Perineal Anaesthetic Injection

[CuppaTeaJanice]

I am due to give birth for the first time in a couple of months. I asked my midwife if I could have the perineal local anaesthetic (the sort they use before an episiotomy) as a form of pain relief, as my last smear test was agony and took me three days to recover from.
I think I'll be able to cope with the contractions and abdominal pains, but it's the last bit I'm worried about.
Anyway, the midwife said no, I should have an epidural instead, which I really don't want as I'd like to be upright and mobile (and definitely not in stirrups!!!).
I just wondered if anybody else has been allowed to have this injection, without necessarily having the episiotomy, and did it help at all, or will I really not care by that point?!!

[Lulumama]

can you explain a bit more about why the test was agony? due to position of cervix? or being tense?

if you have pain relief like pethidine, which acts as a muscle relaxant, you might well find that it really helps

also, baby is coming out, rather than anything coming in, like with a smear test

there are breathing techniques you can practice for relaxation too

are you going to be declining any internal examinations in labour?

[CuppaTeaJanice]

Thanks Lulumama,
I don't think I was particularly tense - the agony came when they cranked open the speculum, and I figure the baby's head will be much bigger, and therefore much more painful.

I'm planning on having entonox, pethidine and hopefully spend most of the labour in water, and I've been practicing breathing & relaxation.

I'll have any necessary examinations - hopefully they won't be in and out every 5 minutes!!!

I don't know if I just have a low pain threshold in that particular area.

[TheDevilWearsPrimark]

Why not go for a mobile epidural?

[izzybiz]

The last bit as the head is crowning is very stingy(only way I can think to describe it!) but its over relitavely quickly. TBH I found the contractions before pushing the hardest to deal with, you will be fine Good luck.x

[GrinningSoul]

perineal massage might help?

[CuppaTeaJanice]

A mobile epidural may be an option if the water bath isn't available - I don't think they let you in if you've had any sort of epidural (might drown!!!). How mobile are you, though? Can you still walk? Do you need a catheter?

[Lulumama]

cuppatea, the speculum opens the vagina, not the cervix

the baby descends through the cervix and into the vagina, over a period of time, and if you are having pain relief then before the baby crowns, you will have got through the worst of it in terms of your vagina stretching to accomodate the baby

you will have internals every 4 hours or so, depending on progress, so not too frequently, you do not need to agree to them id you don't want to

you cannot have an epidural and go in the water as there will be a fine tube going into your back administering the painkillers , and you have to have constant monitoring, and often a drip, which cannot be done in the water

also, if you do have an epidural there is an increase in the need for an instrumental delivery

[Lulumama]

sorry,ignore my first sentence !

it is the crowning sensation you are worried about , yes? in which case i second the advice re perineal massage!

[AdamAnt]

Am I right in thinking that a perineal anaesthetic would only affect the perineum? If that's the case, then I'm not sure it would be of much use tbh. There are so many other sensations going on during the pushing stage, that a bit of numbness in the perineum probably won't make much difference. For example, when I pushed out DS (DC2) I tore a bit and honestly didn't feel it - I was too distracted by the immense involuntary doing-a-poo sensation.

[alfiesbabe]

Lulu has given really good advice here. I completely understand where you're coming from CuppaTea, as this was the aspect of birth which really scared me too! I thought before hand that the contractions, although painful, would be bearable, it was the actual second stage, getting out through the vagina that scared me shitless!Izzybiz is right though, the actual crowning, although it burns/stings and feels like you're, well, shitting a grapefruit, is actually over quite fast, so by the time the pain is there, it's gone IYSWIM.
I've had a good range of birth experiences - first baby in a midwife led unit with g and a, and then the perineal injection you describe because the midwife needed to make a small cut. dc2 was c section under epidural, and dc 3 was vb with gas and air, no perineal injection but he shot out fast and I had a 2nd degree tear. The tear did hurt a lot, I won't pretend it didnt because I dont think it's helpful to gloss over the reality, but it honestly is over very fast. I certainly wouldnt recommnend going down the whole epidural route just for the sake of literally the last minute or two of the birth. An epidural means a different sort of birth, a medicalised one, and a greater chance of forceps/ventouse and other interventions. I know some people swear by them, and I guess they're good if you have a low pain threshold and don't mind childbirth being very medicalised, but if you beleive you will be able to cope with the contractions during first stage, then I think an epidural is probably not what you're after. FWIW, I also found that I coped ok with the first stage - yes it hurts, but it was all quite copable with. In fact I would do the first stage, 0 t0 10 cm dilated again tomorrow, seriously!

[CuppaTeaJanice]

Thanks for your advice everybody, I'll definitely give the perineal massage a go, and hopefully if I take the pushing slowly I'll be able to get through the birth without tearing. It's good to know the bit I'm worried about won't take very long, and I'm sure it will all be forgotten when I have my new baby in my arms!!

[T2M]

Also remember that in labour the hormones work to relax your vagina allowing more stretch and elasticity as babies head gentle moves backwards and forward down the birth channel and looking forward to have a cuddle with mummy, the moment is then forgot as you gaze into your babies eyes. Trust the process Cuppa your body is part of the wonder of life it self

[alfiesbabe]

Or why not write in your birth plan that you would prefer to be cut rather than tear, in which case you'll either a) be given the injection and cut b) not have a tear (or at least not a bad one). That would give you a good chance of either gettting the injection you want, or at least having the satisfaction of no post birth stitching!

[izzybiz]

I tore with my first and didn't even know untill afterwards when the midwife said I needed stitches. He came out faster than my second, where the midwife calmed me down enough to deliver Dds head slowly and I didnt tear at all.
I think its important to listen to what the midwife is telling you at that point, they are down that end and can see whats happening!

[alfiesbabe]

very true. A good supportive midwife is imo the best aid to labour - better than drugs. The midwife can often support you through a very controlled delivery - that's what my first was like, and I'd say it's a thousand times better than being drugged up to the eyeballs.

[alfiesbabe]

That was why I delivered in a midwife led unit. I got to know the team of midwives through my antenatal appointments, so I actually had built up a relationship with all of the midwives who were potentially on duty when my baby was due. I would have had my other two babies there if I'd had the choice - but sadly that was taken out of my hands as dd2 was CS and then ds had to be delivered in a large hospital due to the CS. I can't understand why people would choose a large impersonal hospital over a midwife unit (though of course everyone is entitled to their own view). I found the level of care and support far superior in the unit. Incidentally, when I had my dd there, the midwives told me how frustrated they were that a lot of first time mums weren't confident to book there, and would go to the larger hospitals rather than the unit. It made them feel that their skills weren't being fully utilised, and the unit was constantly on the brink of closure because they needed to have more births there. So, I would say make the most of your local midwives if possible!

[maxbear]

I think that you would not find an aneasthetic for the perineum that useful as only a small area is able to be anaesthetised, also might make you more likely to tear. I would say that the birth itsself is probably the worst bit, but by then you are so close to the end that it doesn't matter as much. Also I personally would say that it was not as bad as I thought it would be although have never had a major problem with smear tests. You will not be able to use a birth pool if you have had pethidine though. In our hospital the policy is four hours afterwards and for most people they have either had more pethidine or gone on to an epidural by then. Good luck

[alfiesbabe]

That sounds awful starlight. No way should a midwife try to hurry you along simply to fit in with her shift pattern. I have to say, I found the large hospital far worse for this - there seemed to be constant shift changes and lack of communication. Whereas in the unit, the midwife actually stayed on duty past her finish time because I was in second stage and she wanted to deliver me! I call that excellent service!

[iampgatlast]

cuppateajuice - i gave birth 3.5weeks ago. i intended on having a home birth but the contractions were so intense and close together i transferred to hospital for an epidural.
the epidural did not work and i felt EVERYTHING still, when the head was descending and i was in the final stages of pushing the midwives suggested an episiotomy which i refused but they gave me the perineal anesthetic just incase. as it happened i did not tear and i didnt fully feel the head crown, there was still some discomfort but definately not as bad as what i had imagined.

after my son was born they told me i had torn internally and had another shot of the anesthetic down there and again i didnt really feel anything.

i thought it was a fantastic form of pain relief even though the contractions were hideous once you start pushing it feels like you are just pushing the pain away.

[barbamama]

i just wanted to add that crowning was the bit I was most scared of as well. I know everyone is different but after 2 deliveries now with just gas and air I can honestly say that I did not feel a particular crowning sensation with either of them. I think by that stage you are so focused on getting the baby out and that area is kind of numbed anyway and the pushing urge is so strong that if you just go with it it should be fine. I had a tiny tear each time and never bothered with stitches so it can sting a bit later with the first pee but fine if you do it in the bath or pour some water over. in my experience, the contractions getting you to fully dilated are far worse than the second stage with pushing and crowning which is actually quite a relief as the intensity of the contractions calms down. And honestly, you are so nearly there by that stage you won't care I don't think. Good luck.