Am I doomed to another another failed epidural the next time I have a baby?

October 27, 2006 2:47 PM

PregnancyFilter: Was the size of my baby the reason that the epidurals didn't work?

3 months ago, I gave birth to my son after 42 hours of labor. He weighed in at 9 lbs, 10 oz and was 20 & 3/4 inches long.

Needless to say, the process was long and extremely painful and in the end they needed to use forceps to get him out because I was simply exhausted. I had two epidurals; the first one failed completely, the second one would only work for a short while before I'd be screaming for additional pain meds.

After he was born, various medical staff said that, from time to time, epidurals fail. One said rather casually that it wasn't suprising, given how big he was. Is this true?

Given that women in my family are prone to having big babies (I was 8 & 1/2 lbs, my brother was 10 lbs, 10 oz and my Auntie Ann gave birth to one that weighed in at 12 lbs, no C-Sections on any of these) I'd kinda like to know if this is something I should expect for the next one. Yes, in spite of it all I want to have another one.

posted by echolalia67 to health & fitness (12 comments total)

I've been to about 20 hospital births when I was studying midwifery and I also did a fair amount of reading about epidurals at that that time. From what I can remember, I've never heard anything that would connect the size of the baby with the effectiveness of the epidural. It makes no sense, because an epidural goes directly into your spine. It sounds like the problem came from the anesthesiologist. Although I don't know for sure.
posted by serazin at 2:54 PM on October 27, 2006

It seems from this site that there are two options. One, it could be the catheter "drifted" and that's why the epidural failed. So baby #2 would be different. Or it could be your anatomy, in which case you should start reading up on Natural Child Birth methods.
posted by saffry at 2:59 PM on October 27, 2006

A few things I overheard during the delivery:

1. That they had given me everything short of C-section level pain meds.

2. One of the nurses remarked that my pelvic outlet(?) was slightly irregularly shaped, which wouldn't be a problem if the baby wasn't so big.

3. That I was too anesthetized to maintain my own weight and balance if I were to try to get into the sqatting position to push the baby out - I proved them wrong by pulling myself up into the position and pushing for a good long time.
posted by echolalia67 at 3:09 PM on October 27, 2006

Was this your first experience with anesthesia? Maybe you're just one of those people who doesn't respond to it very well.

I've never come across anything in a book or on a website correlating baby size with failed epidural, and I've never heard it mentioned on pregnancy message boards. And in all the eighty kajillion articles Mothering magazine has done decrying medicated birth, they've never pulled this factoid out.
posted by padraigin at 3:15 PM on October 27, 2006

Maybe you could explore the possibility of inducing labor once the baby reaches 8 pounds or so. It may be entirely justifiable on medical grounds (on the basis of the health and well-being of the child and mother) not to have such a large birth weight.
posted by Maxwell_Smart at 3:31 PM on October 27, 2006

But induction can be really painful, and brings a higher risk of your delivery ending in a caesarian section. If she's not responsive to anesthesia, that's going to be pretty ugly--imagine having to be put under general anesthetic and miss the birth of your child.

And in any case, size is far less important than lung maturity for newborns, and the ability to accurately estimate fetal weight is pretty much nonexistent.

Exploring alternative pain meds, and alternative birthing styles (hypnobirthing? Water birth?) might be a better course of action.
posted by padraigin at 4:01 PM on October 27, 2006

Congratulations, and welcome to the club. :)

My first baby was 8 lbs. 10 ounces, and no problem with an epidural at all. I've never heard of a connection between size of the baby and success of anesthesia, either. I'd look to other reasons for the problems, and hey, why not ask your OB about it at your next check-up?

For what it's worth, though, a second baby isn't necessarily bigger -- due to a very conscientious effort, I weighed less to start the second time, and gained less through the pregnancy. Baby #2 was almost a full pound smaller at term.

(Oh, and, estimates of fetal weight in utero are somewhat error-prone. It's not rare that it's off by a full pound. As such, inducing labor early over the size of the baby can be a risky proposition.)
posted by Andrhia at 4:44 PM on October 27, 2006

Oh and I forgot to mention that this was induced labor because I had a mild case of preclampsia and I was 6 days overdue.
posted by echolalia67 at 5:46 PM on October 27, 2006

Congratulations on the birth of your baby!

My son was 9lbs 6oz when he was born four years ago. The first epidural worked briefly, for only about an hour. The second epidural only bumbed one leg, and none of my abdominal area.

The doctors never mentioned anything about his size as being the culprit, I always figured the way he engaged is what blocked the epidural from working.

Either way, you weren't alone. Man, I still remember how much those fucking contractions hurt. I pretty much figured I could say I belonged to the natural childbirth club, because I pretty much went through it filled with pain.
posted by obeetaybee at 5:49 PM on October 27, 2006

My daughter was 10lbs 12ozs and the epidural was the most magical wonderful thing in the whole wide world (yeah, it worked good for me).
posted by slightlybewildered at 12:14 AM on October 28, 2006

I'm not a doctor of any description, but my understanding is that epidurals can fail for a number of reasons: the anaesthetist can miss the right part of the spinal cord to inject the anaesthetic into. There's also variability in the effectiveness of the anaethetic used: some people just don't react very well to some of them.

It might be useful to find out which anaesthetic was used, so they can try a different one in the future!

Regardless, congratulations on your new arrival...
posted by pharm at 12:06 PM on October 28, 2006

Having a baby the size of yours (>9 lbs.) is one of the risk factors for Gestational Diabetes, and you might want to be evaluated for that now (because it can persist after pregnancy) and during any future pregnancy.

As for your question, whether the size of your baby could have caused your epidural not to work as well as it should, I'll offer you an explanation as to how it could that you ought to view with skepticism.

If you did have GD or any other form of diabetes during this pregnancy, you were probably chronically or periodically hyperglycemic; your body could have responded by producing more cortisol, because "Cortisol indirectly induces insulin secretion to counterbalance hyperglycemia but also decreases insulin sensitivity" (from Adrenal Crisis). But cortisol is produced by the adrenal glands as part of a cocktail of hormones which also includes adrenaline, so if your body was producing significantly high average levels of cortisol, you may have had high levels of adrenaline, as well.

But epidural anesthetics often contain adrenaline in addition to things like lidocaine and bupivacaine; the adrenaline is included not for any direct anesthetic effect, but for its vasoconstrictive properties. By constricting blood vessels at the site of injection, the adrenaline keeps the epidural from being carried away by blood flow, and thereby makes it last longer and be more effective at a lower dose.

But if you had chronic high levels of adrenaline already because of GD, you could already have been 'adapted' to adrenaline, so that it was not as effective a vasoconstrictor as it would have been, and your epidural was therefore not as effective or as long-lasting as it needed to be.

This is highly speculative and pretty rickety, so take it for what it's worth.
posted by jamjam at 3:44 PM on October 28, 2006