Experiences after a failed epidural?

[BertieBotts]

When I gave birth to DS2 in 2018, I asked for an epidural but it didn't work at all. It did nothing, I had full movement and full sensation. I never got an answer about why it didn't work because DS2 was rushed off to special care, so I was a bit preoccupied but have subsequently read things online like:

Back to back babies can "block" the epidural working (DS2 was back to back).

If you don't sit still when having it sited it can go in the wrong place which can cause this. I was struggling to stay still, as was contracting a lot and close together and I didn't understand their instructions, they just kept telling me to arch my back "like a cat" and I didn't know whether it meant a concave or convex arch, but couldn't communicate this because I didn't really have access to words at the time being incredibly overwhelmed with the stupid contractions.

Anyway. If this happened to you:

1. Did you find out/get any info about why they thought it hadn't worked?
2. Did you opt for an epidural again in subsequent birth/s?
3. If so, did it work the second time around and what was your experience?
4. Does anyone know WTF "like a cat" means - if I do have one another time I would like to know what they were trying to say??

I am pregnant again and can't decide what to do about pain relief. Scared of being let down by the epidural again - the moment I realised it wasn't going to work at all was absolutely terrifying and disappointing and I really don't want to experience that again. I am also concerned if I have it they won't let me in a pool if it doesn't work due to the infection risk of the needle site, and I really do want the pool plus gas and air if epidural isn't an option for me, since that combo was the best for DS1. But OTOH, other people's descriptions of a properly working epidural sound LOVELY and I've had two unmedicated births now and am over the idea that I can magically cope with it because I didn't really last time.

Sorry you had that experience OP. Is this something you will be able to discuss with your midwife? They might be able to find out why it didn’t work last time, which would help with knowing how likely it is to happen again.

“Like a cat” means convex, see photo for illustration. I think they said that because convex/concave could be a bit ambiguous, but obviously it wasn’t helpful for you!

Ah thank you. I can see that cats move their backs like that, but they also move their backs like this when they stretch, which is why I didn't really understand.

I don't think convex/concave would have been any clearer, I just couldn't think of a way to explain it!

Unfortunately no, I don't think I will have a chance to discuss it with a midwife. I had been hoping to but I am in Germany and I have most of my care with a gynaecologist. I am supposed to be able to hire a midwife for pregnancy care but despite being only 9 weeks every one I phone is already busy/booked up/on holiday which is frustrating in the extreme. I never managed to get one last time and managed without, since their job is really to visit you at home and provide newborn/breastfeeding tips anyway. I will see if there is any opportunity to talk to the hospital based ones but I don't know. I want to give birth at a different hospital this time as DS2 had to be transferred away from me which was a bit distressing.

Yeah I see what you mean with the arching! Definitely a confusing way to put it.

I have no idea if this sort of service is available in Germany, but in the UK you can do a birth reflection where you go through your notes with a senior midwife and they explain what happened and why, is there anything similar there? Or you could ask whether your gynaecologist can get hold of a copy of the notes from your last birth to see exactly what happened. I believe that unless you have spinal problems (eg after spinal surgery) which can make placing an epidural more difficult, the odds of it happening again are fairly low, but in your shoes I’d talk to the gynaecologist about it.

OK. I will ask her at my next appointment and see what she says :)

I have heard of the birth debrief in the UK but no idea if it is a thing here. I do have my notes from the labour because they gave me a copy to give my gynaecologist and one for my midwife in case I got one later, which I just kept. The notes are how I found out he was back to back which was a bit of a shock as nobody had told me! But explained a lot about the birth. But it's not a full transcript of the birth, just the medically significant bits.

My epidural didn’t work, I said up the dose. He said I can’t...rang the consultant, she said give her more.
It worked then.

No idea why I needed so much, but it was blissful when it kicked in.

My epidural during my 1st labour didn't work. Well , it did , but only down one side , which still wasn't much use !

They tried to re-site it 3 times and the consultant anesthetist came to try but it still didn't work. I definitely had my back arched 'like a cat' - it is a yoga term.

In the end I needed a section and they gave me a spinal block for that which worked fine.

During my 2nd labour I was very reluctant to get another epidural but they persuaded me and it worked totally fine.

My 1st DD was back-to-back which seems to match with the article you quote. I don't know of any other reason why the epidural didn't work at all during that labour but was fine with DD2 who wasn't back to back.

Sorry , just re-read your OP and it isn't an article about back to back babies blocking epidurals , but that would still make sense to me. I hadn't heard that before and didn't have a debrief so it is interesting to hear.

I had an epidural that only worked on one side. I, too, found it almost impossible to be still while it was being inserted, so maybe that's why. The anesthetist told me to lie on my left, the side that wasn't numbed, when I had a top up. But when the time came for a top up the midwife wouldn't let me move in case she lost the baby's heart beat on the monitor. Unfortunately it happened that it was just the two of us in the room at that point because dh had gone to the loo, and the other midwife - who did listen to me - has stepped out, so there was nobody to advocate for me. And I was not capable of it myself by then. In the end I had so much anaesthetic pumped into me that my right leg was numb and weak for days afterwards.

That was dc1's birth.

I did not need epidurals for any of my subsequent children's births - and each baby was larger than the previous one. Once you've given birth vaginally, your body has a better idea what to do next time, which is why each labour tends to be faster than the previous one. That's my theory, anyway (that, or the stretched rubber band!).

I remember realising during labour with dc 2, just how much pain relief the partial epidural had actually given me, even though the pain on the non-affected side had been extreme. Nonetheless I did not need anything stronger than Entonox.

It may be worth asking if you can see an anaesthetist in clinic (I imagine this is probably a thing in Germany too). Having one failed epidural doesn’t necessarily mean a second go would fail - depends what the problem is/was. An anaesthetist may be able to get an impression for how likely it is to be difficult again, and help plan alternatives if an epidural fails/isn’t a sensible option for you.

Interesting about raising the dose. I usually need a double dose of dental anaesthetic and other local anaesthetic. In my first birth I had four local injections for my stitches and I still complained it hurt but they wouldn't give me any more! I did actually mention this to the midwife when I booked in to hospital and they wrote it on my notes. I am quite small physically so maybe they give me a conservative dose and then it isn't enough?

Yes perhaps I could speak to an anaesthetist directly. I had an operation a couple of years ago and had an appointment with one the day before to discuss the different options and fill in paperwork. Thanks, this is all giving me ideas I can speak to my doctor about next week when I next see her.

Out of interest do you have any sort of hyper mobility syndrome or anything along those lines? Anecdotally people with eg EDS can be resistant to local anaesthetic.

Hope you’re able to discuss it with your doctor and come up with a decent plan for pain relief!

I have ADHD and I am a bit extra-mobile, but not enough to cause a problem or seek a diagnosis. Just bendy!

In my first birth I had four local injections for my stitches and I still complained it hurt but they wouldn't give me any more!

In my first I had a similar experience. The doctor stitching me refused to believe me, but despite local anaesthetic, the epidural (which remember only worked on one side) and Entonox, I still found the stitching excruciating. The doctor's attitude did not help, either. He treated me like an unconscious patient.

For my second birthing I had a marvellous midwife who listened to me and supported me as I needed. She understood my fear after the previous experience. She touched me and said "This is my finger, this is the needle" etc. I could not feel the prick of the needle. What I could feel was her hand on my non-anaesthetised skin, and the tug of the 'thread' being pulled through my skin. Oddly, the touch of her hand just outside the anaesthetised areas was actually painful. At my request (which, again, the previous doctor had ignored) she told me everything she was doing so that I could time my use of the Entonox.

I won't claim that the stitching was painless that time - I still used more Entonox than in labour - but it was nowhere near as distressing. Being listened to, and treated with compassion , rather than like a piece of meat, makes a massive difference.

My first labour, birthing and stitching were very distressing. The second were just as hard and just as painful, but I was better supported and I coped vastly better. The experience totally detoxified my memories of the first. I felt healed by the second. And my subsequent births were shorter, less damaging, almost exhilarating.

Yes, my experience being stitched was very similar. I was only 20 and hadn't had much anaesthetic experience before, so it didn't occur to me to ask them to give it some time to kick in (which is what my dentist always does!) and also I think I was feeling the tugging sensation, and experiencing it as more painful than it probably was.

Increasing the infusion rate/adding top-up doses often helps improve an epidural but you can't just keep adding more and more because of the risk of local anaesthetic toxicity which can cause serious complications. The maximum safe dose depends on which local is being use, how big you are and, to some extent, where it's being injected (also the time a local anaesthetic takes to work depends largely on which drug is being used - dentists use different drugs to midwives, and anaesthetists use different drugs again for epidurals). If an epidural never works then it's probably not in the right place and probably needs re-siting (depending a bit on the stage of labour). If it works a bit, then often changing position, topping-up is enough to improve things. If an epidural does fail it doesn't necessarily mean anyone's done anything wrong. The technique for inserting an epidural depends very much on 'feel' and it just isn't always that easy to feel when it's right - this is part of the reason it's so important to be as still as possible while it's being inserted (the other reason of course is that it's a pretty big needle going a long way in and right up next to some pretty important anatomy!).

If you are able to see an anaesthetist ahead of delivering they may be able to guess at why it didn't work the first time (eg if you've clearly got a scoliotic back then that may explain things)/what the likelihood is of it failing again is. They can also demonstrate the position you need to sit in (or Google has some helpful pictures). Hope that helps. (DOI: (non-obstetric)-anaesthetist)

Thank you! That is very useful :)