Epidural vs. Spinal Block: Positions and Complications During Labor and Delivery (Nursing)

00:01 Now, I told you I would tell you about the positioning, so, here it is.

00:05 So, if you think about the picture that we showed of placing the epidural or the spinal, we have to get in between the vertebrae, so, curving the birthing person's back is going to be really important.

00:16 Now, this could be done in a sideline position as you see here or with the client sitting up on the edge of the bed.

00:22 Most often, the client's going to be sitting at the edge of the bed as you see in the third graphic here.

00:27 So, that we can open up the vertebrae and create space to place that needle.

00:32 Now, just because you have an epidural does not mean that you cannot get up.

00:38 Now, this is not something we would do with the spinal but with an epidural, we may find that we can actually move around.

00:44 Gravity is our friend. So, during the first stage of labor, so, this is, remember, is zero to 10 centimeters dilated, we can still use the birthing ball even though the client has an epidural.

00:55 We want to be careful but know that this is still a possibility.

00:59 We can also, depending on the level of anesthesia and how numb the clients' legs are, we can use the squat bar, we can use sideline position, we can still move from side to side to side every 30 minutes to make sure we're still using gravity to help rotate that fetus down.

01:16 What are the possible complications of an epidural or a spinal? We've already talked about one pretty often.

01:23 Hypotension, so, we want to make sure that as a counterpoint, we keep the client well-hydrated. We can do that through the IV.

01:31 One of the ways you may notice that a client is experiencing hypotension, a client who has an epidural is that you see late decelerations on the monitor, and that happens because the blood pressure drops.

01:43 You may also notice that a client complaints of nausea or they may vomit all of a sudden.

01:49 Now, this could happen as a result of rapid dilation of the cervix but you also want to make sure that you double-check that blood pressure and make sure that it has not gone down.

01:58 Another possible complication is a spinal headache and we'll talk about that more in just a second.

02:04 Clients who have epidurals or spinals overtime may experience an increase in temperature.

02:10 So, making sure that you're taking a temperature every two hours is going to be very important as well.

02:16 Also, having high spinal respiratory paralysis.

02:19 So, remember, the medication they're putting into the body can move and depending on where it goes, if it travels upwards instead of down, it can cause an issue with breathing.

02:30 So, making sure that you're watching the client to make sure they don't exhibit any signs of respiratory depression will be important as well.

02:37 Allergic reactions to the medications that are placed in the epidural or issues around the bladder.

02:43 So, sometimes, it takes a while for sensation around the bladder to come back even long after the medications have long resolved and the epidural or spinal have lost their effect.

02:53 We want to make sure that we double-check for signs of that.

02:56 Now, let's talk for a second about postdural headaches.

03:00 So, remember, we're placing a needle inside the spinal column and inside the spinal column, we have cerebral spinal fluid.

03:09 When we introduce an epidural, we're in the epidural space.

03:13 But if the epidural goes a little bit too far and gets into the subarachnoid space, the CSF can actually leak and that leaking can lead to a change in pressure and that change in pressure can lead to a headache.

03:27 And this headache related to that is called a post-dural headache.

03:31 Now, you may wonder, well, what happens with the spinal if we're intentionally going into the subarachnoid space? Well, the spinal needle is smaller than the epidural needle, so, it's less likely we'll get a CSF leak.

03:44 So, if you have a client, let's say on postpartum day two or even postpartum day one who says, whenever they get up, "Oh my goodness, my head hurts.

03:54 And I notice that every time I sit up that it just hurts so much.

03:58 If I lay down, it gets better but the minute I sit-up my head feels like it's splitting." And sometimes, this can even happen on clients that go home.

04:05 Then, we need to go back and look at that history and see if there was an epidural that was placed and know that a postdural headache is a possibility.

04:14 For treatment for that, we start maybe with caffeine but if that doesn't work, then, they'll come back into the hospital setting and we'll do what's called a blood patch.

04:24 And for a blood patch, we'll draw a little bit of peripheral blood and place that into the epidural space and let those platelets find that hole in the subarachnoid space and plug it up.

04:35 That will stop the CSF leak and hopefully, stop the headache.