Once the Epidural Isn’t Working During Labor

Dr. Greg Thompson, anesthesiologist, discusses epidurals for pain management during labor.

You wanted to know how often epidurals don’t work, and why, and what fixes there are for times when they don’t work. And all of this information just comes from my experience of being a Labor & Delivery nurse for 11 years. And I would say, most of the time, epidurals work really well for women. And it’s important to go into it with the proper expectation. Epidurals don’t take away all sensation. They’re designed to mask pain, but they don’t take away pressure, and tugging and pulling sensations, and those types of things that women might feel during labor or during a C-section and epidurals are used for both. So if a woman goes into it with the expectation that she’s going to feel nothing, then she might feel like the epidural didn’t work, when, in reality, it was working very well..
They’re not perfect though, and there are times when they don’t work as well as the woman would like it to. And there’s a couple of explanations for this. One is that if labor is progressing really quickly, like say a woman’s cervix goes from 4 to 10 in just 20 minutes or something, that would hurt really bad without an epidural, and so even with one, sometimes women have what we call “breakthrough pain”. And so in these instances, the anesthesiologist can come in and re-dose a woman, or sometimes you even are connected to a pump and you can give yourself a dose of medication, and then it helps to bring the pain level back to a point where it’s tolerable for you..
Another thing to consider is that the medication that’s going into your back will work by gravity. And after you’ve received an epidural, you’re placed on one side or the other, and the side that’s up is going to get less medication, because gravity is naturally causing medication to flow to the leg that’s down, and so you might start to feel a little bit crampy, or have a little more of a backache, or be able to move your upper leg more. And so every hour or two, your nurse will likely rotate you, and if needs be, then you can be re-dosed if that upper side was hurting a little bit, and then you can get comfortable again. And this process might have to be repeated every hour or two just to make sure that your pain control is kept even. Now, another thing to consider is that the baby will likely determine which position you get to be in, and so sometimes your nurse will turn you more frequently than that to help to support your baby through labor. If you have more specific questions about it when you’re going though it, don’t hesitate to ask your nurse and doctor, and they’ll be able to give you tailored information based on their knowledge of your circumstances and what’s happening at the time..
Now, of course there are times when epidurals don’t work, because the woman didn’t come in in time. So say that someone had already had a baby before, their labor is progressing really quickly, the woman comes in at 8 or 9 centimeters, almost ready to push. Sometimes we try to get the epidural in place if circumstances permit, but we’ve delivered a few babies while trying to place epidurals, and sometimes we get the epidural in, but then the baby comes shortly after, and so it didn’t set in time, and the woman still felt the pain of labor and delivery, and then felt nice and numb after the baby was born. Epidurals require some tome to place and also to set up, so usually, from the time you ask for it till the time you’re nice and comfy, it’s about 20 to 30 minutes, and so if we don’t have that amount of time before the baby is born, then of course it won’t work for delivery..
Now, as for epidurals not working at all, I’ve never really seen that. There have been occasions when maybe a woman would have pain relief on one side and not the other. That’s just happened a handful of times that I’ve seen, and so the anesthesiologist pulled out that epidural, replaced it with another one, and the woman was able to get comfortable. Again, if you have more specific questions about it, talk with your OB provider, and when you come to the hospital, you can also request to talk with the anesthesiologist, and they’ll be able to give you tailored information and advice. If you have more questions for me in the future, feel free to ask them on our Facebook page at http://www.facebook.com/IntermountainMoms, and recommend us to your friends and family too.