What is Epidural Failure?
There are several medications which are used to ease labor and delivery pains. Spinal blocks and epidurals are the most used and these can fail to work as intended. Here, we look at epidurals and address the issue – what is epidural failure?
Spinal vs. Epidural Block – what is it and how does it work?
Delivering a baby is hard and painful work for the mother. To make the experience less painful, doctors offer epidurals and spinal blocks to make it easier to deliver. The difference between the two is as follows:
- An Epidural block is the most common drug used to relieve labor pain and offer a more comfortable delivery. It is a combination of anesthetic medication and analgesic pain relievers which are delivered into the body via a catheter in the back. The drug blocks pain signals and it numbs the body below the waist. Women who get epidurals are awake during labor and can push the baby out at the right time.
- Spinal blocks also work in the same way by numbing from the waist down. The big difference is that the drug is delivered into the spinal cord, with an injection. This works fast but wears off after a couple of hours.
- Combination spinal-epidural blocks work fast and offer the benefit of both. Pain is kept at bay longer than a spinal block.
These methods help to make labor less painful but are not without risks. As far as epidurals are concerned, there are side-effects like low blood pressure, headaches and itching to name a few. In rare cases, patients who opted for epidurals have had serious side effects. Knowing what the side-effects could be will help in making an informed choice.
Common side effects:
- Itching: Epidurals have a combination of drugs which include opioids. These can make your skin itch badly and it can be counted with other medications to relieve the sensation.
- Nausea: Some women can experience severe nausea and vomiting due to the opioids in the drug.
- Fever: Just like some women experience nausea, others who get epidurals can get feverish. The reason for this is not known and the percentage is 23% of women.
- Soreness in the back: You should feel soreness in your back after labor, but this should not last more than a few days. Back pain is common for most women as the distended belly puts pressure on the lower back. It can be hard to tell if this is due to delivery or the epidural. Do consult your doctor if this persists.
- Lowered blood pressure: About 15% of women who get an epidural experience low blood pressure. It is a good idea to monitor blood pressure during labor to ensure proper blood flow to the fetus till it is delivered. Usually, doctors give women IV fluids in the labor room to reduce this risk.
- Difficulty in peeing: Some women may have a numb bladder due to the epidural. In such cases, catheters are used to assist in urinating, and this goes away when the effects of the epidural wear off.
Some of the rare side effects include severe headaches, breathing problems, nerve damage and infections. Headaches occur when the epidural needle pierces the spinal cord membrane and there is a spinal fluid leak. This can be treated with pain relievers and lots of fluids. Though infections are rare, it can happen as the skin is pierced with a needle. Nerve damage can occur if the epidural needle touches a nerve. This can result in temporary or permanent loss of feeling. If you feel some symptoms, let the anesthesiologist know immediately so they can help in reversing the effects.
What if the epidural fails to work?
Epidural anesthesia failure happens more often than is reported. Reasons for the failure are incorrect placement of the catheter, movement of catheter after primary placement and most of all, suboptimal drug dosage. Monitoring is essential to the pain management process and may require re-siting of the catheter as well as drug dosage.
Outlook on the use of epidurals
Epidural failure is known to occur, but it is rare. If a trained anesthesiologist performs the task efficiently, you will not have any problems. You have other options for pain relief, drugs as well as natural techniques which can help in dealing with the pain. These are:
- Breathing techniques or Lamaze
- Relaxation methods
- Water immersion
- Medications which can be inhaled
Talk to you your OB/GYN about the pros and cons of each. Drugs can help immensely with pain relief, but serious side-effects can also occur. While natural techniques don’t mitigate pain as effectively, it is up to you to decide what to do.