Epidurals/Spinals

[whenyouknow1youknow1]

Hi, just wondering if anyone else has had similar experiences to me. Wished I'd asked for things to be explained to me after my last birth.

First labour was an induction, failure to progress, hyper stimulation etc etc. Requested epidural...had 3 and none took. Had c-section and it took the anaesthetist long time to get my spinal in place (over an hour). I still had sensation, could move my legs etc.

Second baby...planned section. Similar problems with my spinal. I eventually had what they called a pain block but not motor. Still had full leg movement. Surgeon etc happy to go ahead. Lots of discomfort and just at the point my daughter was born the pain became horrendous and I had an emergency GA. I was in agony afterwards, much worse than after my emergency section.

Has anyone else had trouble with anaesthetics or can explain what happened? I know it shouldn't matter now but it's been on my mind a lot.

Sorry you had such a rubbish experience must of been really scary. Are you planning a third baby? @whenyouknow1youknow1
Not the same but I had an epidural and it 'didn't worl' could still feel everything but legs numb and was stuck on the bed- hideous. I then went down for a section and I was really paranoid I was going to feel it I begged them to make sure I wouldn't and they did the freeze spray thing up my body and I didn't feel it until they got to my neck!! After baby was born I couldn't lift my hands for about 45 minutes it was awful

There are several reasons that this may have happened, mainly structural. It doesn’t necessarily mean anyone’s done anything wrong, but just every so often neuraxial blockade really doesn’t behave quite as you’d expect (it’s essentially a blind technique so we can’t see if there’s anatomical oddness on the inside where the local is going). Spinals are often a bit more predictable than epidurals, but even then sometimes misbehave....I’ve done two this week (for different operations) where the motor block took a lot longer than I’d expected but the patients couldn’t feel a thing, chatted away through their operations, but could also still move a bit. Where there’s a clear advantage to trying to avoid a GA (which there is much of the time in obs) then it may be worth trying to proceed but understanding that going to sleep if it’s unbearable is the back up and that that will be performed immediately if it is necessary. There are a couple of things that can still be uncomfortable even with a good spinal though, and the bit where they’re pushing quite hard to get the baby out is one of those bits. Once the baby’s out that’s most of the really stimulating stuff done, but if the block’s misbehaved early on, then it’s possible it could wear off quicker than usual too so that could explain the pain being worse later on.

If you’re particularly keen to find out more about what happened specifically to you then I’m sure the anaesthetist(s) would be able to chat and talk you through things. If you’re thinking of having another baby, I’m pretty sure they’d be able to see you to consider a plan for delivery in the future. Hope that helps a bit.

Thank you both for your responses, 90% certain I'm finished at two The anaesthetist for my second section was fantastic, made me feel in control and explained everything. Most of the pain was after the actual birth....just as soon as baby was out. I found out afterwards I had a lot of scar tissue on my bladder from my previous section so the surgeon was correcting that. Before the surgery started they joked in theatre that I could have my tonsils out as well as the numbness had gone that high, verified with the sprays etc.

Didn't mean to imply that it was someone's fault if that makes sense. The care I had both times from everyone involved was fantastic. Especially the anaesthetist the second time around. Make me feel in control, as daft as that might sound and was on the ball with pain relief when I was in recovery afterwards etc.

Sorry that happened to you - it’s very traumatic. I had a c section with my third and the anaesthetist tried quite a few times to fit a spinal and in the end send she had ran out of needles and that we would go for epidural. The epidural didn’t completely cover the pain and I was in a lot of pain during the section. Worse was after baby was out - I couldn’t even look at her. I didn’t want a GA and she was excellent and topped me up with all sorts of drugs and gas and air and held my hand. I was very grateful to her. I had a debrief after which helped and it was just the case of being ‘unlucky’ for me I am told. I am due my fourth in a couple of weeks and I have to be honest I’m terrified now. I’m waiting on an anaesthetic review as it’s not clear if I can try for a vbac or need a section again. I’ve been told I can have a consultant anaesthetist do it this time but I’m just so frightened. I had an epidural with my first and that worked very well - to the point where it worked too well and I couldn’t feel any contractions or sensations whatsoever to push. In my section I was wiggling my feet a lot which I couldn’t do either with my first. X

That sounds scary, in our trust you can call the midwife/labour ward to speak with the consultants or anaesthetists for a debrief if you’re struggling with coming to terms with what happened to your body.

I’d recommend seeing if that option is available for you? They’ll still have everything on file, I think they said they keep it a few years with us.

@Lovemylittlebear goodness, really hoping you have a much better experience this time. I was the same with regards to my baby...couldn't even concentrate to look at her never mind hold her. Well done you for working through it...I was relieved when they mentioned GA.

@FTEngineerM thanks, maybe something I should look into. I definitely would if I was 100% planning another little one.

@whenyouknow1youknow1oh it was only because I was too scared to have a GA - would have been much better to have one I’m sure. I was also worried I would hemorrage and they might not notice lol which I did afterward and had to alert the midwife - bit of a control freak lol. I hope that you can have a debrief x

Have either of you ladies had any problems with local anaesthetic being ineffective or just the epidural/spinal? I've had problems with ineffective local anaesthetic (dental experiences, and post-natal episiotomy stitching - the latter was excruciating and traumatised me). I don't know why this is and I'm now pregnant with no.2 and thinking about pain relief and birth options. However I'm worried that my poor response to local anaesthesia would mean I'd be more likely to have a poor response to epidural analgesia or are these totally different and it's not likely to be the case? Not sure if anyone knows?

Goodness never even thought but yes. Similar experience when having wisdom teeth extracted. I also have a fairly high tolerance to pain relief. I was in recovery for about five hours after surgery as they couldn't get my pain under control.

No idea if there's a connection though 🤷🏻‍♀️ I hope everything goes well for you.

Very interesting! I spoke to the consultant midwife about this at my birth debrief (but didn't think to ask about epidural analgesia as I didn't have one). She said for some people the local anaesthesia dissolves into the skin straight away so it doesn't provide effective pain relief (or something like that!). I'm so confused about what to do for mode of delivery this time as I'm terrified about tearing again because of having stitches without effective pain relief, it was worse than my labour pains! But then I'm terrified of an elective in case the spinal doesn't work properly! Would love your opinion @greybeardy

Local anaesthetic resistance certainly is a thing, but there are other, probably more common, reasons for local failing. Local anaesthetic 'dissolving in the skin' sounds like witchcraft to me!

In the context of dentistry I suspect either infection/inflammation is the most likely thing, although I'm not a dentist (the acidity caused by infection reduces the effect of local anaesthetic).

Not getting enough local in the right place/ waiting long enough for it to work may be a factor in any type of local anaesthesia.

Different anaesthetics have different onset times and different duration of action and that has to be factored in to what they're being used for. If a drug works for a bit but wears off then a top up may be needed. There are however max doses for local anaesthetics and going beyond those can cause problems even if the local isn't effective.

Some people do seem to be genuinely resistant (and some connective tissue disorders in particular are associated with that), but the mechanisms aren't terribly well understood as far as I know. Anatomical variations that make it difficult to get the local in the right place may also be important in epidural/spinal block.

Occasionally people's expectations confuse things too (not saying that's a factor for any of the pp's, but just that it can be). Even with good local it's pretty normal to feel something is happening even if it's not painful. People who are expecting to feel nothing at all may find this distressing (i tend not to tell people they'll feel absolutely nothing because it isn't usually true).

Having had failed local and a painful experience understandably makes people nervous about repeat efforts. Just because it's failed once, doesn't necessarily mean it'll fail again though. Different bit of anatomy, different drug, different set of eyes and hands doing the local may all mean that things do go better. For someone who's had multiple previous failures of local it probably is worth trying to see an anaesthetist pre-delivery so a plan can be agreed for what could be the back up options in the event of another failure. The options might be different depending on circumstances (eg. epidural for labour/ epidural or spinal for a section/ local infiltration for repairing tears, etc). Hope that helps.

Thank you so much, that's so hopeful and hopefully helpful for OP and other people with similar experiences. I'm only early on in my pregnancy but I will raise this with the midwife next time I see her and push for a discussion with a doctor about it.