Spinal (local anesthetic)

What is a spinal?

A spinal is a single painkilling injection that gets to work faster than an epidural. An anesthesiologist will feel for the right location on the small of your back. Once the exact spot is found, he or she will use a local injection to freeze that area, and then give you a shot of a local anesthetic, into the fluid surrounding the spinal nerves, using a very fine needle. The procedure usually takes 15 – 20 minutes, but, in difficult cases, it can take up to an hour.

How does a spinal work?

The local anesthetic numbs the nerves supplying your uterus (womb) and cervix so that you can no longer feel your contractions, or so that you can have a caesarean section if it is needed.

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 (NICE 2014; Simmons et al 2007).

Full-dose spinals are only given in an operating room. They can be used if you haven't got an epidural in place already, or if your epidural needs boosting (NICE 2011).

Sometimes, doctors may use a spinal during an assisted birth (which uses instruments such as forceps or a vacuum) if they have concerns that your baby won't be able to be born vaginally and will need to be born quickly by caesarean (RCOG 2005; 2007).

Otherwise, you will have a spinal:

  • If you are having a planned or emergency caesarean birth.
  • If you want pain relief for stitches after your baby is born (NICE 2014).
  • If you need a manual removal of the placenta, if you have retained placenta.

What are the pros and cons of a spinal?

A spinal provides rapid pain relief, as it works within five or 10 minutes (RCOA 2014; Hughes et al 2003), faster than an epidural. And unlike an epidural, a spinal can be given in a single injection, so there is no tube left in your back.

Most of the disadvantages are the same as those for epidurals. Additional disadvantages of a spinal include:

  • It is short-acting. Mini-spinals last between 60 and 90 minutes, and full-dose spinals last about two hours (RCOA 20015).
  • It can't be given more than once. Unlike an epidural, a spinal can't be topped up (RCOA 2015).
  • It may make you feel itchy, particularly in sensitive 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 (NICE 2014; RCOA 2014).
  • There is a very small risk of you having a severe headache. The way a spinal is given means the needle punctures the fluid-filled sac protecting your spinal cord. If there is a leak of some of the fluid you may get a severe headache. Its likelihood depends on the size and type of spinal needle used, but on average there is only about a one in 500 chance of this happening with a spinal (OAA 2008a). Accidental puncture is more common in epidurals (one in 100), because the needle used for epidurals is much larger.

Any useful tips?

  • Keep as still as you can while you are having the injection. You'll either be lying on your side or sitting on the side of the bed and be asked to curl over. Concentrate on breathing deeply and evenly. Sigh out and keep your shoulders relaxed. Maintain eye contact with your birth partner.
  • Tell your anesthesiologist 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 2014).
  • It can take up to four hours (or even longer for full-dose spinals) for feeling to completely return to your lower body. You may feel some tingling in your skin as sensation returns, which is normal (RCOA 2014).
  • Not everyone can have a spinal (OAA 2008b: 9). Talk to your doctor if you think you have a medical condition that might affect whether you can have one.


NICE 2011 (updated 2012). National Institute for Health and Care Excellence. Caesarean section. Clinical Guideline. London: RCOG Press. https://www.nice.org.uk/guidance/cg132?unlid=2117196932016410192129 [Accessed July 2016]

NICE 2014. Intrapartum care for healthy women and babies. National Institute for Health and Care Excellence. Clinical Guideline. https://www.nice.org.uk/guidance/cg190 [Accessed July 2016]

OAA. 2008a. Obstetric Anesthetist Association. Epidural information card: Epidurals in labour – what you need to know. www.oaa-anaes.ac.uk [Accessed July 2016]

OAA. 2008b. Obstetric Anesthetist Association. Pain relief in labour. www.oaa-anaes.ac.uk [Accessed July 2016]

RCOA. 2014. The Royal College of Anesthetists. Your spinal anesthetic www.rcoa.ac.uk/document-store/your-spinal-anaesthetic. [Accessed July 2016]

RCOA. 2015. The Royal College of Anesthetists. Anaesthesia explained www.rcoa.ac.uk/document-store/anaesthesia-explained. [Accessed July 2016]

RCOG. 2005. Royal College of Obstetricians and Gynaecologists. Operative vaginal delivery. Green-Top Guideline 26. London: RCOG press. www.rcog.org.uk [Accessed June 2009]

RCOG. 2007. Royal College of Obstetricians and Gynaecologists. An assisted birth (operative vaginal delivery): information for you. www.rcog.org.uk [Accessed June 2009]

Simmons SW, Cyna AM, Dennis AT et al. 2012. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database of Systematic Reviews 3. www.mrw.interscience.wiley.com [Accessed July 2016]

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