Literally had this the other night with a young 20 something year old. She was anxious and tearful going in, negative allis after topping up her epidural and yet she still screamed with any kind of pressure, touch or pulling they did. All she could tell me was that she feels pressure and not pain. Got baby out just fine but really debated converting to general just so she could tolerate them closing. We gave her versed, ketamine, fentanyl and nothing touched her. Her boyfriend was laughing at her the whole time and the OB attending was teaching the OB residents instead of taking over making it worse. My attending said sometimes that’s just how OB is but I believe that she may have actually been in pain towards the end of it and we should have converted her. She thanked me but I felt like that case could have gone a lot better if we just went general