Trying to make sense of a friend's birth story and epidurals. Can you help?

[farmergirlj]

I have a friend who on her first pregnancy with twins delivered with an epidural under hospital policy.  She says her epidural didn't work at all and she went through delivery naturally.  Her reasoning for this is because she felt a lot of pain while delivering (i.e. screaming during delivery) and she could also use her legs to help transfer her to the operating table (they made her deliver in the operating room due to the twins).  Then she went on to say that during the pushing stage she felt it wasn't effective because no one told her how long to push and then the doctor left for awhile to attend to an emergency for awhile and she was told not to push while he was gone.  She told me she didn't push, she said she just had little internal pushes but nothing more then that.  I am having a hard time understanding the story because I have done natural birth and I cannot imagine someone telling me: "don't push for awhile, I am going to do something else for awhile and be back."  I can't hold back from pushing for more then part of a contraction and that takes a lot of effort and concentration.  I also don't understand the feeling of needing someone to count so you know how long to push unless you were completely out of touch with your body which would mean the epidural was working. Was the epidural not working?  Do some women have that much control during an umedicated labor to just not push if told not to push for an unspecified amount of time?  Do some women without epidurals feel that they need help knowing when to push during a contraction to make it effective?  What are other people's experiences?  Is it possible that the epidural was only working on part of her body like parts of her uterus but not her cervix?  I find it fascinating and would love to hear other peoples experiences with this.

[bmcneal]

I had an epidural and still felt the urge to push, as well as not being able to *not* push. I don't remember anyone counting for me, either, but... it's been a couple of years, so that may not be accurate. I told DF that I didn't think my epidural worked, either, but... with that being my first vaginal birth, I have no frame of reference. That being said, I'm due in April, and planning on going without an epidural, so I guess that might give me more of an idea whether it worked or not.

(Side note: With DD, my first, I had a c-section. They did five regular epidurals, and one with morphine, and none of them worked, I could feel everything, and they had to put me under general anesthesia.)

[Quinalla]

I didn't have an epidural with DD, but I didn't ever have the "urge to push" so many experience either. I could feel my body pushing, but as far as an urge to push, nope! It was actually the one part of my first birth that I felt my birth prep failed me on as I was expecting a urge to push no matter what, maybe pushing would hurt maybe it would feel good, but I didn't have it. I could not stop my body from doing its own pushing, but I certainly had no problem not adding to the pushing myself as I didn't try to actively push until my OB arrived (my labor was quick) as the hospital OB was not awesome My OB actually yelled at the nurses over the phone when he heard them telling me not to push, something like "Don't tell her that, she can push if she wants to!" so it was nice that he was supportive of me anyway. Also, I don't think mine was a case of not waiting long enough for the urge as I did not push for long and waiting for awhile for my OB to arrive (~15 minutes) when my body was pushing on its own.

However, I will say that epidurals when they work correctly are not supposed to completely numb your legs and are supposed to allow you to feel what is going on during pushing. Could she still feel contractions the same before and after the epidural? Did they only do a test bit of medicine and it wore off quickly (common for "required" epidurals)?

[farmergirlj]

Thanks for your replies.  It is very enlightening for me.

bmcneal - I would love to hear the follow up if you deliver without an epidural this time.  Someone who has thought the epidural didn't work and then gone on and done it without an epidural would provide valuable feedback and insight.  Congrats and good luck to you in April.  You also have me wondering if you just had bad luck with the epidural or if your body doesn't respond to it.  And if so, are there women out there who just don't respond to an epidural?  You never hear that side of the story!

Quinalla - I can only imagine reading to prepare for labor and then not having any urge to push!  What conflicting information.  I find it fascinating that some women don't have that urge.  I would have never known if you didn't speak up.  As to your other questions, she was vague as to how much pain she felt before pushing and I didn't really ask if there was a difference in the pain with the contractions.  I should though.  I got the impression she didn't feel pain until the pushing stage.

[zapzipzee]

I had an epidural.   I could move my legs, and feel pressure on my legs/feet (my mom rubbing my hip and my husband tickling my feet, even though it didn't tickle (my feet are very ticklish), I could feel him touching them).  I felt an odd  pressure in my hips, they checked and said it was time to push, but, I could not tell when I was having a contraction.  They told me when I was having them based on the monitor.  I felt the pain of her head crowning where I tore at front, and felt the doctor pull her body out of me.  My epidural definitely worked.  I had been having excruciating back/hip pain with each contraction.

[katelove]

She may have had a "window" which is when the epidural fails to work in one section. And she may also have had reduced muscle strength but still had some movement.

I had a combined spinal/epidural for my first c/s. I could wiggle my toes the whole time. I also developed a window of pain when I was back in the ward which we were able to resolve by tilting me over onto that side and pressing my button frequently.

[crunchy_mommy]

I don't think epidurals usually numb everything completely... from what I've always understood, it just takes away a lot of the pain, not all of it.

I had one with DS and it did work but I could still feel what was going on. I could feel the contractions before they showed up on the monitor. I did feel like I had intuitive knowledge of when/how long to push but was overridden by the doctor/nurses, which was frustrating, but not entirely unmanageable since the epidural dulled everything.

Totally unrelated but I had local anesthetic for a surgery that wasn't even supposed to hurt and I needed 2 shots of the anesthesia & STILL felt pain. I'd imagine the variance in response would be similar for the epidural... some will feel no pain, some will feel pressure/discomfort, some will feel dulled pain, and some will feel just as much pain as they would without the epidural. Everyone responds differently. I don't think you could even compare within one person, 2+ births... because each birth is so different, how would you know if the differences were due to epidural/no epidural or other factors like easier 2nd birth, less anxiety/fear, better childbirth prep, etc.

I think what's important here is your friend's perception that she felt more pain than she expected. That can be traumatic... or it could be a source of pride for her that she handled the pain. She feels like she experienced a natural childbirth for whatever reason. Let her process it however she needs to.

[CountryMommy]

I have never had an epideral but my good friend, who is very pro medicated birth had an epideral for her first birth, she swore it didn't work and said she felt everything, it was very painful, etc. Then two years later when she had her second child, she wanted the epideral again but was unable to get one as the anesthesiologist was unavailable (due to a car wreck that happened sometime while she was in labour) so she ended up birthing without an epideral and said the pain was unbelievabley worse with her second baby and she felt like she was dying. Looking back, she said that her epideral must have worked during her first as the differences in birth were like night and day even though she did feel some pain with her first.

[micah_mae_]

Originally Posted by CountryMommy 

I have never had an epideral but my good friend, who is very pro medicated birth had an epideral for her first birth, she swore it didn't work and said she felt everything, it was very painful, etc. Then two years later when she had her second child, she wanted the epideral again but was unable to get one as the anesthesiologist was unavailable (due to a car wreck that happened sometime while she was in labour) so she ended up birthing without an epideral and said the pain was unbelievabley worse with her second baby and she felt like she was dying. Looking back, she said that her epideral must have worked during her first as the differences in birth were like night and day even though she did feel some pain with her first.

I think this is the case most often. Women feel pain and assume the epi isn't working when it really is, just not to the extent they wanted. I've also had a friend with a "failed" epidural who swore she had a "natural" birth, then later actually had a natural birth and said there was no comparison and her epidural must have actually worked.

[bmcneal]

Originally Posted by micah_mae_ 

I think this is the case most often. Women feel pain and assume the epi isn't working when it really is, just not to the extent they wanted. I've also had a friend with a "failed" epidural who swore she had a "natural" birth, then later actually had a natural birth and said there was no comparison and her epidural must have actually worked.

The only reason I figured the epidural didn't work with my second, was because of the amount of failure with the epidural with my c-section. I'm worried that ^ will turn out to be the case, and just for whatever reason none of the epidurals took with my c-section.

[farmergirlj]

bmcneal - I wouldn't worry too much.  Women are strong and everybody is unique.  You could have felt everything before and there is no sense in fearing something that may not be true for you.  Keep your chin up and if you feel natural is the best decision for you and your baby then stick to it and know you can do it. 

It is interesting to have so many different experiences with the epidural.  For an update on my friend she just gave birth to her third yesterday (second pregnancy) and had the epidural again and this time she didn't feel anything at all. 
 

[CrunchyJess]

I've had three births, all very different experiences. 
 

My first I had an epidural that I thought "didn't work". I have scoliosis and the anesthesiologist was having difficulty placing it correctly, giving multiple doses into my blood stream which made me feel drunk and shaky, and when he finally did get it in, he gave me a "test dose" to make sure he had it right and left the room. When it "wore off" about 15 minutes later, I had just started pushing and he was preoccupied with another patient. So I felt like I had felt everything. I did feel a ton of pressure and quite a bit of pain. Pushing lasted a long time and I remember thinking I couldn't do it after about 45 minutes. I was screaming that I couldn't do it (I was very young and uninformed about birth at this point) and did end up getting a full dose of epidural about 5 minutes before DS1 was born. 
 

Next, DS2. I had an epidural after 11 hours of labor that DID work and laughed as my 2nd son was born about 45 min after getting the epi. I could move my legs and felt pressure but literally zero pain. 

DS3. Completely natural. I was older and more informed going in. Had a birth plan and wanted to avoid a horrific experience I'd had with my first. Seriously, recovering from the multiple points of entry of the epi needle on my spine was the worst part of my post partum recovery with him. Really, I'd experienced most of labor without pain meds, since both of my epis were right before transition and therefore less than an hour before birth. So the labor was the same. The birth wasn't. I realized upon my actual natural birth that my epi had worked to some extent on my first birth. I know I was able to feel a lot of pain the first time, but during my third birth, it was a completely different experience. There is a burning sensation during natural birth that I did not feel with my first. And I could actually feel him as he moved down and out of my body. I remember being amazed and slightly bewildered at the detail I was able to feel. With my first I felt PAIN, but it was more of a dull, blunt blast of pain from the pressure and from having the need to push him out but not having the strength. With my third, it was more about having to be restrained and feeling completely in control and having to pace myself through the pain as to not make it too fast and hurt myself. I don't know if that makes sense. I will never have another medicated birth (I'm due with #4 in 12 weeks) after doing natural. That said, there was a moment at about 9 cm. that I remember thinking it was the worst idea I've ever had. lol. 

[MichelleZB]

I think many women assume that their epidurals are going to totally numb them from waist down. Usually, they don't put that strong a dose in anymore, so you can still feel some stuff. Of course, the drug's efficacy can depend on your response to it, so the same dose can nearly numb someone and just take the edge of the pain for another woman. Likely, the drug worked at least partially on your friend, but she could still feel stuff.

[wildmansmom]

I'm very sensitive to pain medications so I knew when I got the epidural the they didn't listen to my warning about my sensitivity it was going to be bad.  I was completely numb from the waist down.  I could sometimes feel some pressure but it was never painful, just different than complete unfeeling.   I had them turn the medication off when I started pushing because I wasn't being productive and after about 30 minutes I started to be able to feel something, but it wasn't clearly an "urge" to push - more like my body politely suggesting I do it.  I think that's the level they try for with most patients so I can see ignoring that urge, I "rested" a couple of times because my pushing contractions were only about 10 seconds apart.

I had a friend who said she got an epidural with her first birth and it numbed the contractions but she could still feel the pressure in her back and hips and pelvis.

[owlhowl]

The epidural I had with DS2 was aaamaaazing. I could walk, dance, squat, get off my bed on my own. I felt no pain, only pressure. I still felt the urge to push (coolest feeling ever)...however, once I decided to request a cesarean (I just knew baby was not going to come out) I was able to stop pushing and just relax.
Epi with DS1 was not working well enough, I was very uncomfortable on one side only and did need a spinal for his cesarean.

I think it's cool how incredibly different everyone's epi experiences can be! I totally wish though every epidural could be like mine with DS2!

[Calladona]

My only experience with spinals and epidurals was my first birth - I was given a spinal for the surgery but I had a "window".  My legs were definitely completely numb, I had to be assisted in any movement.  I had an epidural then, but the window remained and I had to go under GA for the surgery.

That said, I've heard the term "walking epidural" thrown about a lot - basically it's supposed to be just enough epidural to reduce (or get rid of) the pain, but not so much that you lose all feeling in your legs...  Perhaps she had one and didn't know it?

[Quinalla]

Originally Posted by farmergirlj 

Quinalla - I can only imagine reading to prepare for labor and then not having any urge to push!  What conflicting information.  I find it fascinating that some women don't have that urge.  I would have never known if you didn't speak up.  As to your other questions, she was vague as to how much pain she felt before pushing and I didn't really ask if there was a difference in the pain with the contractions.  I should though.  I got the impression she didn't feel pain until the pushing stage.

Yeah, there don't seem to be that many of us (at least with vertex babies, it seems much more common with breech or other variations), but I was definitely one. It really wrongfooted me for that part of labor, thank goodness the OB from my practice showed up as he helped guide me gently as I seriously was having a hard time with pushing effectively. Good thing my body was doing pretty well on its own as pushing did not take long, maybe 20 minutes or so once I started actively pushing? And 15 minutes at least before that of my body pushing her down into position, that's pretty fast for a first labor. I think this time I won't worry about actively pushing as much and let me body do as much of the work as I can.

Sounds like her epi was much stronger or better placed this time around. I'm really sensitive to anesthesia based on past experience so another reason I wanted to avoid as I figured I'd be one who was over-numbed.

[mindihamell]

I had an unmediated vaginally delivery. My cervix wouldn't get all the way out of the way for a while and my body was pushing for quite some time. I swelled and formed a vaginal hematoma. Because of this my midwife made the call that I should go to the hospital. During the 20 minute car ride I was instructed not to push. I give all the credit to God that I was able to breathe through the urges. When we arrived, I was complete and ready to push my son out. He easily could have been born in the car. It was nuts! So yes I think it's definitely possible!

[Calladona]

About the urge to push... it's possible to have a "break" between transition and the urge to push.  In my first labor, I had this happen.  I'm 90% sure I was 10 CM when I got in the car to leave the house.  My contractions slowed and were less painful.  When I was checked at the hospital in Triage, I was already 10 CM.  We still had time to get to L&D, get a heplock (with four failed attempts) and get all set up before my urge to push began to kick in.  In all, I'd say there was at least an hour of "break" between 10 CM and the urge to push, but I was grateful for that.  I did not get that the second time around.  I arrived 7 CM, started feeling the urge to push within about 10-20 minutes, pushed for about a half hour (probably on a cervix that wasn't completely dilated) and had him pretty quickly.

[bmcneal]

Originally Posted by farmergirlj 

Thanks for your replies.  It is very enlightening for me.

bmcneal - I would love to hear the follow up if you deliver without an epidural this time.  Someone who has thought the epidural didn't work and then gone on and done it without an epidural would provide valuable feedback and insight.  Congrats and good luck to you in April.  You also have me wondering if you just had bad luck with the epidural or if your body doesn't respond to it.  And if so, are there women out there who just don't respond to an epidural?  You never hear that side of the story!

Quinalla - I can only imagine reading to prepare for labor and then not having any urge to push!  What conflicting information.  I find it fascinating that some women don't have that urge.  I would have never known if you didn't speak up.  As to your other questions, she was vague as to how much pain she felt before pushing and I didn't really ask if there was a difference in the pain with the contractions.  I should though.  I got the impression she didn't feel pain until the pushing stage.

I'm sorry it's been so long. I've been a little busy. 

This labor was so very different from my first labor! From the time (DH!) realized it was time to head to the hospital (I kept saying, "Let me take a short nap, then we might go." I didn't think it was time.) to the time DS2 was born was about an hour, hour and a half. The whole way there, I was having regular contractions. I'm pretty sure it was back labor, which I didn't have with DS1. It was very intense, and by the time we got there, I told DH I wanted the epidural, but we didn't have time. Once I was in the bed at the hospital, the contractions got a lot better, and I don't remember them bothering me much at all. (Of course, as soon as I got in the bed, I pushed twice and he was born, so there's that. :P )