The difference between epidural and the spinal is the space in the back where the local anesthetic is injected into. And, or in case of the epidural where a small plastic catheter is left behind to enable continuous delivery of local anesthetic or pain medicine to keep mom comfortable. An epidural is placed into the epidural space, which is the space between the dura and the bone of the vertebral column. The spinal is placed in the spinal space, which is also called the subarachnoid space. A combined spinal epidural means usually a one-time injection into the spinal space with a catheter placement for continuous administration of medication into the epidural space. Usually an epidural alone is given for vaginal delivery and the spinal is placed for cesarean sections. The combined spinal epidural is usually placed when one expects that a cesarean section takes longer than usual. For example, after prior multiple cesarean section, there’s a concern for the spinal anesthetic not to be enough. Having the epidural catheter as a backup allows for continuous medication administration, if necessary. A spinal, an epidural, and combined spinal epidural all have their respected places for certain labor situations. Your anesthesiologist will discuss these options in detail with you and guide you towards the best option for you based on your obstetric and medical history.