When a woman is in labor, she's likely to want relief from the contractions. And she wants that relief NOW! Medical staff can insert an epidural for paid relief. An anesthesiologist can carefully insert a narrow tube into her spinal column and deliver a bolus of a numbing medication that should temporarily stop the nerve signals going from her uterus to her brain. Key word: "should."
Several factors can interfere with that blessed relief. If the anesthesiologist isn't very skilled, the laboring mom will continue to feel sensation and pain. Mom may have waited too long to request the epidural. She may be obese, which makes it even more difficult for the anesthesiologist to place the needle and catheter correctly. Or, she may be jumpy and make the doctor miss the correct spot.
Other reasons may be that some women just don't respond to epidurals in the same way as other moms. Or she may have a spinal disorder that literally makes it impossible for anyone to place the needle correctly. This next one is really painful. The anesthesiologist may have punctured the dura (the tough lining surrounding the spinal cord), which can cause a whole other set of problems.
Whatever happens, some mommies-to-be leave the delivery room with a horror story that makes them wonder if they'll ever have en epidural again, let alone another baby.
13 Fail: The Doctor Is To Blame
When mommy goes into the hospital, experiencing labor contractions, she may get to that point where she says, "Get me some relief, now!" She's definitely entitled. Labor is one of the hardest things a woman will ever do in her life. The contractions can become pretty intense.It lasts for hours, if not days (sorry to scare new mommies-to-be). When it comes time to push, again, this is one of the hardest forms of exercise ever!
When mom decides that she's ready for an epidural, she wants her anesthesiologist to be skilled at finding the right spot on her spine to insert the needle. She wants said needle to be inserted correctly the first time. Finally, she wants sweet relief from the contractions—and she wants that relief to last.
If the anesthesiologist is new or just not very good at placing epidurals correctly, mommy is going to hurt all throughout her labor. Small wonder that so many mommies dread subsequent pregnancies. Sarah found this out the hard way when it took her doctor four tries to place the epidural correctly! Once it was placed, she still felt every single contraction.
12 Fail: Mom Can't Stay Still
Wiggling while receiving an epidural, even if mom is having a strong contraction, is verboten. This is why doctors and nurses caution mom to stay as still as she can, even if she feels a particularly strong contraction.
This is because her anesthesiologist has to find that tiny, little "sweet spot" on her spinal column. They do this literally by feeling the spaces in between the vertebrae of the spine. "Okay, I'm close. I'm there! Now. . . and maybe not." Just as the anesthesiologist pushed the needle and catheter into mom's spine, she jiggled. Even a tiny movement affects the placement of the needle and catheter. It has to be pulled back out and placed again. (Ouch. The thought!)
If the anesthesiologist somehow doesn't realize the catheter is in the wrong space or that it's punctured the dural space, mom is going to get a hellacious headache.
Moms in labor, please stay as still as a statue. This way, the doctor only has to push that needle in one time.
11 Fail: Too Early, Too Late
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 labor, she's experiencing the most intense contractions.
These contractions are intended to help open the cervix fully to 10 cm, which means she's ready to start pushing the baby down her vay-jay-jay and out of her body.
Asking for an epidural too early sounds like the ideal recipe for labor: no pain at all! There's a catch to that plan as well. Epidurals only last between two and four hours, though the anesthesiologist can "top off" the medication. This means that, if mom is looking at a ten-hour or longer labor, she's going to experience between six and eight hours of unmedicated labor. That is no fun.
10 Fail: The Pounds Are Too High
The anesthesiologist has to be able to locate the correct spot on mom's spine. If she is too obese, the doctor literally can't use the bony protrusions of the vertebrae to guide them. If mom is set on getting pain relief via an epidural, it just won't happen.
This is why, before a woman decides to become pregnant, she should be at a healthy body weight. It's not a good idea to embark on a weight-loss plan during pregnancy. The baby needs all the calories it can get. And mom needs the calories as well, because she's supporting a new life.
When the big day comes, while she's carrying additional weight from the extra fat stores, the baby itself, the placenta and even the amniotic fluid, she should be at a healthy weight. In this way, her anesthesiologist can run their fingers down her spine, looking for the correct area in which to insert the needle and catheter.
Correct placement is critical. If the needle and catheter are too high, the anesthetic won't affect the area where mom is feeling the contractions.
9 Fail: Every Woman Is Different
We've all heard the nightmare stories about patients waking up from anesthesia. . . during surgery! That's a painful nightmare to contemplate. What if a laboring mother is just "immune" to the effects of anesthetic drugs meant to help numb the nerves that deal with the pain of labor contractions?
It does happen. One woman recounted her failed experiences with epidurals on her blog, "My Mommy Style." With her first labor, she rated her epidural as "just okay." Meaning she felt some breakthrough pain as her labor progressed. Of course, she was also preeclamptic during that labor. At first, the epidural did as it was intended to do. Mom found she needed to pump more medication into her IV because she was feeling the contractions more. She received additional medication, which helped her to enjoy the last 20 minutes of labor.
With her second child, she waited to ask for an epidural until she was 4 to 5 cm dilated. The anesthesiologist was busy with a C-section and couldn't insert the needle and catheter into mom. When she got to the point where she really needed relief, the anesthesiologist was STILL preoccupied with the C-section.
Then. . . she experienced the Ring of Fire. The skin and muscles "down there" felt stretched out and burned. Oh. She's also one woman who wakes up from anesthesia in the middle of a procedure. Wow.
8 Fail: Wrong Placement
Labor and delivery nurses discuss the issue of non-working epidurals. One one nursing forum, several nurses "met" in a nursing forum and virtually discussed this question. One nurse came right out and said that the problem rested on the anesthesiologist.
"Nocturnalnurse" listed several reasons for epidural failures, including patient anatomy, Another cause comes when the baby begins to move through the birth canal. As baby moves down, so does the pain. "Nocturnalnurse" says she encourages her patients by telling them that pushing is coming closer. She then directs them to use the "pressure pain" to detect contractions when it's time to begin pushing.
If a laboring mom is experiencing this type of pain, other pain management methods may help. These include changing positions, applying heat or ice, using breathing techniques and counter-pressure (pressing the lower back with knuckles, fists or tennis balls).
7 Fail: Mom's Body
An epidural can fail if mom's back and spine have an unusual anatomy. This makes it difficult for even the most skilled anesthesiologist to find the correct epidural space where the needle and catheter should be inserted.
For instance, one mother of six has a spinal curvature. Her anesthesiologist didn't take the curvature into account when he inserted the epidural. As a result, she was numb in the wrong areas of her body. In addition, she was numb in the bottom halves of "the girls," which caused a problem when her son breastfed. He wasn't latched on correctly, so she didn't feel blood blisters developing due to the numbness.
This mom ended up having to ask for the epidural to be removed and reinserted higher up so she could get the numbing, pain-relieving effect. If she opts for more children, she and her partner or doula will have to consult closely with her gyno and anesthesiologist to ensure proper insertion of the epidural.
6 Fail: The Accidental Miss
Sometimes, the anesthesiologist will "miss" the correct epidural area of the spine. When they do this, spinal fluid actually begins to leak out of the spinal column. And. . . mom can develop a true "sick headache." These headaches are the kind that come with wicked nausea, so they are to be avoided at all costs.
Specialists say that these accidents do happen and the headache can be a real aftereffect of the mistake in placing the needle. One thing that can help mom with the headache is to drink a diet soda with caffeine. The caffeine in the drink works to alleviate the pain. One thing: While mom won't get any more headaches afterward, the headaches she does get will be noticeably worse.
A blood patch can also stop the slow leak of spinal fluid. They work by "plugging" the tiny holes caused by the dural puncture. A small amount of mom's blood can be injected into the epidural space, where the mistaken punctures are. Once the blood patch has been completed, the headache goes away.
5 Sign: Can't Handle Pain
Some pregnant moms have a low tolerance to pain, which makes choosing an epidural a natural for them. "After all," they think, "anything that cuts the pain will make giving birth a little easier." That's a natural thought progression, but it may not work out that way.
Because of their low tolerance to pain, they may be predisposed to epidural failures. This isn't good news for anyone! So, what are they to do? Along with opting for medicated pain relief, they can discuss other pain relief options with their gyno. These include prenatal yoga, which helps them with stretching Water birth, hypno-birthing (going through hypnosis so they are able to help themselves with the pain and finally, just not asking other women what their birth experiences were like, are other options. Inevitably, they'll run into someone who experienced the Birth from Hades. These moms then have X number of months to ruminate over those TMI details and wonder, "Will my birth experience be that bad?"
If moms with a low tolerance to pain are truly worried, then the best thing for them to do is discuss their fears or concerns with their gyno and, ahead of the big day, speak to an anesthesiologist at the hospital where they plan to give birth.
4 Sign: Overweight
If a pregnant mom has a BMI of 30 or more, there's a chance (just a chance!) that her epidural won't be effective. The extra padding on her back makes it harder for the anesthesiologist to find that epidural sweet spot where the needle should go. (Anesthesiologists rely on their sense of touch to find the right area and, when it's covered with a layer of fat, it's easy to miss the spot.)
Once the correct spot has been found, the doctor will need to use a longer needle. This makes it easier for them to ensure the catheter stays in place. However, with a longer needle, they may accidentally puncture the dura (the strong membrane surrounding the spinal cord). If this happens, mom will have a horrific headache after giving birth.
Mom should also make sure she meets with an anesthesiologist before she goes into labor. At that meeting, she and the doctor will go over what a higher BMI does to epidurals. One thing the doctor may suggest is that mom receive her epidural earlier in her labor. An early epidural means that, if mom needs an emergency C-section, she's ready. On the other hand, an early epi may wear off too soon.
3 Sign: The Placebo Effect
This well-known phenomenon works on the relationship between the mind and body. In controlled drug studies, some study participants receive the drug under testing; others get a placebo, which is like a sugar pill that has none of the drug being texted. Usually, none of the participants knows whether they are getting the drug or the placebo.
Some of the participants who get the placebo report an improvement in their symptoms while others report that they feel the same as they always do.
Epidurals can work in a similar way. If a laboring mom believes her epidural will fail, then she'll feel the pain of each contraction. If she feels the epidural will be effective, she won't feel contractions to the same extent. If a woman has had more than one child and a previous epi has failed, she's likely to go into labor with a negative impression of every other epi she may receive, though she may hope that it'll perform better this time.
2 Sign: Letting Time Pass
A woman and her partner may wait too long to leave for the hospital. Maybe she wants to be sure she's really in labor. Once she gets there, she's in active labor and either in transition or very close.
In this case, the labor and delivery staff won't agree to give the mom an epidural because it's too late for it to be effective. For instance, if the baby's head is crowning (showing), it's too late and it'll take too long for the medication to take effect.
It takes about fifteen minutes for an epi to take effect, giving mom some relief from the pain of her contractions. Even though pushing may take from forty-five minutes to an hour or more, waiting until mom is actively working to push the little one out, she will still feel much of the pain of her contractions.
Most gynos prefer that their patients be dilated about 4 to five cm before inserting the epidural. If mom has a history of fast labors, she may not be given an epi, because she may have a hard time when she has to push.
1 Sign: Bad Staff
An epi may fail if a laboring mom has L&D staff that doesn't try to ease the discomfort of childbirth, or if the anesthesiologist doesn't try to place the needle and catheter in the right spot.
In some hospitals, CRNAs (Certified Registered Nurse Anesthetists) are more skilled at placing the needle and catheter in just the right spot. The women who receive these epis have reported that they felt little or no pain during their labors.
It may literally take a nurse or three who bother to question why so many of their patients' epis fail. Once they start asking questions and looking for the answers, they may be able to increase the percentage of happy moms, by requesting that bad anesthesiologists and nurses not be allowed to administer epis or the medications to moms in labor.
Sources: dailymail.co.uk, mymommystyle.com, healthline.com, allnurses.com, mommyish.com, babygaga.com, theconversation.com, mom.me, portlandpaincare.com, undermyheartbirth.com, draxie.com, babycenter.com, ABC.com, What to Expect, babygaga.com, birthfaith.org, Daily Mail, Baltimore Washington Medical Center, Diamond Headache Clinic, WiseGEEK, BBC News, Baby Center Community, babycentre.co.uk, webmd.com, Cedars-Sinai, Cosmopolitan, abcnews.go.com, childdevelopmentinfo.com,