What if you can’t get an epidural?

Seriously.

I’m a proponent of natural (i.e., no drugs) birth, but I understand that not everybody shares my philosophy; and even many times when women do share this philosophy, life (or labor) throws them a curve ball, and they have to adjust.

So, picture this — you’re in labor in the hospital, and for whatever reason, you ask for an epidural — maybe you planned one since before you got pregnant, maybe the contractions just took a serious uptick in intensity and you decide that now is the time. So you push the button, the nurse comes in, you say, “I’m ready for my epidural now,” and she says, “I’m sorry, but it will probably be an hour or so before you can get one.”

What do you do?

It’s best to think about that question now, rather than while you’re in labor, when it’s too late to go to a childbirth prep class or read all those crunchy granola websites and blogs that talk about breathing and relaxation and hypnosis and whatnot.

For several plausible reasons why your epidural might be delayed, read this post. There are many others, including some that I don’t know about, and others that I have heard about but are so rare you’ve probably never heard about them and never will (unless you’re a midwife or an L&D nurse who’s heard everything). But one reason why an epidural may be delayed, even if some of the possible triage issues of that link don’t fit your particular situation, might be that you will need an IV bag of fluid before you can get an epidural. Sometimes an epidural can make your blood pressure bottom out (which isn’t good for you, and especially bad for the baby), so to prevent that, they load you up with fluid. (It doesn’t always work, and while sometimes repositioning and oxygen can keep you from having to have a C-section, other times it won’t.) It may take time to give you enough fluid, and your labor will continue during that time. This is actually the most common reason I’ve heard for a delay in receiving an epidural; but not having an anesthesiologist available (usually because s/he’s attending another patient) is the other top reason I’ve heard.

It would be very good for you to have some tricks up your sleeve to handle labor contractions, rather than just assume you can snap your fingers and have one appear. Even if you’re sure you’ll want an epidural. Even if you’re sure you’ll get an epidural. It is not unheard-of for it to take an hour from the time you ask for the epidural until it actually takes effect — little delays here and there add up — the nurse has to assess you and call for the anesthesiologist, it may take some time before s/he can actually get to your room, you’ll have to have a bag of fluid run, it takes time to set up for the epidural, and while many women describe the relief as immediate, it may take other women some time before the numbness takes effect. There’s also the less-talked-about phenomenon of a failed epidural — it either doesn’t take at all, or the coverage is only spotty, or it takes effect only on one side of your body. Then what?

This is not to scare you, but to encourage you to educate yourself. There are alternative pain relief methods — but if you don’t explore them now (and some of them need to be learned and/or practiced), you won’t have them then. Also, a doula can be of tremendous help. She may be able to help you avoid the need for an epidural in the first place, but she definitely has lots of tips and tricks to help labor be more manageable.

3 Responses

  1. This was a good post! And definitely something for women to think about. Thankfully I had my MIL and husband to help me through my 2nd daughter’s delivery and they helped me focus and breathe. I feel more prepared now, know more about what to expect.

  2. No sh1t, huh? Epidural do not magically appear when you decide to get one. Inconveinient but true fact. So sometimes, the only thing you have at your disposal is relaxation exercises….Sorry to be the bearer of bad news. But once you have gone through 9 months of pregnancy you should realize this is not all it is cracked up to be…

  3. Hear hear! Being unable to get an epidural when a woman wants one does happen. Sometimes there are just logistical issues (i.e. CRNA is tied up in the OR, doing an epidural for someone else, etc). I have had women who have had to wait…and so I sit with them and provide support, or have them get in the tub, or hwatever it takes to help her cope until she gets the epidural.

    I love this post! Very well written and realistic!

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