If the epidural didn't work last time - will it this time?

[aufaniae]

So, five attempts at epidural didn't work last time.

(The anaesthetist actually came to visit the next day to apologise! But he had no idea why it didn't work.)

Does this mean it might not work again this time?

I really don't want to go through that again!

hopeful bump :)

Bumping with interest as I had four attempts that didn't work!

I guess it depends why it didn't work - was the needle sited incorrectly?, did the drugs have no effect? (are you hypermobile/EDS?), was there any pain relief felt even if incomplete/partial? Were the 'attempts' attempts at getting the needle in or top ups of the drugs?

I had an epidural with DD1's induction and I had 6 lots of drugs before I had complete pain relief. I have since found out that being hypermobile can affect how local anaesthetics work (I have had similar problems with dental injections) so for me that rules epidurals out as a pain relief option.

It depends, but the success rate is certainly reduced. (I'm an anaesthetist).
Was it difficulty putting it in (in which case may do better with someone different trying) or didn't work/only worked a bit/one-sided? The latter is usually due to fibrous bands within the epidural space and unless the epidural is sited at a different level in the back it's likely to happen again.
I've known people have a dodgy epidural once and a fab one the next time, and vica versa.
Epidurals have a success rate of about 80% so it's worth having a backup plan.
Best of luck.

Thanks for the replies :) I appreciate it.
In answer to your questions ..

There wasn't any difficulty putting it in as far as I recall. However I was in extreme pain and high as a kite on gas and air so my memory is a little sketchy.

It had no effect at all.

The anaesthetist was pinching my leg and asking if i could feel it. Yup, could feel leg pinching!

DP says he thinks he's not sure if the 5 attempts were top ups rather than new attempts at putting the needle in, he was round the other side holding my hand! They certainly gave me 5 lots of epidural.

Could be worth mentioning that the midwife wanted me on my back (ouch ). Would lying on my back have been possible if they'd left something in there so as to top me up?

I've never heard of hypermobility / EDS so I guess not?

"it's worth having a backup plan."

What kind of back up plans are available?

(Not really keen on pethidine or morphine if at all possible.)

Last time I was induced btw, and had a big baby. The pain of the labour I had without an epidural was extreme. I never knew pain like that existed and I had hours of it without pain relief - other than gas and air.

I'm really hoping not to have to go through that again!

The thing they leave in your back for top ups is a very thin, flexible, soft tube - so perfectly possible to be on your back with it in situ.

Ideally if it's not working at all then resiting it would be better than a top up.

Resiting would normally involve lots of prodding, pushing, you staying sill, etc. a top up is more of a big squirt of drugs through the tube but they'd probably get you to sit up so they could see the entry point/dressing just prior to it. But no actual poking and prodding.

Do either of those sound more like what happened?

I think it was likely it was a top up but I honestly don't know.

I was high as a kite and in agony. I remember sitting still.

DP says he thinks there was poking and prodding a couple of times but he's really not sure either.

I'm going to ask for my notes.

The anaesthetist said he had no idea why it didn't work (I appreciated his honesty).

Mine only worked on one side and they did countless top ups, making me lie on one side, 3 attempts at resiting until I started crying hysterically (had v bad experience with DC1 as had forceps delivery with no pain relief and it was all coming back to me with DC2 and making me panic, plus was induced and contractions were hugely intense) at which point they gave up and redid it completely on the other side of my spine. It then worked perfectly, which was a relief as ended up with an EMCS.

Sounds like it was one epidural attempt with some faffing to try to get it to work. Which is good from the perspective of another successful attempt being possible.
I'd ask for an appointment to speak to a consultant obstetric anaesthetist (this is not an unusual thing to do) who can look at your notes and try to explain what happened last time.
If it were me and I had a plan for epidural, my back up would be a remifentanil pca. Personally, I'd actually think about this as an earlier option if needed. I was very lucky with my DS and had a quick labour with tens, hypnotherapy and entonox. BUT I had every intention of upgrading to whatever I needed and can fully understand your worry when you went through so much for so long last time.
Remifentanil is basically an ultra-short acting opiate, so you press a button at the start of the contraction, it works by the peak and wears off by the end. No effects on baby but is a pretty big hit when you press the button. Advantage of course is if you don't like it just stop pressing the button, as opposed to diamorphine or pethidine which can't be taken out. It's not routinely offered but any big obs unit will have it available, and another thing to discuss with an obs anaesthetist.

Aufaniae -Hypermobility is where your joints are extra flexible due to ligaments being floppier than normal (EDS is a form of Hypermobility). I knew I had extra flexible joints but didn't know I had actual Hypermobility until DD2's rheumatologist told me DD2 had it and she got it from me as my knees were bending backwards while I was sitting!

Marmite - is Remifentanil okay with epilepsy? I only ask as I have it and I want a back up plan to a HB in case I need to be induced or have problems and the epidural just wasn't right for me. I can't have pethidine/tramadol for epilepsy reasons but can have morphine/oramorph.

Remi is a fairly pure mu agonist, so it works in a very similar way to morphine, just faster and shorter. I believe there is no contraindications to use in epilepsy. My practice is not within obs these days, but I do use remi for general surgeries and have used it in epileptic patients with no issue.

Thank you - I have a cons. obs appt on Monday so I like to be prepared (and know about any new drugs)

Marmite, thank you so much for the information. I will definitely be asking about remifentanil pca.

"Sounds like it was one epidural attempt with some faffing to try to get it to work. Which is good from the perspective of another successful attempt being possible." that's hopeful also thanks :)

TruthSweet thanks for explaining. No hypermobility here though.

Well that's good news aufaniae - one less reason for another epi not to work

No medical knowledge here but when I had DS I was given an epidural that worked perfectly first time, however last year I had a major operation and the pre-GA epidural didn't work, despite a few attempts at re-siting by two anaesthetists. So my experience is that the same person can have a successful epidural and an unsuccessful one.

well ive had a simular experience to you as in with my ds1 and dd1 being babys and vlong labours . I had epidurals with both 1 worked like a dream ,,,,, 'untill they insisted on letting it wear off for hours of pushing'
and the other was horrendous , it came out so had to have another 1 sited then it only numbed parts of my stomack and could feel everything down below includeing being 'cut' and sown up ! they didnt seem to believe me as id had 2 epidural and endless top ups by then .To top it off had to stay in hospital 5 days after with 3 of them lying flat on my back due to worse pain in my head ever because i was leaking spinal fluid, so when it came to haveing my 3rd i was terrified - turned out there was no time for an epidural altho i did ask for it but he was too quick and it was the best birth of all

Blimey tamster83 that's enough to put anyone off epis for life!

I have a mild platelet disorder so risk of bleeding and they didn't want me to have an epi with my last delivery. The cons anaesthetist said he would have been confident enough to do it but couldn't speak for the rest of the team. When I asked what would happen if I needed a CS the haematologist recommended a GA. When I said this was a bit over the top I managed to get them to agree to a spinal (think this is a one off injection into the spine no tube or top ups). Anyway I didn't need a CS but I was induced and had a very long labour, fortunately I coped on G&A but thanks marmite for reminding me what the short acting opiate is called as this was also recommended for pain relief for me but none of the MW knews what I was talking about. I've written it down now for next time. FX I won't need it.

I thought I'd update on remifentanil pca use. I did originally have an epidural but it didn't work at all even with lots of top ups of different drugs as I was induced on syntocin though they stopped as I had a seizure.

For the next attempt they hooked me up to a remifentanil PCA and check it had an effect before starting the synto (I pressed the button and felt detached from reality after a few mins . It worked really well especially in conjunction with G&A so I had pretty much complete pain relief but was able to move around. I couldn't concentrate on looking and listening at the same time so I had to talk with people with my eyes closed

I had two failed attempts at epidural. Ie they inserted into two different spots with no noticeable effect. Eventually the anaesthetist used a sonography machine the find the exact spot in my back it would take effect.

Perhaps it is worth making your midwife aware that they had trouble placing the epidural last time, to see if they can do something like this.