Expert: Dr Ian Jackson - please note UK based - 8/26/2008

Question
Hi, thank you for your time.
For the birth of my son, 15 months ago, I eventually needed to be induced  (after 40 hrs of labour, still only 4cms dilated). I asked for an epidural, the first of which was unsuccessful. After a second and many top ups and turning it eventually started to work. I delivered him vaginally and was able to push well. The experience of being induced and the epidural not working properly was very traumatic. What can I do to help myself and the medical staff if I require another epidural next time? If I need a c-section for any reason, will I be able to have adequate anesthetic as I am concerned that this will not work properly either. Is the anesthetic used in the c-section different from an epidural? Any information and/or reassurance would be great. Thank you.

Answer
Hi there
We find that something like 85% of epidurals work well first time or with one minor adjustment and we try to ensure that mothers are aware of this before we provide one. For those that don't work I encourage my junior staff to talk to the patient and explain that usually replacing the epidural gets rid of the problem. This is why I encourage them to only try one adjustment so the mother is not left in pain for a long time.
With subsequent pregnancies you have exactly the same chance of it working well i.e. just because you had a problem the last time does not increase your risk of problems the next time. So it is likley that it will work fine.
In the UK we tend to use a slightly different technique called 'spinal anaesthesia' for c-sections. This is where a small needle is inserted into the fluid surrounding the nerves in your back and a small amount of local anaesthetic is injected there. It provides an extremely good block for the operation which lasts for about 2-3 hours.
I hope this info helps a bit.
All the best
Dr Ian Jackson