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Comment by rocqua | Hacker News Reader

There's a very strong podcast series about the common failure of Epidurals: "The retrievals" season 2, by serial productions. I found it rather eye-opening. The series includes reporting on a conference of the Society for Obstetric Anesthesia and Perinatology (SOAP) where the professionals in this field also found it eye opening. (mostly episode 2)

I don't bring this up to say that actually Epidurals suck, just to bring attention to the fact that they can fail, and that the system has historically handled such failure really poorly, and that the system itself isn't very well aware of this issue. This isn't just opinion from some podcast, but also admitted by the professionals working within this field.

It's also something valuable to be aware of when you or your partner is planning to have an epidural, because there is real space (and even a need) for advocacy for the patient when an epidural fails and the woman giving birth is in excruciating pain.

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The problem that The Retrievals deals with is epidurals failing during cesarians, which, they're quick to emphasize, is painful, open abdominal surgery. The not-so-simple solution is to convert to general anesthesia (anesthetic gas, IV propofol, etc). This isn't without its risks to the mother and the child, so there's reluctance on the part of anesthesiologists to go that route if there's other options. The result is unnecessary birth trauma.

> This isn't without its risks to the mother and the child

> The result is unnecessary birth trauma.

Not trying to be snarky, but which is it? This is definitely a situation in which having a midwife there to advocate for you is an absolute plus.

Midwives don’t participate in C-sections

If it were as simple as waving a magic wand and fixing the epidural or bringing on the anesthetic gas, we wouldn't have this problem.

The consensus seems to be shifting more towards converting to general anesthesia after epidural failure unless there are very clear reasons not to.

The "risk to mother and child" is referring to using general anesthesia. The "unnecessary birth trauma" is referring to C-section without any anesthesia.

anesthesiologist here, I really fear a dodgy epidural being used for caesarean section surgical anaesthesia, and if there is any hint that an epidural isnt perfect I pull it out and do a spinal anaesthetic (as long as I have time eg. If the baby can wait long enough). Its a big call which needs to be made quickly. I have a theory that modern epidural medication mix has been dropped to be so low concentration of active drug that it is harder to differentiate a good epidural from a patchy one, and as a result people are topping up patchy epidurals and then running into problems with pain during surgery.

I was shocked to discover that if a woman gets an epidural, it stops producing oxytocin that mitigates the pain for the baby (and mom).

That sounds absolutely horrible for that little creature. Yet I am a man, so I really am not allowed to speak on the matter and I absolutely let my wife decide entirely on the matter by herself (we had absolutely no time for an epidural, my wife delivered both kids way too fast)

I looked for a source for this, and found the opposite:

> Newborn oxytocin levels were higher in the umbilical artery vs. umbilical vein, and both were higher than maternal plasma levels, implying substantial fetal oxytocin production in labour. Newborn oxytocin levels were not further elevated following maternal intrapartum synthetic oxytocin, suggesting that synthetic oxytocin at clinical doses does not cross from mother to fetus.

In other words, the fetus makes its own oxytocin during labor. It does not come from the mother.

[1] https://link.springer.com/article/10.1186/s12884-022-05221-w

Interesting! I remember somebody telling me that at the hospital, so this feels awkward. I do wonder if the epidural maybe negatively affects the production?

I have no clue, but that's a big relief.

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