Pudendal Block, anyone got experience?

[kittyonthebeam]

Not many pain relief options available that do not transfer onto the baby. This is a lesser known one that basically blocks the perineal nerve. You'll feel the contractions, you'll feel the transition and you won't lose sense of pushing. However it does numb the area of the perineum when the baby is low and crowning.

It is thought to 'slacken' the perineal area and make the birth easier because you cannot tense, thus guarding the perineum. In case you do tear or need an episiotomy this would be given, too.

FYI: www.google.co.uk/search?hl=en&q=pudendal+block&btnG=Search&meta=cr%3DcountryUK%7CcountryGB&aq=f&aqi=&aql=&oq=&gs_rfai=

The only risk seems to be if it is injected intravenously which can lead to toxicity levels in mother and baby and even fatality.

It's not a very well known pain relief, can anyone please tell me more about it? Midwives, mums, etc?

intravascularly not intravenously

Sorry.

I had one to prepare for mid-cavity forceps. I was told that the risk was that "it's not easy to get it in the right place, so it may work, it may not". By this time I was so tired (I was falling asleep during contractions! ), I didn't really care and my thinking was that the forceps would be over and done with quickly, so that if it didn't work, the pain would be compenstated for by the arrival of my baby. I was also already on diamorphine, so did already have "other" pain relief going on.

As it happened it did work. :)

It also helped with the stitching up afterwards (which I hadn't thought through) becasue although I was given an episiotomoy, I also tore.

Dh, who had been apprehensive about "blood & gore" found himself actually watching them stitich me up, as he said the fact that I was so obviosuly not in pain meant that he was OK about it.

Oh very interesting prettybird. Yes, I heard it wasn't easy to administer. The dutch midwife I asked just waved it off mutting 'not worth the hassle' ans suggested episiotomy, forceps and the like completely without pain relief. No bloody way!!

How long did it work for you before it wore off? Was it lidocaine?

May I ask why you can't/won't use other forms of pain relief? And why you think you'll need episiotomy, forceps and the like - or this a "just in case"?

Local anaesthetics don't work on me due to Hypermobility Syndrome, so I know that if I need an episotomy, it'll be without the usual local. But afaik, I could still use G&A at least.

I can't remember how long it took to wear off. I was left to have a bath after having ds (I was in a labour suite that had a bath) and a cup of tea na dtoast and then was taken back down to the ward.

Reading japhrimel's post reminded me that I was also using Gas and Air and a TENS machine The diamorphine was started when they started me on the oxytocinin drip as my waters had been broken for more than 24 hours (I had actually started labouring about 8 hours before, 18 hours after my waters broke).

I have no idea what the name of the anaesthetic was. I didn't have it on my birth plan as I didn't know it existed (it is very never rarely mentioned as an option). The other alternative offered was an epidural but I didn't want one (irrationally scared of the idea of someone injecting my spine and it would have taken time to get orgnaised and I was exhausted)

In hindsight, the midwife (the second one I had, as it had gone through shift change - and she wasn't as good as the first one) had been encouraging me to push during transition, as I never actually had an urge to push - which was why I ended up being exhausted. However, when it is your first child, you don't know any better.

Japhrimel, I'm not expecting or thinking about epi or forceps or the like. (Well, I do worry, but just like any other mum to be.)

I had an ELCS the last time and should use neither epidural, pethidine, etc because they can well slow contractions down and due to my CS scar I cannot have any augmentation of labour such as oxy or synto.

I didn't like entonox because it made me sick and hence I am considering a pudendal block. And TENS. Will give entonox on mouthpiece a try as last time was a mask and I hyperventilated.

Oh prettybird, what a story, it must have been so hard for you, the interventions and then being so exhausted. Also a very long time. Such a stupid midwife! Not that I know any better as first labour for me but am relying on my doula to keep me going.

Thank you for sharing your experience!

Pudendal block are only used for instrumental deliveries in the absence of regional anaesthesia (epidural or spinal). Total waste of time for normal deliveries as they are tricky to insert (and painful) and can only be performed by an obstetrician in lithotomy. An effective pudendal block may relieve the pain of crowning, but still not worth the hassle and pain of getting it sited for such a short period of labour when delivery is imminent.
IMO more painful to get sited for a normal delivery than crowning - but well worth it for a midcavity instrumental delivery.

So it was totally appropriate in my situation! :)

Interestingly, in my mind, I still had a "natural" birth becasue it was vaginal and without an epidural - the two things that were important to me.

It was the physio who I had to see a year or so later becasue of some ongoing damage (my pelvic floor is knackered, to use a technical term, and it is only my Pilates exercises that keep me together ) who had to point out that the various internvetions (induction, forceps) mean that it was not technically natural.

Hmm, interesting. It sounds like it still might not work for me, because of my issues with local anaesthesia. The hope is that a spinal will work if needed because it's injected straight into the spinal cavity, but even that's not certain.

Has anyone actually had forceps, etc without anaesthesia?

I asked about this on MN a while back.
It was just a query really. I had a natural first birth, and although it was very painful, I felt I coped ok, except for the crowning which I found excruciating.

I asked whether there was any reason why this pain relief isn't routinely given at the last stages of birth, because many women (myself included) wouldn't want to have an epidural, with all the possible knock-on effects, and also the disadvantages of being numbed up and stuck on a bed for most of labour, when actually, it's just pain relief for the final minutes we want.

I was told on here (by a midwife I think) that a) it is complicated to inject correctly and
b) an injection at this stage might actually make tearing more likely, because of the effect on the muscle - which seems to contradict the information in the OP!

I am also interested in this. My child bearing days are over, and actually on balance I would still rather put up with the pain of crowning than go the whole hog and have an epidural just for the sake of having a painless crowning. But it would be interesting to know whether it really is correct that it could make tearing more likely.

IME the crowning is definitely the worst part, especially if you are on no pain relief and tear, as you totally feel it happen, and it would be interesting to know if the reasons for not routinely offering a block for this pain are proven

Thank you for shattering my dream Malteser

I do understand it IS difficult to insert. Hmm, will speak to my OB Gyn directly next week. Fingers crossed.

Violet, did they tell you why it makes tearing more likely? All the google hits seem to say it makes it less likely due to slacker muscle and no tension. You will still be able to push with your other muscles, just the perineum is numbed.

I can't remember the details as this was some while ago, but the poster ( who I think said she was a midwife) definitely said that injecting the muscle at this stage could increase the risk of tearing, and therefore the block is only given for forceps and not routinely just as pain relief for crowning. Tbh I feel in two minds: even if the woman does tear, she's not going to feel it happen, and although of course it would need stitching and there might be some soreness after, that might be a small price to pay for a pain free crowning.

Having had two natural births, I can honestly say this was the worst part by a mile. I know I can cope with dilating to 10cm, I can cope with transition, but actually pushing the baby out and feeling that intense burning and feeling myself tear...... Shudder! It seems the only other way to avoid that is epidural, and as I said, there are so many downsides to that, I wouldn't want to have one just for the sake of those final minutes

I am with you on that epidural plus I felt it didn't sufficiently numb me. I have a history of waking up from a GA though, so obviously need a horse tranquilizer to knock me out

Thank you for mentioning it violet, I will definitely ask my doctor here and my OB/Gyn back home.

Maybe some more people can come on here and tell me about their experiences?