A product of the Patient Education Subcommittee
November 2021
I had an epidural that didn’t work.
(Why? What happened? Will it happen again?)
Your Questions
AnswerEd
1. AFTER GETTING MY LAST EPIDURAL, I DID NOT
GET ENOUGH PAIN RELIEF. WHY DID THIS HAPPEN?
This can happen for several dierent reasons:
Anesthesiologists look at and feel the bones in your
back to locate the correct space to insert the small,
soft tube (the epidural catheter) that delivers the
medication. Sometimes, the tube ends up in a space
where the medication doesn’t work as well, even though
the anesthesiologist did everything correctly, since the
exact location of the tip of the catheter cannot be seen
from the outside. If this happens to you, it is typically
not dangerous. In this situation the epidural catheter or
medications can often be adjusted to help make you
comfortable. If this does not work, the epidural catheter
may need to be replaced. Therefore it is important to let
your anesthesiologist know if you are still having pain
after the epidural is placed.
If you are very close to delivering your baby when the
epidural is done, there may not be enough time for the
medicine to work before you deliver.
Sometimes the epidural works well to take pain away
from contractions in your belly area but does not work as
well to take pain away from your vaginal area or back. If
this happens, it is important to let the anesthesia provider
know so they can see if adjustments can be made to
help get you comfortable.
Even if the epidural is working well, you may feel a lot
of vaginal or back pressure similar to having a bowel
movement - when you are close to delivering the baby. It
can
be dicult to take away this sensation completely, but
you should also let your anesthesia provider know you are
feeling discomfort in case they can help.
2. WHY DID MY EPIDURAL WORK ON ONE SIDE MORE
THAN THE OTHER, OR NOT AT ALL ON ONE SIDE?
After your anesthesiologist finds the right space to put in
the epidural catheter, the tip of that tube may end up being
more on one side of the space in your spine than the other.
If this happens, more medication may go to one side and
you may not get enough medication on the other side. The
anesthesiologist can give an extra dose which may solve
this problem or the anesthesiologist may adjust how deep
the catheter is. Sometimes the epidural procedure needs to
be redone to solve this problem. Even if the epidural works
more on one side than the other all through your labor, it
is still okay, as long as your overall pain relief is good. If
this has been a problem for you in the past, it is possible
it could happen again in a future delivery. However this is
not always the case!
HAD A LOT OF VAGINAL PAIN WHEN I HAD TO
PUSH. WHY?
The nerves that bring sensations of pain from the
contractions of the uterus are different from those
that bring pain sensations from the vaginal area.
Sometimes an extra dose of medication can help
with this pain, but it may be difficult to take away all
of this pain since we are careful about giving too
much medication, which could make it hard for you
to push.
4. MY EPIDURAL WORKED WELL IN THE
BEGINNING AND THEN STOPPED WORKING.
WHY?
This can happen for dierent reasons:
Unfortunately and rarely, the epidural catheter can
partially or completely fall out on its own before you
deliver. If this happens, the epidural procedure can
safely be redone.
It is normal for the pain of labor to get stronger as
labor goes on. It is not uncommon to need extra doses
from the anesthesia provider as labor progresses.
The nerves that bring sensations of pain from the
contractions of your uterus are dierent than those
that bring pain sensations from the vaginal area.
When the baby comes down to the vagina, those
nerves may not be getting enough medication from
the epidural. An extra dose of medication can help
with this vaginal pain, but it may be harder to control
with the epidural.
Labor pain may be felt in the back. This can be due
to the direction the baby’s head is facing. It may be
dicult to control this kind of pain, since it is so intense,
but it is important to let your anesthesia provider know
so that they can try dierent medications to help.
5. MY EPIDURAL DID NOT WORK WELL OR
DID NOT WORK AT ALL. WILL THIS HAPPEN
AGAIN?
Every labor experience is dierent, even your own
labor experiences, and every labor epidural is
dierent too! More than likely, your next epidural will
work well even if this wasn’t the case during your last
labor. It is helpful for you to have a conversation with
your anesthesia provider in advance to discuss what
happened so they can try to understand what could
have caused this and plan for anything dierent that
needs to be done next time.
SMOG Grade: 7
3. MY EPIDURAL WORKED WELL UNTIL I
