Do Epidurals Fail During C-Sections?

I just heard from a friend that her epidural failed during a C-section and she could feel everything. I dug into the research and read that this happens in up to 17% of C-sections. I had a great experience with my first C-section but now have apprehension going into delivery for baby #2!
—Nervous Nellie

This is very scary, and I can see the reason for apprehension. A C-section is major surgery and, without anesthesia, would be torture. More on the data is below, but the bottom line here is that if an epidural fails, general anesthesia would be used during a C-section, and this happens far, far less than 17% of the time.

When we see numbers about epidural failure rates, they almost always refer to failure rates during vaginal birth. This is a difficult thing to quantify, because it is hard to say what “failure” is. Epidurals are not all or nothing — they can work, but not completely. Failure numbers are typically about breakthrough pain after a certain period of time, but, again, how you define pain and over what period will influence these estimates.

medical doctors in the operation theater performing surgery — Amit Gauer / Unsplash

To get a sense of these rates, we can look at a 2004 paper covering almost 20,000 births at a single institution. The epidural failure rate was around 12% — meaning that in 12% of cases, the first attempt didn’t provide enough pain relief for the patient. This figure is overall, including mostly vaginal births. When the authors here look specifically at C-sections, they find that in 7% of cases the epidural given earlier was not sufficient, and in 4.3% of cases they needed to move to a general anesthesia. These rates were lower when a spinal epidural was used.

Other work shows similar numbers: this paper shows a 2% failure rate of epidurals in C-sections, which requires general anesthesia.

If you are going in for a planned C-section, these figures are going to be even more favorable. The doctors will for sure use a spinal epidural approach, which has a low failure rate, and there will be time to make sure it is working. You shouldn’t have apprehension about this!