no epidurals available in this area...

[Goldrill]

Am after advice please!

I'm 32 weeks and went to first ante natal class last night. Was somewhat surprised to find out that nowhere I could go to in my area to have the baby is able to give epidurals in labour - they do have emergency cover for caesarians and I probably should have asked about forceps etc. Apparently there are not enough anaethsatists to go round up here.

I was generally intending to try and go without too much intervention, but was reassured by the thought that an epidural would be an option if I needed it, as I am an utter wimp. I signed up for the largest local hospital partly because it's my first and I am comforted by the prospect of large scale medical assistance being available if required but also because I had (naively) assumed that was also where epidurals were available.

So now am having a bit of a panic - I thought epidurals were fairly normal and routine and not a weird expectation for pampered people. Clearly North Cumbrian mums are very hardy as it seems to have been like this for a few years.

The MW seemed to imply we were the only english area where this is the case: does anyone know if this is correct and where I can find out more about it please? And are there any facts and figures (reliable) out there to show how many first time mums do normally have epidurals - I just want to know how "normal" they really are.

And most importantly: does anyone want a house guest in November as am now mildly terrified - am I just being daft?
Thankyou in advance!

Where are you? That sounds horrific - epidurals are not for everyone but it is surely not right to deny all women access to them.

Epidurals are used in about 33% of all vaginal births. The figure is higher (but not sure by how much exactly) for first births, which tend to be longer.

Same goes where I'm booked in. They can offer a transfer in labour if one is required - only an hour one way or an hour and a half the other! They do spinals no problem for eg Caesareans. I like the hospital though - small consultant-led unit, not too big with the interventions - so it's not bothering me too much. Seems odd that there's no alternative place for you to go though.

I think you should investigate this and find out what the score is and. An epidural is a good option for lots of women. What about pethadine?

Does their scale go from gas and air to full blown cs with nothing in between

well i don't know how helpful this is but in my opinion you shouldn't bother worrying, epidurals are a waste of time ithink. i know lots of people will respond and day no they're the most wonderful innovation known to man, but when they don't work it's pretty rubbish!!! they must have anaesthetists because how would they do any other surgery, not just c sections but any other surgery in teh hospital. so you should be able to have a spinal if you need to have forceps.

you should also consider the risk of epidurals, of increased intervention- you're more likely to need forceps with an epidural rather than require an epidural becuase you need forceps.

next time around i would just use gas and air (its great stuff you'll see when you're in labour!) and pethidine if necessary.

muslimah28 there is no way I would have wanted to give birth (induced, back to back contractions for 5 hours, no respite) without an epidural. I thought I was going to die. Gas and air didn't touch the sides, had so much that my extremities went completely numb. Didn't do a thing to relieve the pain. I would be very cross if I did not have an epidural as a fall-back option in my next labour.

OP, it seems incredible that they are not available in your area at all - barbarian. How can that be even allowed???! It's almost as if someone has decided they are only the province of spoilt women who can't be arsed to experience 'real' labour.

I wonder how many appendectomies they do without general anaesthetic in your area

I am sitting on the fence a bit here, because although clearly for some women, the option of an epidural is totally 'the norm', and they wouldn't consider going into labour, particularly first time around, without knowing one is available, there are plenty of other women who really wouldn't feel so bothered about it.

I think you also need to remember that even if you were booked in at a hospital which offered epidurals, there is no cast iron guarantee you would get one, or at least not at the time you felt you needed it. Anaesthetists are not always available on demand, 24/7, and where they are, they will have to prioritise emergency situations, Csections etc. So it's probably not a good idea to pin everything on having one.

There are so many options inbetween no pain relief and a full on epidural (which is a major intervention and carries risks of increased interventions). I would investigate those. Gas and air can be great - as long as you don't expect it to block the pain, just alter how you feel.

FWIW, if it comes to forceps, you don't have to have an epidural to have these. I gave birth to my first in a MLU, 19 years ago, where epidurals weren't available, but if it looked as though forceps were needed, a GP trained in obstretrics would be called in from the local surgery. I was borderline on needing forceps, and the midwife called the GP in and explained that she would give me a local anaesthetic injection before the forceps were used. As it turned out, the wonderful midwife encouraged me to give one last final pushing attempt before they started on the forceps procedure, and my dd was born without needing them, but this may reassure you that you don't have to go down the epidural route even if you need help to get the baby out.

In terms of stats, I believe slightly over 50% of first time births are with epidural, and about one third of births overall, so although it's a fairly common procedure, I wouldn't describe it as 'routine'.

I would investigate further and look at the range of pain relief options. If you really can't face the idea of birth without knowing that there is an epidural option, then I guess you'll have to talk about delivering elsewhere, but as I say, bear in mind that one may not be available when you want anyway, so I would weigh up the disadvantages of travelling further, outside your area.

narmada i too had a very difficult labour, induction, oxytocin contractions the works. and i had all that with an epidural that worked half the time (brilliant) but didn't work the other half of the time.

violethill is spot on, even if you want an epidural you don't always get one. both times it failed for me, the anesthetist wasn't available (for some reason, they couldn't come for 3 hours each time) so i had to cope on my own.

so now i think having an epidural as a fall back position is fine, but i think its best to prepare for pain management without one eg with breathing techniques, visualisation, whatever works, so whatever happens you 've got your own internal resources to cope.

that's just my opinion.

Our hospital offers epidurals but the average waiting time for an anaesthetist to become free to do one is between 1.5 and 5 hours. Apparently a significant proportion of women who ask for one don't get one anyway because by the time there is someone free to give them one, its too late.
At least if you know you can't have one you can factor that into your plan. I think it would be worse to think you could have one when you asked and then be told actually you couldn't!
I think you should ask what they do for forceps and ventouse though - you might REALLY want an epidural if they are going to have to do an instrumental delivery and it would seem a bit brutal if it wasn't even an option for that.

I didn't have an epidural but I chose to give birth in the clu where they are available in case I decided to have one. With your first baby its scary because theres no way of knowing what the pain will be like or how you'll cope. Ds was born by ventouse and they gave me a local anaesthetic for the episiotomy which totally numbed the area so I only felt pressure, I assume thats what they do in ops area.

Gas and air was enough for me although I could have done with it a lot earlier, I only asked for an epidural once when I was in the taxi fully dilated and trying not to push (dh said I was talking nonsense and asking the taxi driver to do it )! I agree with what a previous poster said that even in areas where they give epidurals its never guarunteed. You may progress too quickly or arrive too late like I did, the anaesthetist could be too busy or it might not work like muslimah's. At least you already know you won't be able to have one so you can make your peace with it now. I'd be scared in your position but gas and air is amazing and moving around helped me a lot too. Good luck I'm sure you'll be fine

thankyou for replies - very much appreciated and very useful in calming me down!

I suppose on reflection that thinking you were able to have one and an anaethsatist being unavailable or it failing to do the job would probably be a lot worse than knowing in advance that it was definitely not an option. I shall definitely find out what happens with forceps/ventouse deliveries.

I think I was just very surprised and slightly shocked to find out - and am now wondering what other things I thought were straightforward or that I understood will turn out to be wrong. I've had five antenatal visits so far, with five different midwives (all very nice I hasten to add!) and I know it's a very busy area so had assumed some of the frilly bits/niceties might be in short supply but this was a bit beyond that. And I do realise every other mum in the area must have had this experience in recent years, and that there was a time before epidurals etc so I shall put a lot of effort into relaxation etc beforehand and try and get a grip!

Thanks again - your comments have really helped.

Goldrill, is it possible to find out where your nearest hospital is which does do epidurals, and then just, well, drive there when in labour? They can hardly turn you away, even if they may refuse to register you during pregnancy.

If it's Cumbria I doubt travelling is the answer. Geographically hospitals can be v far apart.

nymphadora - as I mentioned in my post, my hospital offers a transfer in labour if you desire an epidural. There's no way you could transfer in less than an hour, but they do offer it. DP's family are all in Cumbria and geographically we're no better off up here. I am surprised there's no similar option in this case, although how practical it would be/how many people actually take them up on this offer I have no idea.

I am just over the border in the next county - Dumfries and Galloway - no epidurals her, either! Seems our local hospital has a higher than average rate of cs as a consequence. Midwives suggested that I might want to give birth somewhere else instead. Charming! Prospects of a 2 hour drive in December up the M74 not exactly appealing. So, guess what? I have asked for an elective cs, and it turns out - an epidural will be part of the service. Is it me?

These posts are totally right that often you can't get an epi anyway, even when they are supposedly available.

I got rather obsessed with the birth of my last (first) baby as the date approached. I got consumed with the idea of an epidural and even went to see the chief registrar a week before the due date to beg for a guaranteed one! Of course, it doesn't work like that and as everyone here says, most of the time there is a significant wait that often results in it being too late.

I DID get that epi in the end (DP was very pushy and went himself to talk around an anaethetist in A&E) but 20 minutes later and it was an EMCS anyway. The bottom line is that you just don't know what is going to happen and chances are, what you plan won't see the light of day.

Good in a way to believe that option is closed off - I found all the options a bit bewildering and was a bit misled into thinking I could have the drugs I wanted in the order I wanted them!

Am in Western Scotland as well with only small, MLU.

I had an epi with first birth as she was OP and, turns out, had hand up over her ear. Wound up with H-F forceps delivery consultant said epi was necessary for this type of delivery, so it's not always true you can have a forceps delivery without regional block pain relief.

My second birth was too fast for any pain relief, gas and air made me sick.

I did not enjoy that experience at all in fact the pain and the memory of it really jacked me up.

So I knew with my third I wanted an epidural, especially as I can giving birth on my own.

I travelled 1.5 hours in an ambulance to a CLU then waited 4 hours for one.

Midwives kept trying to convince me to move around, etc.

But no way did I want to feel the way I did with DD2 again.

So I put my foot down and I literally stopped mysel from giving birth till I got that fucking epidural. My lower body was actually spasming on its own to give birth but nope, I wasn't going there.

You need to be firm and insistent if it's what you want.

No one has the right to tell you otherwise.

I had a back to back labour and managed on hypnobirthing and morphine. I was adament that I didn't want an epidural as I had severe SPD and ther are risks that numbing that pain can do serious damage, as you are unaware that you are in a bad position.

In early labour the pain was unbearable from DD being back to back. I would of happily put a shotgun to my own head. My fantastic midwife, when I said I couldn't cope any longer, got the morphine in really quickly and I was lucky that for me it did the trick.

Several hours later it wore off and the pain started to head again to the level where it wa unbearable. I remember begging my midwife 'not to let me get to that stage again'. She was fab, and said 'If you can get through the next hour on gas and air, I will give you more morphine, if you can't I will get you an epidural'.

As it was I managed on gas and air (just) but if I couldn't have the option was there.

What I'm saying is whilst there is all this 'an anaesthatist may not be available etc etc' there are cases where you will be prioritised as the midwives can tell that you really are at the stage where you can no longer cope, which in my experience goes way beyond searing agony.

I managed a back to back labour on morphine, but from my expereince I'd be very wary of 'absolutly no epidural available'.

I had morphine with DS, my third. It did nothing for the pain. It just made me stoned.

I think this is awful, mostly because the idea of it not being an option would send me into a complete panic.
Barbaric in my view. You should contact AIMS they are hot on this kind of thing.

If it were men giving birth there'd an one anaesthetist on staff 24/7 and another one on call 24/7.

hi there
I am in Cumbria and I too didn't have the option of an epidural unless I was transfered. I had failed ventouse and forceps with gas and air - I found it was fine

erm I don't mean to scaremonger here but Epidurals aren't just used for pain relief! with DS (dc2) he was stuck and something to do with his position brought on the urge to bear down even though he was really high and I was only 8cm ... they gave me an epidural in the hope of taking away the urge as it was making my cervix swell ... as an aside he must have been in a random position because an epidural / gas and air and focusing on breathing out through the contractions couldn't stop my body pushing!

expatinscotland I am with you on that one.

There are many pluses and minuses for the uses of epi but women should at least have a choice. It does not seem fair that some do and some don't. I would investigate further for sure just in case.