When I first became pregnant I automatically assumed that I’d want an epidural because I do not have a high pain tolerance. Eventually this changed after speaking to a coworker who had a negative experience with her epidural and also after my husband and I took “Preparation for Childbirth” aka Lamaze classes. We learned different techniques that would help me tolerate labor pain so I decided to try to give birth without getting an epidural.
Well, so much for that plan! While in the hospital I asked for an epidural, and guess what? I ended up getting it TWICE and the epidural did not work for me — BOTH times!
This is my story and the reasons why epidurals may fail to work.
My Epidural Story: Why My Epidural Didn’t Work
My water broke in the evening and I did not have any contractions when I first got to labor and delivery in the hospital. I was only about 1 ½ cm dilated and 50% effaced. I was given Pitocin to get the contractions going and got an epidural.
It was neat seeing that I was having contractions on the monitor and not feel anything… until… I started feeling the contractions again. Our awesome labor and delivery (L&D) nurse had me change positions by switching sides and laying on my back and there was still no relief. The anesthesiologist returned and did not understand why the epidural was not working so she re-did the whole epidural (literally took mine out and re-did the whole procedure, thankfully I didn’t feel it!) The epidural worked once again and I did not feel the contractions. The nurse rechecked me and I was 3 cm dilated. My OBGYN and L&D nurses told my husband and me to try to get some sleep because they were expecting me to deliver the baby within the next 24 to 48 hours. We went back to sleep.
Then about an hour or so later I woke up. OUCH! I started feeling the contractions again. The nurse was surprised since they said I should not be feeling anything with my second epidural. She wanted to see what was going on so she checked my cervix again and sure enough I was in the transition stage of labor and 9 cm dilated! I had to start pushing and was unable to get any pain medication or an increase in my epidural dose. I had to suck it up, start pushing and give birth without the epidural.
So why didn’t my epidural work?
Why do epidurals fail?
There are many reasons why an epidural may not work when you are in labor. Simply put, the three main reasons are:
- Epidural Needle or Catheter issues
- Problematic Anatomy
- Unpredictably Fast Labor (Precipitous Labor)
1. Epidural Needle or Catheter Issues
An epidural may not work if the initial epidural needle placement was not adequate or the catheter was not positioned in the epidural space correctly. Another issue is that the catheter may have moved within the epidural space that it was placed in during labor. This is especially possible if the epidural worked in the beginning and then stopped working throughout labor and delivery.
2. Problematic Anatomy
Problems with a patient’s neuraxial anatomy have been shown to increase the rate of epidural failure. Neuraxial anatomy issues include chronic lower back pain, sciatica, herniated disk, and scoliosis. Each condition is problematic in their own way. The epidural medication has difficulty diffusing into the injured areas of patients with back pain and sciatica. Disk herniation could cause scarring which could slow the diffusion of the medication or block it altogether. Untreated scoliosis could make it difficult for practitioners to find the epidural space and reduce the spread of epidural anesthetic medication, among other complications.
3. Unpredictably Fast Labor (Precipitous Labor)
Epidurals are less likely to work if a patient’s labor progresses more quickly than expected. When dealing with an unpredictable fast labor, the epidural block will not set up on time which will lead to an ineffective epidural.
In my case, I think my labor was unpredictably fast. The L&D nurses said I broke all the rules since this was my first baby and I was in labor for only about 4 hours. Needless to say, I’m glad I took Lamaze classes! Next time I hope to have a better epidural experience (and I will keep you all posted if I do!)