Evidence Library › Labor pain and epidurals › Pain relief
Evidence Library · Pain relief
When the epidural does not work well
Partial or one-sided blocks happen and can be fixed.
An epidural does not always work evenly. It can be patchy, one-sided, or leave a "window" of unblocked pain. It may need to be adjusted, redosed, or replaced entirely.
This matters most if you then need a cesarean, because an epidural that was mediocre in labor often makes a poor surgical block. That is covered directly in the operation stage.
Say it earlyDo not wait to be asked. Tell the nurse immediately if one side is numb and the other is not. A block that is fixed at 4 cm is far better than one discovered to be inadequate on the operating table.
Where this comes from
- Charles EA, Carter H, Stanford S, Blake L, Eley V, Carvalho B, et al. Intraoperative pain during cesarean delivery under neuraxial anesthesia: a systematic review and meta-analysis. Anesthesiology. 2025;143(1):156-167.
Covered in the class
4Module 4. The epidural, in detailHow it is placed, what it feels like, what goes wrong, and the complications in real numbers.Continue
Read this inside the full program, with the questions to take to your next visit and a record of what you have covered.
Obstetric Anesthesia Preparedness →More from Pain relief
What labor pain is actually likeMost American women choose an epidural, and that number is rising.
How American women manage labor painThree quarters use an epidural, and the gap by insurance is not about pain.
The other optionsNitrous oxide, opioids, water, movement, and nothing.
Nitrous oxide and intravenous opioidsBoth are options. Both relieve less pain than an epidural.
This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you.