not allowed epidural. Choose induction or c section under general anaesthetic?(36 Posts)
So I was diagnosed with a PE at week 30 (I'm now 36 weeks). (The scans are notorious for not being totally 100% definitive but they said it was highly suspicious)
Met with haem/obs team last week and they said I have to continue on clexane for remainder of pregnancy and 6 weeks post partum. (I expected this anyway so no shock there). If I go over 40 weeks they want to induce me and I won't be allowed an epidural as I'd have to be off the clexane for 24hrs before and after it. I have to see them beginning of August when I'll be almost 39 weeks for another meeting to discuss things.
In terms of a c-section I'd have to have it done as a general anaesthetic due to not being allowed spinal anaesthesia. I'm youngish (30) and normal BMI so should be ok with GA. Think the Dr's would prefer me to not have c section in case I'm more likely to get DVT or PE afterwards.
Ideal scenario i suppose would be to just hope that I go into labour on my own before I get to week 40 and avoid induction (still nervous about vaginal birth though). If however the baby hasn't appeared by my due date I am unsure whether to say that I'd prefer ELCS over induction. (Very concerned about the pain of induction, increased likelihood of assisted delivery and potential physical issues from that with regard to tearing and incontinence).
With a c-section it's the GA aspect I'm worried about, as obviously I'd like to be awake for the birth and for my husband to be there which won't be possible with GA. He has to wait outside theatre.
Hoping other ladies can share their experience of induction with no epidural or c section under GA!
If you're having an induction, couldn't they just omit the dose of clexane the day before and the day after, so you can attempt a vaginal birth but still have the option of an epidural if needed (I personally would not accept an induction without the option of epidural!)
By PE, do you mean pulmonary embolism? And why can't you have an epidural? Please forgive my ignorance.
I tried to macho my way through a syntocinon induction without pain relief (38 weeks with possible HELLP syndrome) and it was excruciating. I caved fairly quickly. However, I was positioned on my back and strapped to monitors, so couldn't even lie on my side to relieve the pain. It might be worth discussing with your team whether you can move about (obviously not much, as you'll be on a drip!)
I managed induction without an epidural, it was fine. I had an emcs with ds under a general, and I'd try to avoid that if possible - I missed the first few hours of his life and it really upsets me. If you haven't had a GA before then you won't know how you'll react and if, like me, you don't come out of it quickly you could end up in the same position.
If you have a section will they have to stop the clexane anyway for the surgery? Anti-platelet drugs are usually stopped for a short period 24hr for normal surgeries don't know if OBS is different. If that's the case surely you could stop it for an epidural if that's what you'd rather?
As I'm on a treatment dose of clexane vs a prophylactic dose I'd need to stop it for 24 hours before and after. They weren't keen on that when I asked as they think if the risk of another pulmonary embolism Is too high. I've been wondering about asking if we can drop my dose to the prophylactic one if I get given a date for induction/c section so that I only have to wait 12 hrs between my last injection and an epidural.
If induced or elcs could they not omit the dose? Worth discussing next time you see them. Have you been seen in anaesthetic clinic? They can discuss GA with you in more detail and make sure they see no problems with GA as a plan
What about other pain relief options?
Yes saw anaesthetist who said that after stitching up from c section that I'd be brought round very quickly so wouldn't miss out too much. He said if I don't go c section I can have an opiate called Remifentanil during labour. Anyone tried that?!
I can't advise which is best as I have always had c sections. Mine have been done under GA due to a scoliosis in my spine which means a spinal only works on one side of my body. They have all been really positive experiences. The only downside is that DH couldn't be in the room for the births. The babies were whipped straight out to him next door as soon as they were checked over and then I was feeding and cuddling them within 40 minutes. It is major abdominal surgery but I have always found the procedure and the recovery good- up and feeling pretty normal within a week.
My anaesthetist recommended avoiding remifentynal if possible (I think it can make you quite sick, but worth checking if that's correct).
At the minute I'm debating asking for ELCS over induction if it doesn't happen naturally by my due date. Not super keen on the thought of GA but also terrified that I won't be able to handle induction and the risks of forceps, perineal tears etc.
I had one induction with syntocin and couldnt get an epidural as no one available to do one. I will be honest with you. The pain was incredible and I was very traumatised afterwards by the experience. And I did then need to have a spinal block afterwards to have a tear surgically repaired.
I then had another induction with my second baby and was terrified BUT crucially no syntocin drip this time. This one was a piece of cake compared to first timewith just gas and air needed and he was a huge 10lb baby. So I think induction in itself can actually be fine. In my experience it is the syntocin that makes the difference as it is very hard on your body.
I've had remifentynal and I would highly recommend it, you press button as contraction starts and you get a shot which lasts a few minutes then you are completely normal again in between contractions
It's very short acting
I would jump at the chance again to use it, not all hospitals offer it so if yours does I wouldn't hesitate at taking it.
I also had remifentanil during induction as epidural failed after 3 attempts. It is fantastic stuff, and wore off for me to be able to push and deliver baby naturally with no intervention which I might not have been able to do if the epidural had worked. I'm hoping I can have it again with my next labour, even if I'm not induced.
Thanks for that. Good to hear you've had positive experiences of the Remifentanil
Where I work someone in this situation would normally have a date arranged maybe at 40 weeks spot on and stop taking clexane 24 hours before and then be allowed an epidural.
Agree with cakes re syntocinon - I found I went from no contractions to 3 minute spaced contractions within about 20 mins of the drip going in. It was just too quick for my body to adjust. However, I was significantly unwell by the time I delivered, so my tolerance for pain was probably rock bottom!
I needed inducing again with syntocinon for DC2 and opted for the epidural straight away. And had a pain free, genuinely enjoyable birth.
I was induced. No time for epidural and only had gas and air for a few mins as baby was in distress so they had to hurry it along. Hurt like hell but labour was quick. Waters broke at 4.15am had baby at 5.54am.
I knew I'd need an induction from early on, and every single health professional I spoke to insisted I would definitely need an epidural. The contractions caused by inductions are much quicker, more powerful, and more painful than normal (interesting to see one exception to that in comments above, but that's what everybody told me!)
As it turned out, there was no anaesthetist available for four hours after my waters were broken. I don't want to scare you, but it was extremely painful. Much worse than I'd imagined or could cope with.
I did also end up with forceps, episiotomy, and a difficult recovery.
I'm now pregnant with a second, and would definitely choose a Caesarian over another induction.
I had pre-eclampsia when I was induced. I only had some gas and air, the some diamorphine then pethidine.
It took 17 hours and I was adamant that I wasn't letting anyone near my spine with a needle. I had said that from early on. I also had a tena machine which was helpful in the beginning but it irritated me later on so they took it off me.
I had an induction with synctocinon, no epidural. By the time I mentioned that I think I might need one, I was about to deliver! I had gas and air and one shot of diamorphine.
I was induced twice with no epidural.
First time had some diamorphine as I had been having contractions for three days prior and was absolutely exhausted, and second time gas & air.
It's fucking sore, don't get me wrong. But doable.
I had an induction with dc3 at 36 weeks, waters broke and synto drip. He delivered in just over an hour, I just had gas and air, and it was the easiest labour of all three. Certainly not pain free, but just about the level of pain you'd expect for labour. No intervention needed to deliver, minimal monitoring,and I was able to walk / kneel etc to ease the pain. Also back to back. BUT, it may be due to the fact he was dc3, as the consultant said my body would cope with the induction better, having done it before twice.
I would not unduly worry about being unconscious for the actual birth itself. You have a serious, life-threatening condition and you need to be very careful. I know there is enormous pressure promoting skin-to-skin etc but there are all sorts of reasons why a baby and mother might be separated - if either is ill or in need it medical care, etc. these things all rightly take priority over a few early hours. It is not necessarily what somebody might choose if all other things were equal but in these cases, all other things are not equal, and these mothers and babies love each other just as much as those who got the textbook skin-to-skin etc.
I am also on clexane for this pregnancy so I understand your struggles. I personally would not contemplate a labour without epidural. I have not yet had the full discussion on birth options with my doctors but I will be considering all options, including CS under GA carefully.
Best wishes, and every success for both a safe arrival and full recovery from your PE.
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