induction with ARM or drip (no gel) possible without epidural?

[Yelters]

Hi

I'm 38+5 and due to be induced with LO2 on Weds due to gestational diabetes. The aim is to start with ARM, but if unsuccessful/unfavourable will use drip. They won't use gel as I'm a (potential!) VBAC-er so there is an elevated risk to the previous emcs scar.

Whilst I am not ruling out epidural, I am conscious of the risk of intervention escalating if I go down that route so would prefer to manage as long as possible without. I wondered if any VBAC-ers on here had been induced with a drip/ARM and managed without epidural? Or is it a foregone conclusion?

No experience of the drip (my induction was gel and ARM) but my understanding is that it is very painful without an epidural. I think you would find it tough BUT you're right induction at your stage plus epidural isn't going to help you avoid intervention.
I think quite a lot of sex between now and Wednesday is needed - semen contains the same prostaglandins as the gel and might get you to the point that ARM will be possible.

I wasn't induced, but was given the drip when my contractions stopped. I didn't have an epidural - was fine on gas and air.

I was induced with a drip and had just gas and air until I needed intervention (forceps) and had a spinal anaesthetic in case that failed and I needed a section. I didn't find my induced labour worse than my later uninduced labour TBH, but it was a lot longer, and had I known I would end up having a spinal I would have asked for an epidural hours before...

I had ARM after being at 4cm for 24hrs with DD. She is by only one so not VBSC. I did without an epidural (nor GnA incidentally) and she was back to back. I did ask for one, but I practically at transition at that point. So when I knew that I was OK. Thankfully getting to the pushing stage only took a couple of hours, so once there it was fine (although was there for a few hours).

Don't know if that helps of not. Yes it can get intense, but will hopefully not be too long.

I was induced with a drip, had no epidural, but G&A, then Meptid, felt sick with the pain, was totally out of it, until they turned the bloody thing off and gave me a section.

I had 3 lots of gel and then the drip; was on the drip 6 hours before I needed pain relief (opted for epidural after puff on G&A made me sick).

I had gel and then drip after a 4 day latent stage and RM with an OP baby.

The pain was really tough on the first day, tried a little meptid, but a shift change on the 2nd day then brought me (from the heavens) an AMAZING midwife, who knew when I needed a shift of focus, position, to be unhooked from the monitor, a trip to the loo etc.

With her I laboured well (stay off the bed!) and got to 8-9 cm when a consultant said that c-section was needed for distress. Having gone through notes, this was prob. not entirely true and in retrospect prob not needed. But that's another story.

So I'd say, so long as you have good support, anything is possible. I hope everything goes really well for you and that ARMs sorts it out instead!

Thanks all, we have apes tomorrow to review all the options and it's great to know that the drip doesn't necessarily = epidural and lots more intervention

Will keep you posted!

Apts not apes! Flippin auto-correct! :)

I was induced with drip and they wouldn't give me an epidural, dd was back to back and ended up with forceps (they will still intervene with or without an epidural if it is needed), I did have some diamorphine and gas and air. It was my first dc so I have nothing to compare it to, but from what people say it isn't necessarily more painful, it's just that you don't get so much of a break between contractions so you can get tired. Also they don't build up like with natural labour they just go wham! and they're there....For me though, the whole thing was very quick. Good Luck!

I had the drip and had morphine. (ultimately ended in a CS due to failure to progress). It was pretty unpleasant, though I think at least part of that was due to not being able to get off the bed. (they kept losing the monitoring trace if I moved). If you can get round that I imagine its do-able.

I was mobile throughout my drip (and the rest) and am sure that made it far more bearable.

Thanks all. My apt this week was pretty disastrous ("no you can't have an elcs - you don't understand what you're asking for Grrrrr") and they delayed the IOL til due date so I referred myself back to my MW and then a nice consultant who has agreed to try ARM on the due date but we now have an elcs booked for the day after if I want it. So either way I have choices and importantly a long stop date for getting this guesstimated 4+kg baby out!

Thank you for all your stories, they have been hugely reassuring

I have had 2 induced with the drip. The first I could of done without the epidural. I only had it as the anaesthesetist was on the ward and my MW thought I would take ages so would miss my chance. In the end it was only in for an hour so I wish I hadn't had it.The second time I was on the drip for about 18 hours with 3 contractions every 10 minutes without it doing anything. By having an epi I managed to get some sleep. I was immobile as well which doesn't help.

I was induced, drip and gel, and stayed on my gym ball for most of it. They had told me I was only a few cm dilated when I was actually 10 so I really considered an epidural but it wasn't needed as I asked for an examination first.

Gel in at 9pm and contractions (they called them mild cramps and said to sleep through it! they were painful though!) started soon after, then drip in at 9am the next morning. Baby out by 2pm!

Gogoredpanda - I was induced due to severe SPD and I was told I had to have the epi in place before the drip was started (pessary and ARM failed). Seems medical practice varys alarmingly re SPD!!!

Epi failed, pain was just the pits. I would rather smash up my spine again - it was less painful.

Everyone is different OP - go with whatever you need.

Just had little boy on Sunday and was induced! This my second child and I have to say my first labour (longer, went into natural labour just G&A) was far more pleasant than the experience I just had!!! ARM at midday already 3cm dilated! Membranes ruptured shortly after as I had a stroll around hospital. Checked again 4 hours later, few tightenings still 3cms. I had requested that if I had to have drip then I would like epidural! Fobbed off and told to get things set up and that drip would take a good hour to start to have any effect!!! Contractions came on about one hour later and were hugely intense with no build up and pretty constant! Asked again for epidural but was told I wasn't actually in 'established labour' last time they checked!!! OMG I was in very active labour!!!!! All this was made worse by not being able to move off the bed (think I could have managed contractions better if I could have moved around). Anyway all ended up a bit chaotic as my little boy was born just 2 hours later! After me telling them I needed to push and them telling me that I didn't!!!! In short, very intense, very strong contractions, very quick and I felt very out of control! Little mans heart rate dipped enough at the end for tem to be concerned as he passed down the birth canal so quickly due to the drip!!! I would take my first long labour over this one anytime and would insist on epidural before the drip went up next time!!! All is well and little man is gorgeous but I didn't enjoy the birth experience this time AT ALL!

Another nOt too positive experience here I'm afraid- I had an arm with dd when was already 3cm dilated; was offered epidural in advance but refused. Contractions kicked in 10 mins later at 100% intensity and the pain was just beyond endurance. I went to 10 cm in just over an hour. uckily I got an epi in fairly speedily as mw saw how far I was from coping, which only semi worked but did dull the agony.
I've had friends with much more positive experiences, so my experience is clearly only one of many possibilities, but I do feel I should warn that arm even without a drip can get out of control v quickly.
By contrast I managed second labour with just gas and air, even with syntocinon to speed things up, so you never can tell.
Good luck!

It is entirely possible to be induced (with synto drip or ARM) without an epidural.

The main difference between natural onset of labour and artificial augmentation is that with natural onset there is a build up of pain to the point of unbearable (transition) at which point your focus changes to pushing through. Artificial augmentation forces contractions at a greater strength and frequency from the word go - there is no build up so you don't have time to get used to regular pains and your body hasn't had the earlier stimulus to make its own endorphins to get you through it.

Many people opt for an epidural with augmented labour but it isn't by any means mandatory and I have known patients manage fine without them.

That said if your baby is 4kg+ that's a hell of a size to be pushing out! You may well need some intervention if only for sutures :)

Good luck with your delivery and I hope all goes well for you!

I used TENS after the 2nd (I think) gel because the 'cramps' (!) were painful and I needed to build up my own endorphines.

And I didn't think 4kg was considered that big anymore?!!!

I was induced and after the gels did sweet FA ended up with ARM and the drip and only needed G and A. I had made the decision before hand I didn't want epidural and at no point did I consider changing that view.

That said it was only 5 hours from them breaking my waters and putting the drip on to him being delivered so if it had been a long labour perhaps I would have felt differently.

I'm pleased I didnt though as he was B2B and got a bit stuck on his way out so the mw told me afterwards chances are I would have needed intervention if i had had an epidural.

I had drip and at the point where it happened after failed gels etc. the midwife said that she would sort out an epidural as now I couldn't get off bed or change position much due to the various wires and monitors. I didn't think I needed at that point but by time the epidural came I was climbing the Walls and so pleased I listened to the midwife. Still I did end up with forceps and then an emcs but it is v difficult to fight contractions when you really can't move so I would still say go for the epidural if put in that position and if you are lucky enough to have a good midwife listen to them and what they say. Good luck!

'It is entirely possible to be induced (with synto drip or ARM) without an epidural'

Yes Technokitten it is possible, it is bloody painful though.
My Mum was induced twice this way and she was only offered G&A which made her throw up. She managed both deliveries but was in such intense pain it took her 4 years to even consider having a second child.
The MW I had with DC4 said she could remember when inducements were done without Epis and she can't believe how they got away with it.

It's bloody painful for some people not all. Perhaps I have a high pain threshold but I wouldn't say I found it bloody painful!