Expert: Dr Ian Jackson - please note UK based - 2/7/2007

Question
Hello,

I have had ongoing pain in my back at the epidural site as well as a tingling feeling that I can only best describe as "popcorn" in my left leg and my right leg feels like it is asleep ever since I had my epidural during the delivery of my 3rd baby.  I have had the epidural with each delivery, by the way.  I was dialated to 4 cm when I arrived at the hospital and it was not until about 2 hours later that I received the epidural.  They did not check to see how far I was dialated before administering the epidural and my daughter was born about 15-20 minutes later.  It seems like it was administered higher on my spine than my previous two epidurals.  Is it possible that something could have gone wrong?  I am currently seeing a Neurologist for my condition, who is still trying to diagnose the problem.  Are there any specific questions that I can ask or anything that should be checked?  Please advise.

Thank you for your time,
Natalie

Answer
Natalie
It seems to me that the appropriate referal has been made and that your Neurologist should be able to get to the root of the problem.
You raise several points
timing of epidural - this is dependent on many factors - how busy the unit is, when the midwife feels you need an epidural, how many women already have epidurals as there may well be a limit that each unit can manage, is the anaesthetist in theatre with another mother having a caesarean section etc. If you asked for one earlier then they should be able to explain why it took so long.
Not checking to see how far advanced - again not unusual as they do try and minimise the number of examinations you undergo.
Administered higher than previously - again not unusual these days. We try and insert the epidural higher in your back than the old days as we are using much weaker solutions of local anaesthetic (usually slowly infused by a pump) and so it is important to get it at the right height for it to work. Basically this is higher than used to be used even a few years ago.
Now as to the pain etc in your leg. I cannot say this is definately not related to your epidural, however there are many reasons why you may be experiencing problems. These include
issues around the pressure effects of babies head on the nerves in your pelvis as they are born
issues around wear a tear on your spine during pregnancy when your hormones tend to relax all the ligaments
issues around the epidural and the use of local anaesthesia - there is an incidence of usually transient problems with numbness and change of sensation in an area of your legs following epidurals (1 in 10,000 or so)
So I cannot provide you with the answer you are probably searching for - however I can say that your problem has been taken seriously and I am glad that you are seeing a Neurologist. For the record this is not what I hear from many other mothers around the world.
You may never find an answer but I hope that the problem settles down and that you can enjoy motherhood.
Kind regards
Dr Ian Jackson