\n<\/p>\n
The first time I got an epidural, it was too late.<\/p>\n
I\u2019d heard it was best to wait, for fear the medication would run out mid-labor (I later found out this is a myth). So I gritted my teeth through hours of contractions, and when I finally told the nurses I was ready, the anesthesiologist was with another patient.<\/p>\n
Another unbearable hour passed before I finally got the medication. But by then, I was minutes away from pushing. I went through the final stage of labor feeling almost everything.<\/p>\n
When I had my second baby, I got my epidural right away, but it made me incredibly itchy. Throughout 24 hours of labor, I scratched and wiggled so much that the epidural catheter, which administers the numbing medication, fell out, was put back in, fell out again, and wore off by the time I was ready to deliver.<\/p>\n
During my third birth, the epidural provided a welcome numbing sensation on one side of my abdomen, but I still had sharp, intense pain on the other.<\/p>\n
After this experience, I was frustrated. Were my anesthesiologists doing something wrong? Was I?<\/p>\n
I\u2019ve talked to dozens of mom friends over the years. Most say their epidural was like a magic wand that eliminated their pain in minutes. Some recalled napping or watching a movie through most of labor. I was envious and dumbfounded.<\/p>\n
But epidural failure isn\u2019t necessarily the fault of the medical provider or the patient.<\/p>\n
\u201cEpidurals are complex; it\u2019s not like when you order something from a vending machine, it falls down and that\u2019s what you get,\u201d says Dr John W Patton III, director of regional anesthesia at Ronald Reagan Medical Center at UCLA. \u201cEvery patient is different, and a patient could have a different experience each time they receive an epidural, for various reasons.\u201d<\/p>\n
Here\u2019s what you should know before getting an epidural \u2013 and why it might not work as expected.<\/p>\n
An epidural is a form of regional anesthesia used for surgeries, traumatic injuries, chronic pain relief and childbirth. A thin, flexible tube called a catheter is inserted into the epidural space, a narrow corridor just outside the spinal cord. The catheter connects to a bag containing pain-relieving medication, administered through the tube to numb the connecting nerves. This continuously provides pain relief to the abdomen, pelvic region, lower back, and sometimes legs.<\/p>\n
The main ingredient in epidural bags is the local anaesthetic, says Julie Steele, a certified registered nurse anesthetist and assistant clinical professor in the Nurse Anesthesia Program at Northeastern University; common ones are bupivacaine, chloroprocaine, lidocaine and ropivacaine. Some hospitals add low-dose opioids, such as fentanyl or morphine; others add a small amount of steroid, which can also help reduce pain.<\/p>\n
Decades of research show that epidurals are one of the safest forms of pain medication for labor. \u201cStudies have consistently found no long-term effects on babies\u2019 health, development or bonding, and no increased risk of birth defects, autism or developmental issues,\u201d says Dr Ashraf Habib, chief of the women\u2019s anesthesiology division at Duke University. \u201cFurthermore, epidural analgesia has an excellent safety profile for the mother, with serious complications being very rare.\u201d<\/p>\n
However, experts say they can sometimes decrease a patient\u2019s blood pressure, which, if not treated, could put the fetus\u2019s health at risk. In rare cases, an epidural can cause postdural puncture headaches, which are treatable but uncomfortable.<\/p>\n
There\u2019s a chance an epidural may provide only partial relief, or in very rare cases, none at all.<\/p>\n
\u201cEpidurals aren\u2019t foolproof,\u201d says Steele. In her experience, epidurals don\u2019t work as expected about 10% of the time, though studies report epidural failure rates range from 8% to 23%.<\/p>\n
\u201cYou can\u2019t get a 100% success rate with any medical procedure, including epidurals,\u201d says Dr <\/strong>Michael Bottros, an anesthesiologist with Keck Medicine of the University of Southern California. \u201cSomeone might have a great experience with their epidural one time, and then it doesn\u2019t work at all another time. But that doesn\u2019t mean anyone did anything wrong.\u201d<\/p>\n He says there are many variables to consider.<\/p>\n The epidural catheter might not be in the right spot: <\/strong>If the tip of the catheter isn\u2019t in the correct location, the medication may not reach the intended areas. If this happens, it might not provide adequate pain relief, or there may be patchy coverage, experts say.<\/p>\n Correct placement can be difficult \u201cbecause everyone\u2019s anatomy is so different\u201d, says Steele. For one thing, the distance from a person\u2019s outer layer of skin to their epidural space can vary. Plus, epidural spaces themselves are uniquely shaped and sized. Other factors include body type, past surgeries, injuries, tissue structure, whether or not a person has scoliosis and nerve placement.<\/p>\n Even if the catheter is placed well, it can migrate during labor. \u201cThe patient may be getting in different positions, going on all fours and standing, squatting, then lying back down,\u201d explains Steele. \u201cSweat can get in between the tape and the skin, and the epidural catheter may move around.\u201d<\/p>\n Luckily, fixing placement issues is generally quick and easy. Gentle adjustments to the tube or helping a patient change position may help, says Steele. Otherwise, the provider may take the catheter out and start again.<\/p>\n skip past newsletter promotion<\/p>\n Practical advice, expert insights and answers to your questions about how to live a good life<\/p>\n Privacy Notice: <\/strong>Newsletters may contain information about charities, online ads, and content funded by outside parties. If you do not have an account, we will create a guest account for you on theguardian.com to send you this newsletter. You can complete full registration at any time. For more information about how we use your data see our Privacy Policy. We use Google reCaptcha to protect our website and the Google Privacy Policy and Terms of Service apply.<\/span><\/p>\n after newsletter promotion<\/p>\n The dosage may need adjustment: <\/strong>Providers want to give patients a high enough dose of epidural medication so they have relief, but not so much that they\u2019re at a higher risk for side effects or complications such as low blood pressure, being too numb to feel when to push, nausea, vomiting and itchiness, Patton says.<\/p>\n But patients should speak up if they\u2019re in need of more medication. Patients \u201cmay require more medication as labor progresses and contractions become stronger and more frequent,\u201d says Patton.<\/p>\n In addition, people metabolize medicine differently. \u201cSome people metabolize numbing medicine very quickly, and need higher than normal doses,\u201d Bottros says.<\/p>\n Some notable studies have found this is true for people with red hair. The gene mutation that causes red hair can also cause variations in pain perception and medication metabolism. \u201cBecause of this, higher doses of local anaesthetics may be required for redheads,\u201d says Steele.<\/p>\n The patient responds poorly to a particular formula: <\/strong>Each hospital has its own unique epidural formulation, created in response to its anesthesiology team\u2019s experience, published evidence or data, and patient feedback. \u201cAnesthesiology teams often develop a standard mix based on what\u2019s worked best for their patients and clinicians,\u201d says Habib.<\/p>\n Patients may respond differently to the various epidural components. Opioids improve pain relief and allow for lower doses of numbing medications, but some people experience side effects, such as itchiness, says Habib. Plus, some patients may be allergic to a particular anaesthetic or preservative, points out Bottros.<\/p>\n Generally, patients don\u2019t know if they\u2019re going to have a reaction to any of the ingredients until after the fact. For my second delivery, I didn\u2019t know the fentanyl in my epidural would make me so itchy. (I didn\u2019t even know this hospital\u2019s formulation contained fentanyl until I asked.)<\/p>\n If patients know they shouldn\u2019t have a particular ingredient, providers can have a custom formulation prepared \u2013 but this requires time.<\/p>\n The timing is not optimal: <\/strong>Experts say some patients mistakenly believe that epidurals will \u201crun out\u201d \u2013 as a result, laboring parents try to put it off until they feel they really need it. Some then find themselves in pain for hours, and risk delivering their baby before the epidural has time to kick in. (This is what happened during my first delivery.)<\/p>\n But this is a myth, says Steele. The epidural slowly administers medication through the catheter, she explains, and when the medication bag is empty, the provider can simply attach a new one. The whole point of epidurals is to provide a steady stream of relief for an extended time, says Steele, and it can remain in place for multiple days. \u201cFortunately, labor epidurals are rarely needed for that long,\u201d she adds.<\/p>\n Where did this belief in the limited epidural originate? In the early 2000s, it was recommended to wait until the cervix is 4cm to 5cm dilated, partly due to concerns that early epidurals might slow labor or increase the risk for a C-section, says Habib: \u201cHowever, well-conducted studies have shown that this isn\u2019t true.\u201d<\/p>\n So, there isn\u2019t any particular stage of labor you need to wait for. \u201cIf you\u2019re uncomfortable and feel ready, you can safely request an epidural,\u201d Habib says.<\/p>\n Preparation and communication can help. Pregnant people should carefully prepare a birth plan with their doctor and discuss potential options ahead of birth, including whether or not they want an epidural, Patton says; some providers offer options for communicating with the obstetrician anesthesia team ahead of labor. If this is an option, they can ask questions about pain relief when they\u2019re less anxious, says Steele.<\/p>\n When it comes time for delivery, Steele recommends laboring patients call the anesthesia professional as soon as they get to the hospital.<\/p>\n \u201cThe earlier you can talk to anesthesia, the better,\u201d says Steele, \u201cSome people worry that if they call anesthesia, that means they have to get an epidural right away. And that\u2019s not the case at all.\u201d<\/p>\n Calling the team earlier means they have more time to learn about any requests and get consent for the epidural, making for a much smoother process.<\/p>\n \u201cEvery epidural is different, and they, like babies, don\u2019t always follow the book,\u201d says Steele.<\/p>\n","protected":false},"excerpt":{"rendered":" The first time I got an epidural, it was too late. I\u2019d heard it was best to wait, for fear the medication would run out mid-labor (I later found out this is a myth). So I gritted my teeth through hours of contractions, and when I finally told the nurses I was ready, the anesthesiologist<\/p>\n","protected":false},"author":1,"featured_media":35239,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[51],"tags":[4764,19889,1845,2538],"class_list":{"0":"post-35238","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-births","9":"tag-epidural","10":"tag-expected","11":"tag-worked"},"_links":{"self":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/35238","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=35238"}],"version-history":[{"count":0,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/35238\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/media\/35239"}],"wp:attachment":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=35238"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=35238"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=35238"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}What will give you the best chance of an effective epidural?<\/strong><\/h2>\n