Failed epidural during C section - how rare is this and has it happened to any of you?

[TeddysMother]

Hello,

I had my baby last month and had a quite traumatic birth experience. I am wondering if anybody on here has had something similar and also wondering how common this really is.

Long story short, I had to have a emergency C-section following over 20 hours of induced labour. I had had an epidural fitted during the night which was working wonders. I got into surgery and they topped it up until I couldn't feel anything.

Then they began surgery. The first issue was during the initial incision I felt what was initially like a scratch along my stomach followed by a very sharp pain. I made them aware at this point that I could feel the epidural was increased and they were happy to proceed.

The C-section was going well. I only felt the typical tugging that other people describe and then all of a sudden it went very very sharp. I told them the surgery was paused and I was basically left wide open whilst they put me under anaesthesia. This process wasn't instant and the pain I felt of basically being wide open and what they had done really hurt. Unfortunately they only had one more incision to make which was my uterus so I was extremely close to being able to meet my son being born, but this was taken away.

I do want another child but I now feel scared of having a C-section. The pain of the surgery was one thing, but knowing that my son was born and I wasn't there for him for quite a while, really hits an emotional pain I was never prepared to have as I had a major hemorrhage on top of the anaesthesia. It was a long time until I could even focus my eyes on my son and that hurts.

Did anyone else have a similar experience to any of these aspects? And does anybody know how common a child birth like this actually is?

Thank you very much for taking the time to read this.

It happened to me but I don’t know how common it is, sorry! From others in a similar boat I’ve spoken to, the pain of not seeing them enter the world doesn’t go completely but it fades slightly. I’m still in the raw phase and we ended up in the NICU as well and not knowing which baby was mine still haunts me but I hope one day I can do it again. Sorry if that’s not what you want to hear but I found there aren’t many of us in this boat. Wishing you luck 💐

Hi, I had a similar experience (in my case I started experiencing pain after my baby was out, while they were trying to sort out a haemorrhage). They offered to put me under general anaesthetic but I declined so they paused the surgery while they upped the medication. They were able to get me up to the right dose and finish off. However due to these issues I didn't feel comfortable to hold my baby as I was in pain and shaking/panicking so I was only given her when being taken to recovery which was tough.

It was awful and unexpected. My understanding is that it is more common in C-sections done under topped up epidural rather than a spinal block. If I was to have another C-section I would specifically request a spinal block as I wouldn't feel comfortable to have it under epidural again.

I will say when you feel ready, you may benefit from a birth debrief (ask your midwife) to help you to make sense of it a little.

I had an epidural for my first for ventouse with possible c section and it only took on one side. I have since been diagnosed with Ehlers-Danlos which means risk of local anaesthetic not working is much higher.

I have had many things done on the NHS recently and am now at the stage they will agree to use deep sedation as the jabs on their own are often not enough. It's also common in people who are hypermobile and redheads too apparently.

Sorry you didn't get to meet your LO, if it's any consolation I'd been in labour for 38 hours by the time DS was born and was so unwell I turned over and left DH to him so they could work on me and I could try and rest. I came to terms with that quite quickly.

Hope you recover well

obs anaesth PoV... it's not that common, but not unheard of either. Epidurals can be a bit more unpredictable than spinals, but if one's worked well during labour then that usually means it should top-up well. The block should be well tested before starting surgery and obviously they shouldn't proceed until the testing looks good, however, just occasionally epidural don't behave quite like we'd expect. It can happen with spinals too, although is a bit less likely. It sounds like they did the right things by pausing, topping-up further, offering a GA. There is a limit to how much you can top-up an epidural without causing increased risk (of local anaesthetic toxicity, or the block getting too high, but still not dense enough where you need it). Doing a spinal on-top of an epidural that's worked well in labour/has already been topped-up a bit can also be a bit hairier, but can be an option. For most women, doing a GA is higher risk than both epidural and spinal so it's sensible to try and avoid that where possible, but if the alternative(s) have failed then it's the only remaining option. The anaesthetic decision making isn't always super-straightforward in obstetrics!

If someone's experiencing pain intraoperatively then the management depends a bit on where the surgeons are up to in the operation - if it's right at the start/baby's not out yet and an epidural's been topped-up as far as safely possible the GA is the only option really. If it's right towards the end, then sometimes a bit of IV pain relief +/- local anaesthetic by the surgeons and a bit of gas and air to breathe will do the trick, but GA remains the back-up plan. Sedation is not usually an appropriate option in obstetrics.

OP if you have questions/ want to chat to an anaesthetist then most units should be able to arrange an anaesthetic debrief appointment/planning for a next delivery (if/when you're ready). Having had one disappointing top-up doesn't necessarily mean it would be a problem again, but they'd be able to give you a better idea based on the exact details of what happened this time/ what the best plan of action might be for different scenarios in the future.

My understanding is that it is more common in C-sections done under topped up epidural rather than a spinal block.

Exactly this @MarinaRuby

A spinal block is stronger and goes deeper - it's what they'd usually give you if you don't already have an epidural in.

But if you've started off in labour with an epidural, it often works to top that up.

Ask for a spinal block next time OP, if you do have another.

I’m so sorry to hear your experience. I had a bad experience, 28 hours of labour with an epidural, then an emergency c-section. Prior to this I’ve had 3 instances of anaesthetic failing so they were patient doing tests in theatre ( well as much as they could be in an emergency situation ) so they had to put me under a general anaesthetic.

I was so worried in my recent pregnancy so I had many discussions with the anaesthetist prior to labour. I recommend you do the same in any future pregnancies.
It was agreed that if I had an epidural in labour, they would then give me a spinal anaesthetic if i needed a c-section to insure it worked.

I had a 30 hour labour, then emergency caesarean. I reacted strangely in labour to the epidural, it worked but not always in the
way the midwifes thought.

I’m glad I had many conversations prior to Labour as it made my anxiety a little easier, the spinal pain relief worked. Apparently the epidural failure rate is actually quite high!

Please make sure you push for things, this experience was better because Labour & anaesthetic was discussed in detail prior.

So sorry to hear your experience OP. I had an induction with my eldest, eventually has a spinal block for pain relief then epidural. After the spinal wore off I could feel the contractions again even with the epidural. then long story short I ended up having emcs and just after my son came out I was put under GA. no choice, it just happened. I can barely remember a lot of it, I think my brain has blocked most of it out. It was horrendous and I remember feeling so sad that I don't remember my son's first moments because it took so long to come round from the GA and when I did, I wasn't myself. But he is now 5 and a half, and it doesn't bother me nearly as much now. I found his birthdays hard, until his 5th one and that felt normal and happy. Previous birthdays I'd keep checking the time and be thinking about what had been happening at that point in the labour etc. I had a debrief with my community midwife and that really REALLY helped. I would 100% recommend if you can.

I've also since had a second by elcs and it was totally different and I'm now pregnant with #3 and will have another section.

I had a failed epidural then a failed spinal block (they tried twice), so I had to have a GA.

To be honest by that stage I just wanted baby out and it had all gone so wrong I was just happy to go with it, there also wasn’t much time!

I woke up to my DH holding my son and we’ve had no issues with bonding, despite the unusual way he came into the world!

There’s no easy way to give birth and I do find from my friends everyone wishes something was different about their birth experience.

I also went on to have a VBAC which I do think helped to put it all to bed.

My epidural wore off towards the end of my emergency caesarean, while my incision was being stitched up I think. They said if I couldn't endure it I'd have to have GA but as I was nearly done I said to continue , (it felt like it was a bit of a threat tbh).They went to move me on to a trolley and I remember them exchanging glances when I said 'it's ok, I can move my legs by myself'. I had another baby by emergency caesarean 13 months later (!) but that one was fine, and I'd had a good discussion with the anaesthetist about previous experience

You might be interested in season 2 of the podcast "the retrievals" from the New York Times. It's about failures of anaesthetia during C-sections.
Be warned, it's not easy to listen to, but it is very informative and deeply moving.
https://pca.st/episode/731cf33a-69a1-4121-847e-d741710d6e2b

It happened to me , baby was two weeks overdue , was induced and quickly went into labour, epidural didn’t work and I ended up haven’t a very traumatic emergency c section. No idea why it didn’t work but I was bleeding badly and the emergency c section saved both of us, sad I wasn’t awake for quite sometime after and on waking didn’t realise I’d had the baby and struggled afterwards with pain and also to bond, but were both alive and that’s what counts.

So this exact thing hasn't happened to me but I was told I had a 1 in 5 chance of needing GA and if I did it would happen mid surgery ( ie similar to you) the Anesthetician walked me through what could happen in detail and I felt very prepared and accepted this was a real possibility.
If it had happened I think I would have been okay because I was prepared.

I didnt need GA but what no bothered to fucking mention was my child statistically was very likely going to end up in nicu with hypoglycemia. It was not discussed in any detail maybe one sentance max obtusely referencing it in my pregnancy. It was my 2nd baby my first needed a heel price test it took 2 secs was fine and we were discharged in 24hrs post section.
I was totally unprepared for a 3 week nicu stay it left me honestly with some form of ptsd. I had no faith or trust in the Dr's as things kept going wrong. I truly believed my child might die at points

I got talking therapy and it got worse I was having panic attacks at one point about 6m pp.
In utter desperation i tried something called 3step rewind (which honestly i would dismiss as mumbo jumbo if described to me but I was desperate so thought fuck it!).

It was, no lie, transformative. Its like I was trapped in time. Every time I thought about the birth I was taken back to that moment and it felt overwhelming like a tsunami.
3step rewind let me hit "play" and start moving forward. It all feels less raw and more processed now.

I think your behaviour/ response is totally normal in this situation.
You will likely need to heal mentally as well as physically I cannot recommend 3 step rewind enough.

Edit hospital debrief helps some people. It actively made it worse for me.

Your experience sounds awful and you're right to feel traumatized.

I'd request a spinal block next time. I had them with both of my sections and they were fine, no pain at all

I had an epidural that just didn't work. I was induced and in labour for hours well over a day. In the end my blood pressure was that high i was given a spinal block and taken into theatre to deliver my baby, if they couldn't deliver with forceps i would have had a cesarian. There were 9 or so people in the room and it was terrifying. They did manage to deliver with forceps. I wasn't able to breastfeed. There were other issues as well due to the midwife not understanding my daughters position in the womb and it was really quite a bad birth experience. I really should have complained.

It isn’t always quite so straightforward if you already have an epidural in. Best bet is to have a conversation with a real-life anaesthetist who can talk through the various options in different scenarios for the individual customer in front of them.

Not quite the same but I tried to have an epidural with my first baby (vaginal birth) which completely failed - it made literally 0 difference.

I then needed category 1 EMCS with my second baby and tried the epidural first but it failed again which thankfully was discovered before the C-section started. I had GA instead.

I needed a category 1 EMCS again with my third baby and this time they did a spinal straight away (which did work) because epidurals don't work for me for some reason.

Yes it happened to me back in 1995 with my second EMCS for failure to progress. Absolutely horrible. They topped it up but it still hurt a lot. I never had another, but that was from choice rather than fear of it happening again. The first one had gone absolutely fine.

This happened to me with an elective CS. Just like you, I was feeling the expected tugging and then suddenly, a sharp pain. They topped up, tried again, same thing happened. They explained they were close and would have to put me briefly to sleep. My DH said I wasn’t out for long, and though I missed the moment of birth, I was awake to give him a first kiss after they’d done the apgar checks etc. I was a bit woozy though and don’t remember much of the return to our room. It didn’t affect my bonding or bf, luckily.

When I was due for my second ELCS I did talk to the anaesthetist about it and they explained it can happen, as @Greybeardy said. In the end though it was fine.

Yes, but if she doesn't already have an epidural

If someone doesn’t already have an epidural in (for labour analgesia) it would be very unusual to site a de novo epidural for a c-section or any other procedure in theatre - a spinal would be the more common neuraxial block (there are a few exceptions, but not many).

Yes it happened to me.
They also had the wrong blood type saved for me so had to recover the blood I lost and transfuse that in to me post surgery. Had I not told them that the blood type written on the board was in fact incorrect (both blood and rhesus type) I dread to think what could have happened.
As for the failed spinal, I was telling them that I wasn't entirely numb and could still move my foot but was assured that they had seen an appropriate drop in my blood pressure to assure them that the anesthetic was sufficient.
The pain when they delivered my DD was phenomenal and another anesthetist rushed in and gave me a GA.
This all happened in 2013, however traumatic it was both my DD and I survived to tell the tale, which is the important thing .

It happened to me but the pain was an intense heat as if I was being burnt rather than sharp pain ? The epidural had been incredibly hard to place with 3 attempts then a consultant came to do it whilst I lay on my side as they couldn’t do it with me sitting . I think it just didn’t work in one side

Yes, that's how I would explain it. Like somebody burning my abdomen. Very odd sensation

The blood type written on the board won’t have made a blind bit of difference - the lab would have provided the correct blood based on your group and save samples and the products crossmatched for you would have been checked against your id before it was set up. Using the cell saver to give you back your own blood is a good idea when it’s an available option.

I'm presuming the cell saver was used as the group and save matched the blood type on the board, rather than my actual blood type?
Otherwise they would have used the blood they had stored for my group and save?

They looked rather panicked when I pointed out the error and tried to tell me I was wrong, however it was my fourth c section and I'm rhesus negative so even my husband was aware that the blood type on the board was incorrect and told them this.
When they then checked my notes they did apologise for their error.