Expert: JM Starkman, MD - 9/4/2009

Question
Hello, a little background on me and my situation. I am the mother of 4 children. 33 years old, very good health, no major health conditions- being treated for hypothyroidism. Mid to upper end of normal weight for my height (5'8") BMI of 24. I had successful epidurals during labor for my first 2 children ('95&'98). With my second child, it was a "walking epidural" and I was able to walk to the bathroom with assistance. Both were vaginally delivered with minimal discomfort. When I went into labor with my 3rd child ('01 vaginal birth), the epidural did not work. I had one spot on my upper thigh that was numb, but other than that, I felt everything. With my fourth child ('05 vaginal birth)it was basically the same as with my third-except no numb spot. I never had any relief. With both of the failed epidurals, I was examined by the anesthesiologists repeatedly and it was determined that the epidural was in the right place and working properly, in both cases. The medication was increased in both the 3rd and 4th epidurals and still no pain relief. I was told that there was a very strong possibility that future epidurals would fail also but was not given any specific reasons as to why an epidural would work 2 times and then not work 2 times. Fast forward.... We are surprised/excited to learn we are going to be having baby #5 in early January. I am started to get nervous about labor/delivery and would like a professional opinion on whether I should even try for the epidural this time around. My OBGYN has not been very helpful on the matter. After giving birth medicated twice and without pain relief twice, I am hoping to end my reproduction days on a high note by having a wonderful delivery/birth-PAIN FREE! Advice please:)

Thank You!


Answer
First, congratulations on your 'surprise #5'!  

Second, I don't think you'll ever know precisely why, in your case, the epidural analgesia sometimes worked and other times did not--I think your best approach though, since you you want a proper professional opinion is to get an early consultation with one of the anesthesiologists at the location where you plan to deliver and permit him to review all your history, examine you and proceed with his recommendations.

You and your anesthesiologist might want to consider a long-acting saddle-block for the latter part of labor and delivery.  The disadvantage is that this cannot be "converted" into a C-section anesthetic if necessary.