Epidural - would you insist it is in your birthplan?

[TheSockPuppet]

My labour with DS was difficult at first, the midwives at the hospital wouldn't believe that I was in labour until quite far on when eventually I was examined (at which point I was rushed to the labour ward with some very embarrassed and apologetic nurses as I only had a few centimetres to go before I was fully dialated), I had no pain relief at this point and was in a lot of pain and once I was in the labour ward I asked for an epidural straight away - the birth after that was fairly stress free as I couldn't feel any pain and by this point my partner was called and came to the hospital to support me.

We're trying for DC2 which got me wondering if I should ask for an epidural again or try with gas and air instead - but then that risks it being too late for an epidural and I may regret trying without iyswim? What is the general consensus of mners towards epidurals?

I had an epidural with ds1 and intend to have one this time (due on thurs). In hindsight I wish I had waited a bit longer with ds1 until asking for an epidural but i was so worried id get too far and there wouldn't be time. I was coping really well with contractions with my tens and gas and air. My waters went at 8pm. I asked for an epidural straight away and it was around 11pm by time anesthetist arrived to give epidural. Ds was born at 3am.

This time I'd like to see what happens but at the same time I don't want to get to the point when it's too late for epidural. I think I'll ask for one early as it could take the anesthetist a while to arrive then if I'm coping ok when the time comes I'll maybe re asses the situation. Well that's the plan anyway

I had one last time and it did slow everything down. I don't regret it though. I was also terrified of being too late for one and will be again (although I don't necessarily want one this time, I want the option!). I've specifically chosen a hospital with more available anaesthetists. I hate the attitude of trying to persuade women out of having them. Luckily for me, DH is a Dr and they probably wouldn't try that with him around!

I've wondered about this too.

I've made it clear to consultant and senior mw (who I get to see as part of my care this time after a not-so-great experience last time) that I want pain relief regularly reviewed, that I absolutely want an epidural if there are signs that things may go the same way as last time and that there are certain procedures which I absolutely do not want to take place without one. However... in the birth plan which the snr mw has now attached to my notes, it doesn't go any further than to say I want pain relief regularly reviewed.

She reassures me that it therefore is a foregone conclusion that an epidural will be available. I think I may bring this up with the consultant next time I see him.

It's tricky isn't it, because it's the same 'gamble' - I'd like to avoid epidural if possible... but don't want to end up in a situation where they tell me it's too late.

(Incidentally, that was their reasoning last time and 4 hours later we were still pissing around trying to get the spinal in for trial by forceps/cs with no pain relief)

Unless you go private, there's no guarantee of an epidural. I needed a spinal block (waiting to go to theatre, 2nd stage, malpositioned baby) and the only available anaesthetists were dealing with real emergencies so had 1.5hrs waiting for one.

Have you researched other options inbetween gas and air and epidural in case one isn't available?

What other options are there? I thought the only other option was diamorphine which also affects the baby.

Diamorphine, pethidine, natal hypnotherapy, water, aromatherapy, massage, moving around etc. Doesn't have to be a drug.

I think one of the most difficult things to come to terms with is labour 'not going to plan'. If you've decided you want an epidural and it isn't available, that can be psychologically very upsetting.

NICE says epidurals should not be denied. I know you may have to wait for an hour or so but you could start digging your heels in as one as soon as you go into labour. You could just say you've changed your mind if it all progresses well.

I really don't go with 'accept second best' - men wouldn't do!

No anaesthetist should be working on back to back caesareans for hours on end without alternative cover. Providing good pain relief services is part of a good maternity service.

I would ask some questions about cover both at night and when the consultant OA is doing caesareans - AND - ask the Department of anaesthesia not the midwife. (Sorry to those lovely midwives out there who are the majority but there are a small number of dreadful ones who lie to women about anaesthetists not being available just to 'jolly women along' so that they (the midwife) can chalk up another one of those 'lovely natural births' on their score cards regardless of the effect on the woman

Good luck whatever you decide

I think being prepared for 'labour not going to plan' means 'it's an unpredictable physical process which ultimately for all your efforts you may not be able to control'.

I don't think it means 'accept that you may be denied the pain relief you desperately want through substandard or misguided care.' I agree with Ushy's approach.

I'm not saying accept it. I'm saying sometimes if there's no anaesthetist at that moment, there's no anaesthetist at that moment. I had to wait 90 minutes for a spinal so that I could have an emcs (I'd been labouring for 31hrs, pushing for 6). There is NOTHING they could have done, there'd been a v serious accident and two women were having crash emcs. Emergency cover got there asap.

NICE say a lot of things. And what maternity services should be is sometimes a long way from what they are. Yes you ask ask ask ask and you should get it. But very occasionally it doesn't work like that.

Epidurals are not supposed to be denied at any time. I think you would be a little silly asking for it at crowning as it ain't gonna happen, but technically your pain should be taken seriously at all times and appropriate pain relief given according to YOUR needs which only you can possibly know.

I understand that if there is going to be a long wait you should be offered a transfer. At least a hospital where I begged for 6 hours showed me their policy that stated this after a written complaint about my treatment.

For dd, I had absolutely no faith in their promises or policy though so made sure I could damn well cope without an epidural. I had a birth plan that was very precise and became a pita necessary to secure a very experienced midwife on the day as well as lots of birth partners to act as 'witnesses'.