To think that this birth plan will be ok?

[Anxiousally]

I'm 35 weeks pregnant with baby number 2. My last labour I had an epidural and it ended in theatre with forceps and I signed for an emergency section if the forceps didn't work. I have a healthy 21 month old.

I am overweight so have been advised to have an early epidural to avoid the risk of a c section under General anaesthetic. I have lost weight through pregnancy but not enough to make a difference to delivery (Please, I don't need to hear the fat people shouldn't conceive spheil, thanks).

My plan is to have the epidural and let it wear off slightly ready for the pushing stage and use gas and air as part of the reason for forceps last time was that I couldn't feel contractions to push.
Is this my best bet? I feel stuck and really anxious I'm consultant lead and I don't feel comfortable talking to him about a birth plan. Hes been great but seems to brush off any concerns I have sometimes.

My anxiety is building now its getting closer and I feel like I need to get my head straight for the Labour and delivery. Any advice is very welcome!

I think that sounds very sensible op. maybe discuss it with your midwife? Good on you for the weight loss.

You don’t have to have an epidural if you don’t want one. If you want one, fantastic and it’s a good plan, if you feel like you should have one because they are saying you should, DON’T. this is your birth. Have what you want. Unless it’s a true emergency, ie baby is very compromised, the likelihood of you having to be put under a GA is slim. There is almost always time for a spinal. If you’re not bothered about an epidural, and want to see how it goes, ask for the anesthetist to attend when you arrive. They will check your back but don’t have to insert right away. It will let them know if there are any issues with access.

Good luck - you’ll be a total rockstar. All women are ❤️

I am 30 weeks and under consultant care for high bmi and also adv early epidural. The reason for this is incase you need a c section there ready to go as a high bmi means your more likely to have a csection. I am planning not to have an epidural as this also increases need for a csection so I feel is counter productive. But it can all change xx

Sounds sensible. Unless it's a crash they won't put you under for the section.
I had an epidural and ended up with a section.

I'm not sure if you have the epidural that it will wear off in time for the pushing stage! I had an early epidural when I had our son as I have neuromuscular issues that meant they weren't sure if I would physically be able to push him out or not, so I was on standby for a c section. I was induced too. The epidural only worked on my right half which was completely immobile and on the right I could feel a lot of pain with the contractions but I had absolutely no urge to push at all, so like you I had to be told when to push. I also had forceps. The thing is that if you have an epidural to avoid a GA then it will need to be a full on epidural in case they need to get you into theatre quickly. There's no way of telling how long your labour might be, and if it's quick there won't physically be time for the epidural to wear off. Mine too a good few hours to wear off.

i'd just go with the epidural and hope for the best. A healthy baby at the end is the most important thing.

I don’t understand why you need an epidural? Are you likely to need a very emergency section or is there some reason a spinal block wouldn’t work? I had emergency section with a spinal. I thought GA was only for crash sections where every second is vital. I was sort of under a consultant second time but not really, didn’t end up discussing a birth plan with anyone formally. My birth plan was no epidural - no induction (agreed by consultant) and other than that go with it. I would ask to speak to the midwife if you can’t discuss it with the consultant and you are worried though.

I would love to do it without the epidural however I did need it in my last labour. I would have loved to just try and be more active through labour to see if it helps delivery. At my hospital every lady with a high bmi is invited to a meeting with the anethnatist to discuss the risks and options etc they advise you to have an early epidural in case there is a problem placing it as it's harder sometimes with ladies with a high bmi and also risk of needing intervention is higher too.

I thought about having the epidural placed and not having the drugs in straight away but the drugs are what tells them the epidural is placed right and working or not so that's not a good idea. I feel like I have alot of thigs to talk about but I'm not sure who to ask!

I'm also overweight, I was actually bigger with my second. I had an epidural with my first after I was induced due to GD. I didn't have anything with my second other than gas and air and it was a less traumatic delivery. I also didn't have GD with my second. Have you got a Midwife you can speak to? Good luck x

Hello, retired anaesthetist here! If you have a very high BMI, you are more likely to need either forceps or a Caesarian, but it will be much more difficult to get either a spinal or epidural into your back, as the thicker layer of fat obscures all the landmarks.
Some patients are so obese that we have to use special extra long needles to even reach the epidural space, and in extreme cases it might not be possible.
It’s far safer to put in the epidural slowly and calmly in early labour, than struggle to get any kind of block in later on in a screaming emergency, when you’re wriggling about with contraction pain and the fetal heart rate is nosediving!
I’d suggest having a chat with the duty anaesthetist on arrival and be guided by their opinion. General anaesthetic is best avoided for sections and is particularly dangerous in high BMI patients due to airway issues, which is why we always prefer to have a spinal or epidural block in place.

My last epidural was a success 1st time but obviously this has no bearing on future attempts and I'm not sure what needle egg was used. Thankyou for the advice.
I just want to do what's safest for baby but there's conflicting information.

I would always listen to medical advise but have to admit it was never suggested to me to have an epidural in preparation for needing one and my bmi has always been in the early 40s.

My first was induced due to GD and even though my plan was to not have an epidural I changed my mind but both attempts were not successful. I ended up with an emergency c section and thankfully a different anaesthetist was able to get the spinal block in and it all went well.

2nd time my DD was in so much of a rush to get here there was no time for much more than Gas and Air and a few pushes! Completely different births. I'm not sure if it helped but I always think it did - with my second I spent a lot of time on the birthing ball from 37 weeks and all of early labour on it (only 2.5 hrs really as labour was pretty fast). I always advise a birthing ball now 😀

It was recommended that I have an epidural at the start of my last induction due to high bmi. I pointed out that my last two inductions had been fast and no forceps/ventouse required. Plus I’d had issues with an epidural in my first labour. So I declined. Yes, it would be harder for the medical staff to place it later and the risk of intervention is higher if you have a higher bmi. However, the chances of intervention after an epidural is higher too.

Medical advice is just that - advice. Could the consultant assess you to see how difficult it would be to place? It might put your mind (and theirs) at rest.

The anethnatist checked my back at my appointment but did say either way about how difficult placing it would be.
Thankyou for the advice I will definitely be on the ball from 37 weeks!

Just to offer my experiences (although obviously everyone responds differently) - I last topped my epidural up at the start of my passive hour, baby was born 3.5 hours later (🙄). I didn't have any pain with my contractions but could still feel when they were happening.

Another anaesthetist here. Agree with both the explanation from my retired colleague and with your plan. In most places, an epidural is a constant infusion of anaesthetic through a thin plastic tube in your back. It can always be turned down or off if required, and the feelings should return once the anaesthetic wears off. I would be happy to do this once we’d established your epidural was working properly and if your labour was progressing well.

However, the fact you couldn’t feel pushing for your previous forceps was because it was in theatre. In this scenario, your epidural will have been topped up to enable the emergency caesarean if it was needed. If you end up in theatre for a trial of instrumental again, your anaesthetist will probably want to do the same - but discuss it with them, and as PP have suggested, discuss your plan when you arrive on the delivery suite.

Hope everything goes ok with your labour and you get to meet your little one soon!

Thankyou for the insight from actual anethnatists it's very helpful. I am going to try and get a midwife appointment to talk about everything but i think i need to accept the fact that I won't know really what's going to happen till it happens 🙈

Just to give you my story, I have had two babies with a >35 BMI, hight risk as old bird here as well!!

First I was induced at 40 weeks, 5 days later baby arrived, having had the epidural at around 4pm on day 4 - emergency section as baby was stuck head looking the wrong way and too far up to use forceps.

Second I was much more determined in what I want, had a lot of conversations with my midwife in the community and did loads of research - my consultant was off for my last appointment and her registrar was abominable so I complained - upside is I ended up speaking to the Midwife Matron who got me onto a pilot project for a Foley Catheter Induction - I went to 40+12 as I refused an early induction. With no hormonal induction - my little one decided they weren't going to wait around and from waters breaking at 3am baby arrived at 6am! Completely different experience and no chance to even consider an epidural!

Your next labour could be so different.