early epidural?

[Kveta]

I'm 20 weeks pg with DC2, and had a horrible birth with DC1 - 3 day labour, no pain relief until 3rd day, then pethidine made me hallucinate (and scream a lot, apparently - DH is still quite traumatised by it!), gas and air made me vomit but didn't touch the pain, 1st epidural failed, 2nd was brilliant, ended up with forceps, episiotomy, 2nd degree tear, and 9lb baby.

I am TERRIFIED about the birth this time around, and to make it worse, we don't have guaranteed childcare in place for DS, so I may need to go it alone (which is fine in itself, but I'm worried I'll be incoherent with the pain again and get a crap midwife and then be screwed!).

Anyway, I had a chat with a consultant last week, and she said I could ask for an early epidural, so request it at 4cm, and that could be my birth plan. she also said the forceps last time were because I was so exhausted after 3 days of contractions and 2 hours of pushing, that they had to get him out somehow, but this time she sees no reason why I can't push baby out without assistance, given that so far baby is smaller than DS was at the same stage, and also, I am obviously 'slacker' than I was last time (nice...)

Does anyone know whether an early epidural is actually ever granted? I was so delighted to be told it was a possibility that I cried (and could have hugged her!) but am now worrying that I'll get a different consultant who says 'no epidural, let's wait and see' and I'll be on my own and in pain and not able to demand it for myself. I do NOT want pethidine or gas and air if at all possible, and last time I broke the TENS machine by pressing on it too hard, so although will start with TENS, I want a second level of pain relief.

(I know it should be a shorter labour this time, but tbh I don't care, I still want the option of pain relief!)

thanks if you've read this waffle all the way!! :o

I really, really hope you can get one. FWIW I have had two recent inductions and the epidural was sited v early, in one case before the drip even began!! My consultant took the view that I have delivered normally before so the idea the epidural would slow everything down wasn't a problem. And I pushed both out without assistance but not freaked out by pain either. So clinically it is clearly possible. In fact safer, as I was able to hold still v calmly as was not in pain! Whether it is a budget/policy thing I don't know. I was lucky enough to be going private where you're paying extra for the epidural anyway. I suspect the general starting point on the NHS may be to dissuade people out of the epidural and wait to see if events take over, so maybe you could get something in writing? Especially if you're going it alone.

Good luck and I hope it all goes well.

It's in my birth plan and was suggested by my consultant to have an early epidural so it's certainly possible! Am going to see how it goes first though!

I would ask to see this consultant again, and to get her to actually write it in your notes that you should have an early epidural, and then in your birth plan make sure that you highlight that the consultant has agreed this and that you expect the epidural to be put in at the earliest available opportunity.

I'm an anaesthetist and have done quite a lot of epidurals for labour. You can have one as soon as you want once you are in established labour (usually 3cm) or prior to syntocinon drip even if not in labour as most people really need one.

It's actually a lot easier and therefore safer to put an epidural in early because there is more time between contractions and it's easier for a woman to sit still.

If for any reason you can't get an epidural or it fails, you could consider a remifentanil pca. It's a drug from the same family as morphine but it works within a minute and wears off in 3-5 mins so you press a button when you need it and if you don't like it, it'll be gone in no time. And no after effects for baby. It was on my list of anaesthetic choices before epidural but fortunately had a quick labour with brilliant natal hypnotherapy. Not all units offer pca's and you almost always need to ask.
Hope you have a better birth experience this time.
Best wishes.

thanks for the comments, especially Magnum!

I will definitely try another appt with the consultant, I have one at 36 weeks (growth scan and general review appt), so will try and get it in writing then.

The remifentanil sounds interesting, I have done a quick pubmed search on it, and found some useful studies. Not sure I'd be the ideal candidate due to my weight (am quite fat), as all studies I've found have been on very average-sized women. I think I will still be asking for the early epidural tbh, but will bring up the remifentanil with them and see what they say.

I actually had the 1st epidural at 4cm last time after a consultant refused me one ('she's only 4 cm FFS, get her walking!') then saw me having a mild contraction, and said 'oh, actually, get the anaesthetist down here', but there was quite a fight between the consultant and DH/my midwife, to get it approved. I'm hoping that by a) being on my second birth and b) by having it written in my birthplan/notes I can be taken seriously this time round, rather than being fobbed off by midwives/consultants who are not actually experiencing my contractions at the time.

thanks again for reading, it is so good to hear that it may really be an option!!

Good luck Kveta.
If you get any problems just demand to speak to an anaesthetist and if they refuse to call get your dp to make a fuss of getting out a pad of paper, note down the time and the midwife's name and say your making a note of their refusal to allow access to pain services. I'm sure it won't come to that though. Most midwives are actually really nice.
In a lot of units only the anaesthetist will be able to tell you about remi, a lot of midwives and obs docs have never heard of it!

When I had epidural it wasn't an issue how far along I was, think I was about 4-5 but it didn't come up when I screamed asked for one. I didn't realise there were rules about when you could have one!

Not really answering your question about early epidural but there is so much you can do to prepare for a positive experience this time. Research HypnoBirthing - I teach this and am a doula. I have supported women who have had a difficult first birth (even CS) but have gone on to have amazing second births. Look at www.hypnobirthing.co.uk for more information and local practitioners. Or look at my website where there is a birth story which may inspire you to know each birth is different.
I want to add that I am not against epidurals they are great things but if women are scared of birth then labour will be longer and more difficult even with the epidural.