. Once the caesarean birth is under way you will hear the sound of instruments and suction of fluids from around the baby.
How long does a caesarean birth take?
Your baby is usually born early in the operation. Most of the time is then spent closing up. Every caesarean birth is different.
Am I given any other medicines during the caesarean birth?
Before your caesarean birth starts, an antibiotic will be put into your drip to reduce your risk of getting an infection. After the birth, a drug called oxytocin is put into your drip to help tighten your womb and to cut down blood loss.
If you feel sick, you may be given medicine to help you stop feeling sick or vomiting. If you feel any discomfort, the anaesthetist may give you extra medicine to help relieve the discomfort and, sometimes, they will need to give you a general anaesthetic. For pain relief after your caesarean birth, see the section below.
What pain relief am I given after my caesarean birth?
Good pain relief is important so that you can move, care for your baby, and recover safely. After your caesarean, we use a planned combination of medicines that work in different ways.
In hospital (first day):
- You will usually receive a dose of morphine placed into the spinal fluid (intrathecal morphine) at the time of your anaesthetic.
- This provides strong pain relief through the first day.
- While you are in hospital you may also be given Targin (oxycodone + naloxone) twice daily. This is an in-hospital medicine - you do not continue it at home.
After the first day / at home:
- Celecoxib and paracetamol: taken regularly for 5 days to reduce background pain and inflammation.
- As-needed medicines: if extra pain relief is required, options may include buprenorphine, tramadol, oxycodone, or hydromorphone.
If you prefer not to take opioids:
- You may be prescribed diclofenac suppositories for 3-5 days, together with regular paracetamol.
What happens when the caesarean birth is over when I am awake?
After the operation, you will be taken to the recovery room where your blood pressure will continue to be monitored. Your partner and baby will usually be with you. Your baby will be weighed if not already done so in the theatre and then you can begin breastfeeding, if you want to.
In the recovery room your anaesthetic will gradually wear off and you may feel a tingling or itching sensation. Within a couple of hours you will be able to move your legs again.
What happens to my baby after it is born by caesarean birth?
Immediately after the birth of your baby, the midwife dries and examines your baby. A paediatrician will do this with the midwife. After this, as long as they are happy that the baby is doing well, you and your partner will be able to cuddle your baby and, in some cases, have skin-to-skin contact.
Shivering during or after a spinal anaesthetic
Why does it happen?
- During surgery, body temperature often drops slightly. The operating theatre is kept cool and anaesthetic medicines reduce your body's natural ability to control temperature.
- Spinals and epidurals widen the blood vessels in your legs and skin, which increases heat loss.
- Shivering can also be triggered by the anaesthetic medicines themselves or if you are experiencing pain after surgery.
What does it feel like?
- You may notice shaking or trembling in your arms, legs, or whole body.
- It can be uncomfortable and sometimes distressing, but it is not dangerous.
- Shivering usually lasts 10-30 minutes and then settles on its own.
How is it prevented?
- You will be kept warm before, during, and after surgery.
- Warm blankets, heated air blankets, and warmed intravenous fluids are often used.
- You can help by bringing a dressing gown or warm clothing for before your operation, and telling staff if you feel cold.
What if it happens to me?
- In recovery, your temperature will be checked and you will be kept warm until it returns to normal.
- Oxygen may be given by mask because shivering increases your body's demand for oxygen.
- Shivering usually stops within 20-30 minutes, but in some people it can last longer, occasionally several hours.
- Medicines such as pethidine and clonidine can reduce shivering, but they are not routinely used because they may cause drowsiness or affect your memory of events such as the birth of your baby.
Key points
- Shivering is common after anaesthesia.
- It is uncomfortable but rarely dangerous.
- It usually stops within 20-30 minutes.
- Nurses and anaesthetists will be with you the whole time to keep you safe and comfortable.