“Why isn’t it working?!” I yelled into the labor and delivery room, hoping someone — my doula, my husband, the nurses — would have an answer. It was 20 minutes after the anesthesiologist had administered my epidural, and my contractions were worse than ever. The one and only thing on my birth plan was getting an epidural, and nobody had warned me that some epidurals fail (obviously I knew it was a possibility, but I figured it was incredibly rare).
“I can’t do this,” I told my doula, begging her to find a solution for my pain. “I thought I was supposed to be feeling better by now.”
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I had been at the hospital for about eight hours when I finally asked for the epidural — my water had broken in the middle of the night and contractions hadn’t started in earnest until 12 hours later, around 4 p.m. By 8 p.m., I was 6 cm dilated and ready for some pain relief. The anesthesiologist administered the epidural flawlessly (although, I have to say, sitting perfectly still while having contractions isn’t particularly easy), and I laid down in the bed so it could work evenly. The first two post-epidural contractions felt a little better, and the anesthesiologist told me I should feel the full effect of the epidural within a half hour, but the pain should start to dull in just a few minutes.
Forty-five minutes after my epidural, I was in more pain than ever. I didn’t understand why the epidural was providing no relief whatsoever. The anesthesiologist promised he’d come check on me as soon as he finished administering another epidural — he might be able to increase the medication or remove and replace the epidural.
When the pain was unbearable, my doula called in my doctor, who decided to measure me again; I was 10 centimeters. “Are you ready to have a baby?” the doctor asked excitedly.
“Uh, no,” I replied. “I’m waiting for my epidural.”
“No such luck,” my doctor told me. It was time to start pushing.
Thirty minutes later, my beautiful daughter was born.
After giving birth, it took me some time to process the fact that I had actually delivered a baby. I thought I was totally prepared for birth, but my epidural not working took me by surprise. I decided to look up how often epidurals fail — I was shocked to learn that epidurals have a failure rate of just over 10 percent.
What Is an Epidural?
According to the American Society of Anesthesiologists, “An epidural is the most common type of anesthetic used for pain relief during labor.”
Unlike what many people believe, an epidural used during labor isn’t administered one time with a massive needle. “If you choose to have an epidural, an anesthesiologist will insert a needle and a tiny tube, called a catheter, in the lower part of your back,” explains the American Society of Anesthesiologists. “The needle is removed and the catheter left in place for delivery of the medication through the tube as needed.”
How Often Do Epidurals Fail?
There’s mixed information about how often epidurals fail, but most studies report an 8% to 23% epidural failure rate. According to a study by Katherine Arendt and Scott Segal published in Reviews in Obstetrics & Gynecology (shared by the National Library of Medicine), a comprehensive review of over 19,000 deliveries “demonstrated an overall failure rate of 12%.”
That said, 46% of failed epidurals in the study became functional with simple manipulations (like adjusting the catheter or replacing a poorly functioning catheter). In the end, 98.8% of patients reported adequate pain relief. This is probably why epidural failures aren’t commonly discussed — since most patients end up happy with their pain management options.
Why Do Epidurals Fail?
There are a number of reasons epidurals can fail. According to Arendt and Segal’s study, the causes of epidural failure are:
- improper initial needle placement
- improper catheter placement
- catheter migration during labor
- patient has problematic anatomy (like uncorrected scoliosis or a history of back surgery)
- patient’s labor progresses more quickly than expected
Why My Epidural Failed
The most likely reason my epidural failed is because my labor progressed so quickly. Between 12 p.m. and 8 p.m., I went from 3 cm dilated to 6 cm dilated, but from 8 p.m. to 9 p.m., I went from 6 cm to 10 cm. Although my epidural was placed properly, it wasn’t able to take effect before it was time for me to push.
When all was said and done, I still had a relatively easy labor and delivery (I say relatively because all childbirth is hard). Everything went very quickly, and after nine long months of pregnancy, my childbirth experience felt incredibly fast. The fact that I had an essentially unmedicated birth came as a huge surprise to me, but the timing of my delivery was a surprise, too.
So you might be wondering, if I choose to have more kids in the future, would I skip the epidural? Since I’ve done it without pain relief, would I do it again? The short answer is no — I’d love to try for the epidural again. The long answer is… I don’t know. Labor is unpredictable! I’ll just have to see what happens.
