What to Do When the Epidural is Not Working

5 Things to Help When the Epidural is Not Working

Pregnant woman in labor on hospital bed
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Epidural anesthesia is a common and effective form of pain relief in labor. It is a regional block, meaning that it blocks sensation in a region of your body, usually this is from your "nipples to your thighs". For the vast majority of moms who receive an epidural, they are pleased with how well it works as pain relief for their labor. Though sometimes, for a variety of reasons, an epidural might not provide you with complete pain relief coverage.

If you find that your epidural is not working, do not panic. There are still things that can be done to help relieve pain in labor. Here are your options:

Try flipping from side to side.

Sometimes you might have one spot that isn't quite numb or isn't as numb as another side. Your labor and delivery nurse can help you move from side to side in an effort to help you get better pain relief from the epidural. In general a position change may be helpful, even if not side to side. Your labor nurse or anesthesiologist can help you, also ask if a peanut ball might be helpful.

Increase or change medication. 

Your anesthesiologist may decide that you need more of the epidural medication or a different medication. This can be done without redoing the epidural, as the catheter is still in place. This means medication can simply be added or altered with no work or additional pain from a procedure on your part.

Replace the epidural catheter. 

In some cases, the problem may be with the placement of the epidural. This means that by redoing the epidural, you may get better coverage. This is not terribly common, but can happen.

Use IV medications. 

IV pain medication can be used in conjunction with an epidural. You can ask your nurse what has been ordered as a standing orders by your doctor or midwife.

These are usually not given very late in labor, so be sure to ask earlier in your labor what is available. They can also be used as a temporary relief while the cause of the problems with the epidural is figured out. They are given easily through your IV and take effect fairly quickly, helping you to relax during contractions, but not removing all sensation.

Call on skills from your childbirth class. 

When all else fails, you can always fall back on the pain relief skills you learned in childbirth class, particularly relaxation and breathing. Depending on the situation with the epidural, you may or may not be able to change positions. If you have a doula with you, she can help you figure out what are the best methods for use at the time. This would be based on discussions you had had previously before the birth. Talk to your labor and delivery nurse for advice to ask if changing positions would be helpful.

The most important thing to remember, which can be difficult in the throes of labor, is to try to remain calm.

There are things that can be done, but a checklist of what ifs and potential issues should be walked through in a thorough manner to ensure that you get adequate pain relief from the epidural and/or the fix that is put into place.

Source:
Labor and Delivery: Pain Medications. Mayo Clinic Accessed 2/21/16 at http://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/labor-and-delivery/art-20049326

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