birthing positions with epidural?

[nightowlmostly]

I am 6 months pregnant and have been told I have SPD. I went to the physio the other day and she gave me some exercises and good advice, I think I'll stop work a bit early and try and rest as much as I can before the big day.

One thing she said was that I shouldn't give birth on my back because it limits the pelvis from opening up at the back, and puts strain on the front bit. She said I should try to be on all fours or squatting. This all sound ok to me, as I would like a water birth I think, and was going to try and avoid having an epidural anyway. But the fact that I have the option of taking the epidural has made me quite chilled about my birth plan, as in, I'll try it my way but I know that if it gets too much then I can take the pain relief!

Does this mean that an epidural is out of the question now? This is maybe a stupid question, but I thought I'd ask anyway, just to see if I've got the wrong end of the stick. I've always thought that having an epidural means lying on your back but maybe there are other ways?

Thanks for any info!

Personally I would not have an epidural with SPD as you will not be able to feel your limits so might end up in a position which feels ok at the time (because you can't feel) and end up in agony once it wears off. But with a baby to look after. Also with an epidural you are more likely to end up with intervention/instrumental delivery and that would require lying on your back in stirrups. Again, not great in the long run.

The increased risk of interventions is one of the reasons I intend to try and avoid an epidural! But I guess it's been comforting to think that it's there as an option if I can't cope with the pain. It's my first so I don't know what to expect.

I had an epidural and pushed kneeling on the bed, holding the head rail for support. Another friend had one and gave birth squatting. The main disadvantage is that it's harder to get in and out of these positions quickly as they have to adjust the wires around you.

Surprised she recommended squatting. My physio re SPD advised absolutely no squats either in pg or childbirth. Don't you find them painful?

I would really try to avoid an epidural personally for the reasons given. The whole point about an epidural is that it blocks the feeling- so you won't necessarily realise until after it wears off that you've been in a bad position. Why not consider a water birth?

helium I'm sure she said squat, maybe I misunderstood. I haven't tried any lately so not sure if they hurt or not!

callmemrs I'd love a waterbirth ideally, that is my plan at the moment. I was just trying to figure out if an epidural is now out of the question. It's been nice to know it is an option if I'm struggling, but if it isn't I need to be prepared for that!

I don't have SPD (thought I did, but apparently it's just my back is generally knackered and flares up in pregnancy) and I am living proof that the epidural allows you to do things that you don't realise until afterwards have caused more damage than you knew at the time. The idea of birth without an epidural is really frightening for me because it is a lovely thing to fall back on, but my back was absolutely in bits for months after birth and I am sure that lying on my back really, really didn't help......

I guess it's probably best to do without then! Hopefully it'll be bearable with gas and air, in water. Fingers crossed!

Thanks everyone!

OP You need to find out what sort of epidural is available- i.e. whether it's a mobile epidural or the old fashioned type. Some PCT's offer the mobile one. Some don't. You need to discuss what your physio told you with your midwife.

Also, they should be able to monitor it so that it wears off and you can feel to push

What I would say is that yes, Plan A should be do without, but it may not work out like that- e.g. if they end up inducing you.

Even with the highest version of epidural it is possible for you to be put into (you can't do it yourself) a position where you are up on your knees.

It is also possible, that using gravity you can get away without pushing much or even at all.

But, I would always recommend that every woman go into childbirth assuming that epidurals aren't an option, because using it as your fall-back option and then finding out it isn't available when needed can impact negatively on a good birth outcome or good mental health post-birth.

With induction, you can negotiate an epidural before induction however but tbh there are very few situations where I would agree to induction and having SPD would rule out most of them even further.

It is a really good idea to be pushy and ask for an interview with an obstetric anaesthetist prior to the birth.

Bearing in mind that it is quite common to need a caesarean as a result of some problems during labour, the last thing you want is for a junior anaesthetist to turn up trying to insert an epidural in in late labour.

If you have any kind of spinal problem, good anaesthetists like this 'flagged up' in advance so they have a care plan for the potentially complex cases. For some reason epidurals don't seem to work quite as effectively in some women with SPD but there is an alternative ; a spinal.

I think there needs to be a bit of realism about the 'do without epidural' message. Yes, fine if you can but you might not be able to. If you think the pain is getting out of hand, please get an anaesthetist involved before you are in so much pain you cannot keep still. Getting the epidural placed correctly is much much easier, is safer and more likely to be placed properly if you can keep still.

Hospitals that are unable to provide a 24 hr epidural service are offering a substandard quality of care. I can see Starlight's point that it might be worth considering what you will do during labour if there is no epidural available. However,if this happens, (hope it doesn't!) please help other women by writing a formal letter of complaint to the hospital and the Trust and putting a nasty comment on the NHS choices website about the hospital. 'No availabe anaesthetist' would not be an excuse if men went through the pain of labour - they'd be more anaesthetists than midwives!