There are a million scenarios pregnant women might encounter when it comes to labor and delivery. Childbirth classes introduce moms-to-be to breathing techniques, intervention options, pain management techniques, and instructions about when to call the doctor. Expectant parents soon learn that having a baby is more complicated than they once thought—and they soon realize they have many decisions to make.
One big option moms will consider is whether or not to request an epidural. Sixty-one percent of women who deliver in a hospital receive an epidural or spinal anesthesia, according to the CDC. The American College of Obstetricians and Gynecologists (ACOG) states “there are no other circumstances in which it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care.” If the experts say women should have an epidural, why would a woman ever opt to labor without one? Well, sometimes that decision is beyond your control.
Here are five reasons you may not receive the epidural you’re planning during labor and delivery:
1. Some babies come fast.
First-time moms usually labor for 14-22 hours, according to the Mayo Clinic. However, not all first labors follow this timeline. My first labor was 4 1/2 hours long. I describe my son’s birth as something similar to a freight train with no scheduled stops. The average labor length is likely to shorten with each subsequent delivery, like my friend who delivered her third child in the hospital parking lot. Fortunately for her, the doctor arrived just in time to catch their son! Just because you plan to make it to the hospital for delivery does not mean that you will.
2. When you get to the hospital, you may be too far along.
Technically there is no “cut-off” for when labor has progressed too far for an epidural. Technically. The problem with an epidural is that you will not receive pain relief the moment you inquire about an epidural. There are explanations and the consent forms the hospital is legally required to cover. Then there is tracking down the anesthesiologist (more on that below) and allowing time for him to retrieve supplies and make it to your room.
Epidurals take another 10-20 minutes to take full effect. If you deliver during the time this process requires, you will not get your pain relief—no matter how many papers you’ve signed. You also must be at a point in labor where you can sit still long enough for them to administer the epidural. Many women cannot accomplish this task in the last stages of labor due to their pain levels.
3. Anesthesiologists get busy.
We were the first of a crazy rush of deliveries when I had my son. A storm front was rolling into our small town, and during our two days in the hospital 14 babies were born. Labor and delivery nurses will swear to you that storms send women into labor, and they are right.
If you are unfortunate enough to be on the latter end of such a rush, the anesthesiologist may not make it to your room in time. If there is another patient in the unit that requires more attention and constant care, the anesthesiologist may not be able to leave that mom. No matter how badly you want your epidural, if the anesthesiologist gets tied up, you will be out of luck.
4. Sometimes epidurals don’t work.
Some people require more medication to numb an area. Nearly everyone in my family has experienced a cavity filling without being entirely numb, or the numbness wearing off before the dentist has finished. Everyone’s body responds differently to pain and to medication, so epidurals are not a “one size fits all” type of science. For some, the epidural only relieves pain on one side of the body. Other times “hot spots” are created with intense pain in just one area.
Research tells us that 12-13% of epidurals need adjustment or catheter replacement, but after adjustments, 98-99% of epidurals are placed satisfactorily. So, even if you get a speedy anesthesiologist, relief may not be as fast as you want, or you may be in the 1 or 2 out of every 100 that are not satisfied with their epidural’s pain relief.
5. Some medical conditions make you ineligible to receive an epidural.
Unfortunately, some women will not be able to receive epidurals because of their medical history. The following reasons may prevent a woman from getting an epidural:
- Use of blood thinners
- Low platelet counts
- Hemorrhages or shock
- Infection in the back
- Blood infection
- Epidural space can not be located by the physician
The good news is that, whether you get your epidural or not, it will be worth it. Holding your sweet newborn, counting her fingers and toes, comparing her nose to grandma’s, and remarking on how much (or how little) hair she has will quickly erase the intensity of the labor you just survived. To best prepare yourself for labor and delivery, plan for the worst, just in case. Hopefully you will be one of the many who get their epidural just as planned. But if not, you will be ready.