Advice please - short pushing stage due to previous health issues

[festive]

So, am 35 weeks, a first timer, and starting to get anxious about the birth.
Was told by consultant that due to previous health issue their advice is to have an epidural and a short pushing stage of only 30 mins.
Am not keen on having an epidural and don't think a short pushing stage sounds realistic for baby no1! Am worried that after 30 mins they will whip out the forceps or whisk me off for an emcs...
Think would prefer to just see how things go on the day and decide depending on how I'm feeling / how things are progressing.
Am not trying to be stubborn and am not obsessing about a natural birth etc - just feels wrong to start out with that as the plan. If I end up with that then thats fine, at the end of the day I will of course do whatever drs tell me is in best interests of my baby
Just wondering if any other mumsnetters have experienced similar? keen to get some reassurance!
thanks ladies x

Without knowing your medical past it is impossible to make a full reply but as a primiparous woman (first time mum) with an epidural a 30 minute second stage is an unrealistic expectation ime. NICE recommends a 1 hour second stage as the 'normal' length for primips and I have known women push for 2 hours with an epidural if mum & baby are fine.
Your best bet would be to wait as long as possible after full dilatation (2 hours is normal with an epidural) to let baby come down as low as possible before you start pushing. Without an epidural the second stage may potentially be shorter as you can adopt upright positions.

Personally, I would try no epidural (if that is what you want).

Ask the staff to support you in delaying the pushing stage. The further baby descends on it's own, the longer you hold off pushing, the less work you will have to do, the less time you are likely to be pushing. Having an active labour, standing or on all 4s will also help baby descend on it's own.

With dd3 she didn't descend as her cord was short and acting as a bungee. When I got to 10cm mw wouldn't let me push cos baby was too high and she said I would wear myself out and end up with intervention. I spent the next hour fighting pushing urge on a birthing stool, but it was worth it cos she then slipped out in less than 10mins (still on birthing stool...so another tip avoid flat on back approach if you can). All of this was in.mw led unit, and u was told that if I was in consultant led I would have been coached to push at 10cm cos that is the normal expectation.

Thanks for advice.
Yes am keen to start out with no epidural if poss so I can still move around and adopt positions to help baby along.
Told consultant this and she said that was OK, it is up to me and I can see how I feel on the day but 'we have given you our advice, you can choose to ignore it'. Eek!
Reikizen - have had two spontanteous pnemathoraces, one on each side...
Haunted - am not allowed to labour in mw led unit due to previous health issues so has to be on delivery suite in case need a consultant (although if all goes well I may not even see a consultant the whole time)

I was only allowed a 30 minute pushing stage due to medical complications, I was induced at 36 weeks, I wasn't allowed an epidural and ended up with forceps delivery. Although I was stuck on my back for the whole ten hours with a back to back baby....

On the other hand my sister was induced at 38 weeks and pushed baby out in 20 minutes, she had a mobile epidural.

Both our first DC. It is hard to advise when not sure of the actual circumstances as obviously you want to do what is best for you and your baby and as we all know everyone is different.

Can you have a talk about your situation with the senior midwife on the delivery suite? I have been on consultant-led care for all 3 pregnancies because I have a fibroid and have had other issues. However, I have never seen my consultant during labour because everything went straightforwadly. The midwives were perfectly happy to treat me as if I was on the midwife-led unit.

I wasn't trying to say that you shouldn/would be allowed on MW led. What I was trying to say is that my experience on MW led of delaying pushing stage could help you out, but it might be something you have to request/put in birthplan/discuss with MW/consultant cos it is not necessary something that is the "norm" in a consultant led unit IYWSIM.

Right. Ok, I can see the logic of a short pushing stage, but not the epidural to be honest. Especially as with an epidural you will be required to do 'directed pushing' which would put more strain on the lungs than spontaneous pushing. If it were me I would simply see how you feel on the day, have an epidural by all means if that's how things go, but as I say I am unsure as to the clinical reasons for this. It may simply be similar to one of our consultant anaesthetists writes in everyones notes 'advised to have epidural analgesia'. No clinical reason, just her opinion!

I guess the logic of the epidural could be in preperation for intervention (instrumental or forceps).

However, I think research supports the fact that intervention is more likely with a epidural and pushing stage is more likely to extend beyond the 30 mins with teh epidural....

The epidural seems a bit catch 22 - you're more likely to need it because it's in place....

I would recommend looking into the approach of having a break between full dilation to 10cms and beginning the pushing stage. I've seen research (probably on the links below) to say that hanging off from pushing until you feel an overwhelming urge to push does not lengthen the entire duration of labour, but means you have a break then a shorter pushing stage. This is thought to be more important in a first pg as your body and the baby have some time to get into the ideal position (you'll know the baby's head has to rotate and mould, your pelvis also changes shape during descent, pushing before these physical changes occur means more chance of 'getting stuck'.)As you know, an epidural -> directed pushing rather than spontaneous pushing, and means that active labour is really not possible from the point of the epidural being put in place. Again check below, but I think there's advice on not getting an epidural sited until the head's engaged at zero station or lower to reduce the incidence of instrumental / caesarean delivery. I.E. let the head get well-engaged before having an epidural.

Have you looked at any evidence-based research? The Cochrane reviews are gold-standard:

<a class="break-all" href="http://www.thecochranelibrary.com/view/0/index.html#www.thecochranelibrary.com/view/0/browse.html" rel="nofollow" target="_blank">www.thecochranelibrary.com/view/0/index.html#www.thecochranelibrary.com/view/0/browse.html
(Browse the left menu list to pregnancy and then see specific areas e.g. induction of labour)

Also this MW resource is good
midwifethinking.com/

That midwife thinking link is really interesting Odille.

Thank you.

My second stage was a whole 13 minutes...my DD was in a hurry. I was even induced, didn't have any time to even consider any other pain relief other than gas & air.

So as Loopy said the hard and fast "rules" aren't always hard and fast!