Is it standard to be offered an epidural with augmented labour then?

[SuddenlyAtHome]

Following on from the "well done" thread, seems like an epidural is the norm?

I am just interested because I had pints of syntocin once fully dilated for 4 hour second stage and wasn't allowed an epidural!

I was not offered one. When I asked, I was told I was doing really well and didn't need it. To be fair, I did cope quite well with the G&A.

I think the vast majority of women with a synto drip for more than a couple of hours have an epidural. I would have thought most doctors or midwives would discuss pain relief with someone in labour at the time of starting the drip as it is different to a normally progressing labour, and an epidural is likely to be the most effective pain relief.

Here (in HK) it's standard to be offered one if they're using syntocin and in fact not to be offered in those circumstances is considered pretty barbaric.

I was offered one at the same time as they told me if I didn't allow them to start the syntocin I'd be putting my baby at risk. I was so tired I didn't have the strength to argue anymore. Ended up with shoulder dystocia-no idea whether it was random, because of the super long and ineffective labour or because or the labour+drip+epidural. Part of me wishes I'd stuck to my guns and continued to refuse induction-but then maybe that would have led to no baby. Or no shoulder dystocia? Who knows. It gives me chills to think about it to be honest.

They may not have wanted to give you an epidural because you were in 2nd stage, from what I remember of my antenatal course we were told they don't like to top up epidurals for second stage and generally other forms of pain relief aren't given or effective at 2nd stage. They probably weren't expecting you to have a 4hr 2nd stage though! From my own experience I had to beg to have my epidural topped up in 2nd stage, as they'd let it wear off for/during the pushing, and they only did after being in 2nd stage for over 2hrs and I was waiting for a theatre to become available for a forceps. They gave me the initial epidural about 4 hrs after having the syntocinon drip put in but I was induced and only 4cms at that time. From what I've been told and from my experience epidurals can slow down labour and they do generally mean you can only labour on your back which isn't an ideal position to keep things moving along. If your labour slowed down in 2nd stage and they were giving you the drip to make your contractions more effective to push then having the epidural at that stage could have been counter productive in my logic.

I don't really remember the drip going up as I was already fully dilated and had been in established and very painful labour with back to back baby for several hours. I wasn't given anything until I was fully dilated when I finally got gas and air, diamorphine and a bed in the labour ward. I pushed for 4 hours then waited for theatre for CS so finally got spinal!

Obviously I was already unhappy with the way my pain wasn't managed at all but that pisses me off even more and makes up my mind I will NOT be having a VBAC unless I win the lottery and can go private.

I take your point ayearoverdue, I have a tiny bit of obs and gynae experience and trusted the very senior MW I was allocated, I suspected at the time that I wasn't going to get the baby out and certainly not if I had epidural, but I was so tired (had been contracting for 48hours by this point) and the pain was indescribable, not like "normal" contractions. If the MWs on the antenatal ward had looked after me properly I think the whole thing would have been different. Oh well.

re. contractions, positioning, etc, there was a clear point where the pain changed to something very sinister which must have been baby going OP.

I was offered an epidural at the same time as they were talking about putting the drip in. But I had been having having one long weird pain for what DH seems to think was 2 or 3 hours where I apparently just sucked constantly on the gas and air, coming up periodically to mutter "fuuuuckin' hell" and then going back into myself again. Also I had absolutely refused a catheter which the midwives were determined I needed. So I think the midwives and anaesthetist reckioned I needed an epidural so they could do what they needed to without me causing a fuss.

And lo it came to pass that after the drip and epidural, I had a trial of forceps and an emergency C-section under GA which was pretty much what I had been told in the natural birth classes would happen - the "cascade of intervention" I believe it is called.

I must admit I always thought an epidural was pretty much standard practice for an induction - from what people say above, clearly not.

They really poorly managed your pain relief and labour by the sounds of it! You should have been offered an epidural a lot earlier, sound like they really neglected you. I'd feel the same if I were you and I'd be complaining about the care you received.

Thanks ayearoverdue, I didn't formally complain but did raise my concerns with the MW in charge of delivery suite at my debrief, she was really kind and took me seriously.

At my consultant appt for this pregnancy I explained that was my main reason why I don't want a VBAC, consultant was not impressed and said that if I did change my mind she would make sure that my notes said very clearly I was to get G&A as soon as I asked for it!

There weren't enough beds, nowhere near enough midwives and I was unfortunate enough to be lumbered with a couple of cowbag types who told me to "stop making a fuss". The shift change were lovely and moved VERY fast when they realised how far gone I was - the rest of the patients on the ward were at the stage of saying "oof" and rubbing themselves so must have been terrified by me!

I'll never know but I think if I had been given the G&A earlier I would have coped fine. I would have still needed a CS but wouldn't have had the awful window of total panic where I thought we were going to die because I knew the pain wasn't normal and nobody would come to reassure me, just kept shouting from the desk to tell me to shut up. Once I was handed over to the fabulous MW on labour ward who did a trace on the baby and told me it was fine I relaxed and don't actually remember my second stage as "bad" - painful and tiring yes, but fine and what I was expecting from childbirth. My CS was great too, really calm.

I'd try a VBAC if I could afford an independent midwife!

In your position I'd probably go for an ELCS as well. It's all the ifs buts and maybes I wouldn't cope with. I also ended up with a CS after I had failed forceps due to baby in a bad position. That was only 6 weeks ago but I'm not sure what I'd do if I get a next time, I know I may feel different when actually pregnant. I was overdue I wanted an ELCS rather than an induction. I couldn't stand the thought I all the intervention, I felt sure it wouldn't work and I'd end up with a CS. I was right I did. With an ELCS you know where you stand, with a VBAC there are no guarantees of the kind of care we'd get (unless you had a private birth) and how it'd go and I know I really wouldn't handle going through it all again.

Did your debrief help you understand what happened and why? I'm going to be booking a birth reflections to go through mine, my CS was under a GA and there is a lot I don't know or have made presumptions about what happened and why.

kaloobear Re the shoulder dystocia. As far as I understand your baby must have been "mal positioned" for the shoulder dystocia to occur. And its this "mal position" of your baby in the birth canal, that slows the progress of the labour. So your body was working really hard (strong and regular contractions) but because of the position of your baby the its boney head wasn't pushing down on your pelvis and moving down.

I think what happened to you, could have easily happened to me. I was put on the syntocin drip. After 3 hours I asked for an epidural (I had been using gas and air). I had an epidural straight away. Then in 8 hours I dilated 2cms!!! I think I dilated 3cms in ALL!!

Although I wasn't in any pain anymore, I was exhausted. And I had an EMCS. The midwife said to me thats why it had been so slow, because my ds had his hands on his head. His nails had grown into his scalp!! He still has the scars and he is 8 yrs old now.

Obviously if the labour had progressed, all be it very slowly, he would have come out with his hands on his head, and this would have damaged me and ds I think.

Anyway - I had 2 more dds - by planned c section [laugh]

I mean !!

I was put on syntocin drop on day 4 of induction and even when I asked for epidural was told too early. It was only after I had completely lost control that mw went to fetch anaesthetist who couldn't come and then everything went to hell in a handcart after that. Was left in corridor outside theatre waiting for spinal and screaming blue murder. This along with very chaotic forceps delivery has a lot to do with why I'm elcs this time.

Hi,

I cant find the exact information I had the other day but the NICE guidelines say it is standard practice to offer an epidural at the same time as a drip. If they offer me the drip I will refuse unless I get one. With 1st DC epidural was sited before drip so it worked that time.

I was offered the epidural with the drip. I wanted to 'see how it goes', 3 hours later I had the epidural!!

i was offered the epidural with the drip, with ds1 i had a three day labour so had one as i was already knackered.

with baby no 5 i had the drip but no epidural, it only took 3hr and lots of gas and air, i figured i would try with out as i had had 3 babies with just gas and air and tho i knew the drip would make it more painful i wanted to see how i got on. had it taken much longer i may have been begging for one tho!

I had pessaries which worked quickly and begged for an epidural and got it. They then started synto once it was working. That was 5 years ago at st mary's. My sister had the drip after her waters broke and no contractions started. They refused to give her an epidural despite hours of begging. That was uch this summer.

I was offered the epidural before they gave me the syntocinon (though it was only a matter of time for them to give the syntocinon). It didn't work though and I had a 'window of pain' (aka a bit of my womb that wasn't covered by the epi).

I think I would have thrown myself out of the suite's window if I hadn't have had the epi and ensuing dead legs as it was excruciating - it felt like my womb had been set on fire. They had to keep turning up the synt. as I would stop contracting after a while if they turned it down or didn't keep cranking it up. DD1 was not ready to be born at 38 weeks.

I had about 5 top ups to manage this 'window' so I was dead from the chest down by the time it came to be told to push which ended with a ventouse delivery as I was too tired to keep pushing.

I was on the synt. for 8 hours before DD1 was born and had to be kept on it afterwards as my womb gave up and stopped contracting as soon as they turned the drip off so they had to switch it back up to full blast so I didn't bleed out (had registrar's arm inside me manually contracting my womb or something - I was so out of it I joked she must feel like James Herriot - I don't think I realised just how much blood was pouring out of me at that time!).

Not a pleasant experience but I don't think I could have done it without an epi. Needless to say DD2 was a homebirth!

I was offered an epidural but declined. I didn't know that the drip would make my labour more painful. Nearly 8 years on l can remember every minute of my 22 hour labour and frankly one of the reasons ds is an only is that. I remember at one point they increased the rate of the drip so ds would be born before a shift change.

With ds 1 I was induced with no pain relief at all despite begging for it. With ds2 I refused the drip until I had the epi. If I were to have any more I would demand the epi again

I was on a syntocin drip in both labours. With ds I was pretty much told I wouldn't cope without an epi because hardly anyone would . I had one and it failed, was a total waste of time.

With dd I don't remmeber being offered one but I didn't want one anyways and just used gas and air and morpheine but only got the morpheine minutes before dd was born so pretty much just had gas and air. Her labour was agonising - I think due to her being 9lb+ and back to back rather than the drip though because ds' labour was easy peasy in comparison.

Suddenly, I had a very similar experience to you. I was fully dilated after a natural spontaneous labour and pushed for two hours on G&A only in a midwife led unit and all was well but due to complications was then transferred to consultant care and put onto the drip to strengthen the contractions to try to push the baby out faster. I was told I'd be given a strong dose as they needed to see immediate progress as the plan was to continue to try for a VB (and the monitoring showed the baby was ok).

I was given only gas and air and was literally writhing with pain and begging for pain relief. I was effectively ignored every time I asked for pain relief and told I'd coped well until then so to just carry on with G&A. I kept being told to continue with gas and air but after an hour my partner intervened as I got to the point where I was struggling to breathe through the pain, never mind push. The pain was horrendous. They finally went and discussed it with someone and came back and offered me morphine or an epidural straight away. I took the morphine so I could continue to push. Plus they'd never have been able to get an epi into me at that point as I couldn't keep still. It was amazing. Everything fell back to the same pain level of the previous pushing and strong, intense contractions but minus the unbelievable back pain and pain down my legs I'd had with the drip that had crippled me as the contractions rolled into one ongoing contraction. I was able to concentrate on pushing again and delivered naturally.

My birthing experience was amazing otherwise but my partner still feels angry that I was literally ignored when he said it was clear to all that the drip effect was something altogether different for me.

I was subsequently visited by one of the team who had been involved in my earlier care who asked if I'd delivered naturally or had a c-section in the end. I told her naturally and mentioned I felt guilty that I obviously hadn't coped with the pain well and had taken morphine potentially affecting the baby and she said she was astonished they'd given me the syntocin without offering me an epidural which is the standard.

Wow - I feel better for just getting that off my chest. Haven't really discussed it with anyone other than DP as the rest of the care was great and so happy to have a healthy baby but I do feel angry that I was made to feel as if I wasn't coping well when having pain relief for that kind of dose is standard.

I wasn't offered an epidural when I had the drip with DS1. He was back-to-back & I'd had 48hrs of stop-start labour beforehand with no sleep & no food. I attempted to get some pain relief but was so out of it with the pain that I couldn't get the gas & air to work. I dilated from 2cm to fully in 3hrs so I reckon they had it turned up too high. It was highly traumatising to say the least. One of the obs remarked that I had a low pain threshold. With DS2 at a different hospital I went for induction when overdue & had an epidural before the drip was started. I still found it agonising when they allowed the epidural to wear off for pushing &