WHy do you haved to be 4cm dilated before getting an epidural?

[sarahscot]

Anyone know? I assume there is a medical reason? Why can't they put the needle into your back earlier so that as soon as you need the pain relief it can be give?

The reason I ask is I put on my birth plan that I want an epidural but my MW laughed and said I wouldn't have time. My first labour was induced, agony from the first contraction and was all over in 3 and a half hours. By the the stupid MW believed me when I said it was moving fast and I needed an epidural NOW it was too late. I had nothing but G&A throughout. I honestly thought I was dying. I'm scared this time and want pain relief but from what my MW says I won't really have this option as my labour will prob be quicker than the last.

by the time, not by the the

Because the want to be sure that you're in established labour- byt the time you're 3-4 cm dilated, it's unlikely it'll stop. 1-2 cm you can be for days or weeks and it doesn't mean that you're actually going to give birth shortly.

Also epidural might slow down the labour, so they want it to be established.

(I think)

I think it's so they know that labour is really established.

I had epidural with ds1 as really struggling and none of the other pain relief options worked.

I went in when I thought I was having strong regular contractions with ds2 and MW believed me so I stayed on labour ward for a couple of hours before she examined me. I wasn't dilated at all - they were strong braxton hicks which I'd never had before

But you did get a stupid midwife- I was induced with my first and they proposed epidural right after they started me on the drip.

Here's something to quote to your dopey midwife - "Women in labour who desire regional analgesia should not he denied it, including women in severe pain in the latent stage of labour'." Page 115 of the NICE Intrapartum guideline -the one she is supposed to be following. Do you know you can discharge a midwife? I think I would be a bit worried about her Good luck anyway!

I know someone who was extremely scared of the thought of the pain of childbirth; she did a lot of extra ante natal visits and the doctors agreed that she could have an epidural on arrival at hospital. there was no condition of being a certain number of cm dilated.

I imagine the reasoning behind the putting it off til later, is as others have said though. Imagine getting a cm or two dilated, having the epidural, and then actually your body was just 'getting ready' and you weren't in established labour for another few days! Also, there is a risk that epidural will slow labour down, and there are increased risks of other interventions once you have an epidural, so I guess this is why the medics don't want to rush straight in there. It's a major medical procedure.

Thank you for your replies.

I can see that the 4cm rule is to ensure you really are in labour.

Hopefully this time I won't need to be induced and it won't be so agonising . . . I can but hope! I have an appointment with my consultant to discuss my fears arising from my last labour, perhaps he can say something to ease my fears a bit???

I think it's highly likely your second birth won't be as bad, simply because your body has been through it once before.

FWIW, I thought I would die during my first labour (natural drug free birth). I then had a CS for dc2, and for dc3, who was a VBAC, although it was very painful, it didn't last nearly as long as first time, and there wasn't that absolutely terrifying sheer fear that your body will be torn asunder - simply because you've been through it and survived.

So tbh, you'll probably manage fine this time

Violet, are you sure it makes any difference? The Nice guideline (looking at it online) says "There is high level evidence that intrathecal or epidural analgesia administered during the early first stage of labour does not affect the progress of labour, mode of birth or immediate neonatal condition compared with administration later in labour." Seems as though there is no point in waiting, is there? The danger is that when you need it they can't find the anaesthetist or he/she is busy with a c/s.

I've been induced twice with a "natural" start labour in between. The 2nd induction was nowhere near as bad as the 1st. It was a completely different experience.

I got one when I was 1cm dilated! Was in total agony with my first and couldn't bear it. Mind you he was 10lbs 3ozs. It did slow down the labour but I couldnt have got through it without it.

Im not a whimp! 2nd labour, I just had gas and air and she was 9lbs 91/2ozs.

In relation to the epidural so early on, it did slow down the labour and a midwife from the midwifery unit later told me that I was very lucky they didnt give me a C section.

BTABODS - my point was that an epidural increases the risk of labour slowing down, or the risk of other interventions compared to NOT having one. I agree that if you have an epidural at any point in labour, the risk is increased, and it may not make a difference whether it's at 2 cm or 8 cm. However, I imagine the thinking behind encouraging women to wait, is that if the mother puts it off and manages another few cm, she may subsequently decide she can manage a few more cm without... and then may get through the whole of labour without.

Violet - thanks for that. I guess the only problem with encouraging people to wait is that if complications develop, it is likely to be right at the end so the woman is climbing the wall with agony but it is too late to place the epidural because she can't keep still. I've had two friends that this happened to and they felt really trapped, desperate and traumatised. One of them had to have counselling with a clinical psychologist and she is too scared to have any more children. I can see your point but I still think midwives ought to respect women's wishes.

According to my obstetrician, it is preferable to have the epidural put in at 3-4cm dilated once labour fully established, as putting it in too early may 1) slow down labour and 2) increase risk of intervention. He told me prospective studies on women giving birth show that epidurals inserted once labour fully established (3-4cm) do not have a greater incidence of intervention than labour without pain relief (or other forms of pain relief). If put in too early, it increases risk of intervention because of labour slowing down.

You can have an epidural when you want, nothing to do with how dilated you are. Tell them all to fuck off and that you want it NOW

Mosschops, you're so right:) It is so creepy - what is it with some midwives? There is no other field of medicine where people are left screaming and yelling for pain relief and it is considered 'ok' to 'support' them to manage without. All pain relief has some risks but the risks of epidurals are not that great otherwise the litigatious US would not have something like an 85% rate plus. What's more, why isn't more effort being put into REDUCING whatever risks there are? There doesn't seem to be any..I've never heard a midwife demanding more research into pain relief. GRRRRR...

I have a friend who is an anaethnetist (sp?) and he reckons there's no time when you can't have an epidural, and it very much depends on the mw you get. He's just in the middle of an obstetrics stint so I take his word for it!

I arrived at hospital 9sm dilated, requested an epidural and had it refused on the grounds that I was about to give birth. It was a half dose of pethidine, gas and air, or nothing. Five hours (two of which were spent pushing) later, out came DD.

I think in the USA you get an epidural practically at the first contraction, and I understand it's similar in France. A friend of mine had her first 2 in America, and couldn't believe that in the UK they make you wait to have an epidural

Not really sure, but I was given one late on (MW examined me after the thing had gone in and I was 9cm - wouldn't have bothered if I had known, thought I was gonna be ages!) and it slowed the whole process down and I ended up having an episiotomy and ventouse

I was induced and had one when I was 2cms. If they had wanted to wait until I was 4cms then I would never have had it, because 3cms was as far as I got in 24 hours and off we went for an emcs.

IME, it is always a good idea to think about other coping strategies and pain relief as it is not always possible to get an epidural when you want it.. if one aneasthatist on and he's in theatre, you could be waiting an hour or more for an epidural and it takes a while to site it.. so definitely worht considering other options eg. TENS, G&A, diamorphine/meptid/pethidine... aswell as staying mobile and upright which helps move things along