What Makes An Epidural Not Work? An OB-GYN Explains

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You know the old saying that if something seems too good to be true, it probably is? The adage unfortunately describes the epidural experience for many laboring women who carefully plan for the needle, hoping for an effective pain reliever, only to be distraught in the heat of the moment to find it only partially or not at all successful. Obviously the procedure is effective in most cases or it wouldn't be so popular, but when it fails, it can throw a laboring mama's mental game way off. So exactly what makes an epidural not work?

First let's take a look at how they should work. According to the American Pregnancy Association, "Epidural anesthesia is a regional anesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide pain relief, rather than anesthesia, which leads to total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body." So basically, you should be fully conscious and attuned to the beauty of the moment of your child's birth, but feel nothing from the waist down. That's the dream, right?

And it usually works. But, as many women will quickly tell you, not always perfectly. In an interview with Fit Pregnancy, Dr. Cynthia Wong of Northwestern University Feinberg School of Medicine in Chicago reassuringly said that the number of women who experience unrelieved labor pain after receiving an epidural is less than 5 percent. However, when the topic comes up on my social media accounts, women come out of the woodwork in droves to complain about the ineffectiveness or patchiness of their epidurals, and other sources have cited statistics up to 12 percent. When you start talking about something that's affecting the deliveries of 12 out of every 100 women, suddenly we start sitting up a little straighter in our chairs.

So, what's the deal?

G. Thomas Ruiz, M.D., an OB-GYN at Orange Coast Memorial Medical Center in California gives Romper the scoop. "The most common reason is it is not in the correct place. For an epidural to work, a catheter needs to be placed just outside the dural sac. The spinal cord is inside the dural sac," Ruiz explains.

What is the cause of an epidural that successfully numbs one side of the body, but leaves the other side sensitive to pain? Ruiz says this is commonly called a one-sided block. "The catheter can be in the correct spot and give what is called a patchy or one-sided block. This happens when the local anesthetic does not cross effectively across the dural membrane."

I've also heard women speak of epidurals that initially worked, but wore off too soon — like, way too soon. Is that normal? Ruiz says no, epidurals should last the length of the labor and well after. The cause for effectiveness waning too early, he says, is that "an epidural catheter can initially be in the correct space, but if the catheter is accidentally pulled back so it is no longer in the space, it will also stop working."

For most women who choose them, epidurals work well and fit into their labor plans just as expected. But some are taken by surprise in the moment when they realize that their plan for pain relief is failing them, which can be more stressful than having an unmedicated birth or opting for a different form of pain relief medication to begin with. When making a birth plan, talk to your doctor (and if you have a doula for support, even better) about what to do if your planned epidural goes awry. (And make sure they have that thing in the right place.) A little crisis preparation can go a long way.

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