When The Epidural Doesn’t Work

Doula supporting client in labour with a sacral counter pressure

Look, epidurals can be absolutely fantastic, and I really appreciate them. So this isn’t going to be an anti-epidural tirade. However, the challenge with epidurals is that sometimes they don’t work. Why? Well, there are a bunch of reasons that include an incorrect placement, migration of the catheter or drugs that aren’t as effective as they could be. The effectiveness is also impacted by how quickly labour goes, what sort of pain someone is experiencing, and the position of the labouring person. The good news is that there is often a lot that can be done to get an epidural working. When I’ve witnessed ineffective epidurals, they’ve almost always been able to get them working better. 

When an epidural doesn’t work, we’re now working to manage the (often) overwhelming sensations of labour with an almost empty toolbox. Some of our favourite tools (heat, TENS machine, cold packs) have been taken off the table because they are no longer safe to use. Even if the epidural isn’t effective at blunting the labour sensations, it can still dull the skin signals enough to cause pretty serious damage. Getting out of bed is also no longer an option because of the fall risk. This also eliminates the use of water, in the forms of a bath or a shower. 

So then our question is, what can we do, other than suffer? 

The good news is that we still have tools available! These options fall into two different categories: mental and physical. Our mind can be our biggest ally in managing sensation. When we are scared, when we tense up, everything feels worse. So by sinking into relaxation, we can make those physical sensations less overwhelming. 

Our first tool under this category is our breath. Those nice deep slow breaths (I like to call them yoga breaths) help our body slow down and calm down. And the extra oxygen acts a bit like a pain reliever. (I use this technique to great effect with my migraines). If you are struggling to do this on your own, you can google breathwork videos to help. (Insight Timer is an app that has some amazing resources)

Once we’re breathing slowly, we can add in affirmations. How we think impacts how we feel. Now affirmations tend to go into two categories. There is what’s helpful for me to say, and what’s helpful for me to hear. Sometimes swearing helps. If a string of profanity is your affirmation, go for it! (As a sidenote, there is some research suggesting that swearing does actually help manage pain). But you probably don’t want to hear your support people swearing back at you. Some very common affirmations are “You can do this”, “You are strong and powerful”, “You are birthing this baby”. 

And then the last piece here is visualization. Again, there are two different strategies to use here. The first is more of a body-based method. During each contraction, you can picture the baby moving down, your cervix opening, or your breath moving down and helping things soften and open. For some people, this is really helpful. For others, an escapist vibe is much more helpful. You might picture being on the beach, floating in water, or in a peaceful meadow. The goal is to picture anything that will help you relax and soften. 

Doula holding clients hand in labour

Our next set of strategies is physical. This gets a little trickier because your mobility can be impaired. Epidurals impact everyone differently, so how much strength and control you’ll have will vary. 

In general, different positions in labour feel differently. So moving out of sidelying can make a big difference in how you’re experiencing contractions. A position almost everyone can do with an epidural is throne. This involves lowering the bottom of the bed, and sitting in an upright position. Depending on how much control you have, you may be able to labour on hands and knees. Searching for “labour positions with an epidural” should pull up a lot of helpful ideas! 

Touch can also be a game changer. Not always, sometimes people hate being touched in labour, and that’s super valid. But massaging hands and feet, running hands through hair, and massaging shoulders can all help you feel less awful. Counter-pressure can also be helpful, especially if you are experiencing back labour, or pressure in your hips. This can involve placing a hand on the sacrum, or sliding a tennis ball behind your back on the bed. When sidelying, someone can put pressure on your top hip, which can feel absolutely amazing.

If you’re reading this in labour, I’m so sorry your epidural didn’t work! I hope these tips help you get through this. 

If you’re reading this during pregnancy, I’m sending you all the good labour vibes! My suggestion would be to practice some of these relaxation techniques, and figure out what works for you, just in case. Having a backup plan is always helpful!