Once the Epidural Isn’t Working During Labor

 

Epidurals during labor

Video taken from the channel: Baptist Memorial Health Care


 

How often do epidurals not work, and why? What can fix the problem?

Video taken from the channel: IntermountainMoms


Around 61% of women get an epidural or spinal anesthesia for pain management during labor—and research shows epidurals don’t work 12 percent of the time. That’s usually due to the placement of the. If you find that your epidural is not working, do not panic.

There are still things that can be done to help relieve pain in labor. Try Flipping From Side to Side Sometimes you might have one spot that isn’t quite numb or isn’t as numb as another side. Epidurals can cause a sudden drop in your blood pressure.

Your blood pressure is monitored throughout your labor and delivery to ensure adequate blood. Epidural that is not functioning properly is one of the most frustrating situations for obstetric anesthetists. However, every medical procedure, including labor epidural, has its failure rate. Sometimes surgical operations do not produce the desired result, drugs.

However, in certain circumstances, it may be harder to get an epidural late in labor because: The anesthesiologist may be busy with other patients, so it could take longer for her to arrive once you decide you want the pain medication. Your labor and delivery team may urge you not to request pain relief if they think you’ll deliver your baby soon. An epidural usually takes about 10-15 minutes to take effect and, because the medication can be continuously administered via the catheter as needed, it can last throughout labor.

So the not-so-great news: sometimes, labor can last a long time. The really great news: so can the pain relief from an epidural. Let’s hear it for modern medicine!

If mom decides she wants to wait until she goes into the last stage of labor (transition) before receiving an epidural, this won’t work. If she tries, she’s going to be painfully disappointed. This is because, by the time she’s in the transition phase of labo.

Because of this, additional medications or interventions may be needed, such as a vacuum, episiotomy, forceps, or a cesarean. Talk to your doctor when creating your birth plan about what interventions he or she generally uses in such cases. (You can also request for the epidural to be turned off when pushing. As to this problem, because labor contractions may come at intervals of two minutes, an epidural will be put in place even as the contractions come and go. But this is all right.

The procedure is not too delicate and although small or moderate movements may slow down its placement, the effect is minimal. When can an epidural NOT be used? An epidural may not be an option to relieve pain during labor if any of the following apply: You use blood thinners; Have low platelet counts; Are hemorrhaging or in shock; Have an infection on or in your back; Have a blood infection; If you are not at least 4 cm dilated; Epidural space cannot be located by the physician.

List of related literature:

Hägerdal M, Morgan CW, Sumner AE, et al: Minute ventilation and oxygen consumption during labor with epidural analgesia, Anesthesiology 59:425–427, 1983.

“Wall & Melzack's Textbook of Pain E-Book” by Stephen B. McMahon, Martin Koltzenburg, Irene Tracey, Dennis Turk
from Wall & Melzack’s Textbook of Pain E-Book
by Stephen B. McMahon, Martin Koltzenburg, et. al.
Elsevier Health Sciences, 2013

• When the woman has received narcotic medications or an epidural for pain.

“The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia” by Penny Simkin, Lisa Hanson, Ruth Ancheta
from The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia
by Penny Simkin, Lisa Hanson, Ruth Ancheta
Wiley, 2017

During labor, avoidance of fluid overload, oxygen administration, labor in the lateral recumbent position, and pain relief with epidural

“Critical Care Obstetrics” by Michael A. Belfort, George R. Saade, Michael R. Foley, Jeffrey P. Phelan, Gary A. Dildy
from Critical Care Obstetrics
by Michael A. Belfort, George R. Saade, et. al.
Wiley, 2010

To resolve this issue, spinals were combined with epidurals.

“Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant” by Richard J. Martin, Avroy A. Fanaroff, Michele C. Walsh
from Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant
by Richard J. Martin, Avroy A. Fanaroff, Michele C. Walsh
Elsevier Health Sciences, 2010

Hemodynamic consequences and uterine contractions following 0.5 or 1.0 liter crystalloid infusion before obstetric epidural analgesia.

“Nurse Anesthesia E-Book” by John J. Nagelhout, Sass Elisha, Karen Plaus
from Nurse Anesthesia E-Book
by John J. Nagelhout, Sass Elisha, Karen Plaus
Elsevier Health Sciences, 2013

Adequate uterine activity in a patient with an external tocodynamometer is defined as at least three contractions in a 10-minute period, with adequate intensity assessed via manual palpation (inability to indent the fundus of the uterus at the peak of a contraction).

“Management of Common Problems in Obstetrics and Gynecology” by T. Murphy Goodwin, Martin N. Montoro, Laila Muderspach, Richard Paulson, Subir Roy
from Management of Common Problems in Obstetrics and Gynecology
by T. Murphy Goodwin, Martin N. Montoro, et. al.
Wiley, 2010

If the patient is in labor, observe for indications of advancing labor such as apprehension, restlessness, increasing difficulty coping with the contractions, screaming, nausea and vomiting, bearing-down effort, increase in bloody show, or a bulging perineum.

“ASTNA Patient Transport E-Book: Principles and Practice” by ASTNA, Renee S. Holleran
from ASTNA Patient Transport E-Book: Principles and Practice
by ASTNA, Renee S. Holleran
Elsevier Health Sciences, 2009

Forsnes E, Occhino A, Acosta R. Spontaneous spinal epidural hematoma in pregnancy associated with using low molecular weight heparin.

“Chestnut's Obstetric Anesthesia E-Book” by David H. Chestnut, Cynthia A Wong, Lawrence C Tsen, Warwick D Ngan Kee, Yaakov Beilin, Jill Mhyre, Brian T. Bateman, Naveen Nathan
from Chestnut’s Obstetric Anesthesia E-Book
by David H. Chestnut, Cynthia A Wong, et. al.
Elsevier Health Sciences, 2019

Intradural (subarachnoid, spinal) block: given in second stage of labor to deaden uterine and perineal pain (1) Rapid onset, but highly associated with maternal hypotension which can cause maternal and fetal distress (2) Client must remain flat for 6 to 8 hours after delivery.

“HESI Comprehensive Review for the NCLEX-RN® Examination E-Book” by HESI
from HESI Comprehensive Review for the NCLEX-RN® Examination E-Book
by HESI
Elsevier Health Sciences, 2010

Anesth Analg 1986; 65:31 Jouppila P. Jouppila R, Hollmen A, Koivula A: Lumbar epidural analgesia to improve intervillous blood flow during labor in severe preeclampsia.

“Clinical Anesthesia” by Paul G. Barash
from Clinical Anesthesia
by Paul G. Barash
Wolters Kluwer/Lippincott Williams & Wilkins, 2009

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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13 comments

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  • I’ve had to have 9 placed out of 4 births… I only had my 1st one I ever got work the way it should… the others were one leg or the other and even from only my belly button up to my chest. Do mine not work bc of scar tissue? Can i even get scar tissue from to many tries of epidural placed?

  • They dont lay us on one side here in Ontario. I was on my back. I also fell asleep and got woken up and told the baby was crowning and to push lol

  • I had two kids and tried to get epidural and my anesthesiologist tried to give one but did not succeed both times they said I dont have any space in my bones of spine. Is that can be the reason too for not able to get one? And now I expecting my third surprise baby by the first week of dec. And I want epidural this time too. What should I do?

  • 2 kids, 5 years apart with the exact same symptoms. Shaking, cold, numb legs and butt, nausea, vomiting but still felt all the pain even with maxing out the dispenser/pump. The epidural just makes me sick but doesn’t mask the pain at all for me.

  • i dont plan to have a baby any time soon but i have concerns about labour pain i have a very low tolerance to pain and im highly sensitive to pain and want to get through it without to much Pain

  • I had 5 epidural placements between my two children and zero of them worked. I guess epidurals don’t fail enough to warrant research as to why they would fail for some women.

  • Epidurals are NOT maintenance free. The intensity and location of pain varies significantly during labor and frequently requires “tweaking” by the anesthesia PROVIDER. She makes NO mention of it but it is MORE than likely that a Nurse Anesthetist, CRNA, will be doing your epidural. A lot depends on how busy the anesthesia provider is on the rest of the unit. You may be very comfortable when you are from 4-9 cm and then the pain will shift from your abdomen to your perineum. Frequently, this will require a position change and additional and sometimes stronger medication to get you comfortable “down there”. If the anesthesia provider is busy doing other epidurals or CS’s, you may not get this dose and all you will remember is that near the end, the epidural didn’t work. As well, just like any other line of work or profession, some anesthesia providers are just better than others.

  • I delivered my second baby less than a week ago and the epidural didn’t work at all. I got an epidural with my first child so I know how it’s supposed to work on me. With my second child I was begging them to take my pain away. I literally wanted to die. The nurses was confused why nothing wouldn’t work. I delivered my son approximately 2 hours after receiving the epidural and screaming in agony. I spent about 4hrs and 40mins in labor at the hospital. Crazy thing is after delivery still no pain medication I’ve taken so far has worked(ibuprofen, motrin, aleve etc). I want more kids but I’m terrified of this happening again. I think I have PTSD from the experience because I’m still shook every time I think about it.

    What upset me the most is the nurses thinking I was lying because they machines was telling them that the epidural was working even though I was screaming like someone who was having their arm sawed off. So they refuse to do anything else because they said it was work. At one point they even try to convince me that I was imagining the pain. Fuckers

  • I asked for the epidural but I was 10cms already… I pushed for 3 hours then they gave me one but it still took another hour for my kid to be born.

  • I had always had a fear since my first baby that the epidural would only work on one side and I would feel everything on the other. Well, it happened with my first and they fixed it. With my second, it was a different hospital and they waited too long to redo my epidural and I had to birth my baby without medication on one side. Most painful experience of my life.

    And the kicker??? This was EXACTLY what I was fearing the whole time during my pregnancy.

  • Great information and very great video! A minor caviat however, gravity plays a negligable role in the effect of an epidural. It is the dose and volume of anesthetic as well as location of the epidural catheter that contribute to the effect of the epidural. 

    Chestnut., D. (2014). Chestnut’s Obstetric Anesthesia: Principles and Practice. 5th ed. Elsevier Health Sciences, p.235.

  • My epidural didn’t work!! I had back labor & could feel everything. I could move my legs and I could feel all my contractions. When the anesthesiologists gave me the epidural my left leg twitched and I felt tingling twice when she was inserting the needle. After my heart rate went up from 81 to 163 in seconds. I honestly thought I was going to die. Do you know why that could of happen? And is that normal?

  • I just gave birth and the epidural did NOT work! I begged them to give me the epidural when I was 3cm dilated and they waited too long before giving me the damn thing. I was a hell of an experience and the hospital though very well known, sucks at L&D.