Pain relief at 2cm. What happens if you just NEED it?

[StarlightMcKenzie]

I gave birth in an amazing unit last birth and my birth plan was agreed to say:

No internals. I'm in active labour when I say I am and require any pain relief/birth pool I say I do. Gas and air to be offered on arrival.

I've moved area since and can't get to amazing birth unit so am opting for a homebirth.

How can I ensure a similar arrangement? I know of many places that refuse pain relief if you refuse internals but an internal result has feck all to do with pain levels so it seems barbaric.

I think in your situation it might be a bit difficult to get the arrangement agreed since you can't seem to see anyone useful!

I know I've commented on your other thread, but just wanted to add that IME they take you more seriously as a second/third time mum. Of course, the birth pool in your own home is your own business. They can advise, but they can do jack shit to stop you getting in whenever you want. On the gas and air, I think you need it written all over your birth plan and briefed to your doula that you are likely to need more support in the earlier rather than later stages and you want the gas and air as soon as possible.

speak to your community midwives
ask them if you can get some PR paracetomal, it is a much better pain relief in earlier labour than regular paracetomal/codeine

if you are at home, normal rules re pain relief might not apply

speak to supervisor of midwives and ensure things are signed off ASAP

pain is subjective and pain relief/management should not be predicated on a certain number of cm dilation esp as you can go from 2 cm to delivery v quick

If it was me I would scream and shout until I got the pain relief I wanted. If it wasn't forthcoming I'd plan on rupturing their eardrums.

I can't imagine a midwife at a homebirth refusing G&A if you are obviously in labour . If they don't want to give you G&A, they may as well go away and come back later.

Lol one of the disadvantages about a homebirth is you can scream and shout as much as you like and the mw just won't care.

I'm expecting a back to back labour. I have experienced one before and the inability to cope was at 2cm with the pain and bearing down at that point. I needed nothing later on.

The gas and air is for pain as well as panic. If I 'lose' it at 2cm then I'll be heading for the trauma I suffered before.

have you got any other coping strategies?

getting in the knee chest position to take pressure off the cervix ?
water?
TENS?

I totally know the sensation you are talking about Starlight. Giving birth was a blooming walk in the park compared to 'early' labour for me.

I think perhaps you need to work with your doula at coping strategies and not rely toooo much on the gas and air. Say you phone the midwives and they agree to come out even though it's 'early' to check you and bring gas and air. It could easily be an hour between calling in and someone arriving. You need other strategies alongside the gas and air being available. I really recommend some positioning stuff - one leg up on a chair and leaning forward really worked for me. Also maybe check out Rebozo (or something) sifting (it's on spinning babies)?

I'm better equipped/prepared this time.

I have breathing, natal hypnotherapy CDs, Doula, inversion technique practiced, pool, TENS .

I think I've put the odds in my favour and I've got a level of confidence in NOT needing anything I have to beg someone else for. But securing the G&A provision would really help!

(chances are I would refuse it anyway as all the above become less accessible if you're dizzy, even if you're technically allowed them).

You've practiced inversions? Well done. Make sure there is someone there in case you get stuck!

I know what you mean about gas and air. Second time I thought I was so early on that there was no point ringing the midwives. First time they were that I was in any pain as I was only 3cm and not in active labour. Second time ended up being a BBA as a result of exactly the same labour pattern. I coped ok, but looking back a bit of gas and air at the point I was a bit panicky (thought I had about 36 hours to go, actually had about 90 mins. Would have been ok if I had known!) would have been nice. I luurve the stuff.

Good luck getting it sorted. I think the trick is to make a big deal of your history of labouring atypically, so that they take you seriously.

Yes but I doubt inversions and gas and air are compatable.

I won't get stuck though. I'm probably at my most athletic when heavily pg. Ran for the bus this morning then sat on a single seatwith my 5yr old AND 3 yr old sitting on my lap

I had the same experience as you. Demanded gas and air and immediately freaked out as not only was I pushing but head was most definitely coming out which was scary since I didn't myself believe I was even 2cm yet (never mind the midwife who was also surprised). I thought my cervix was going to shred!

Birds, your story doesn't alarm me. I experienced similar. Losing it early on and having no way of regaining myself due to the denial of pain relief which led to a far from optimal labour and interventions I believe need never have occured had I been taken seriously and helped at the start.

For my home birth I had pethidine in the cupboard (depends where you live if they allow) I didn't use but it aided me knowing it was there. Some good advice on a homebirth website on obtaining what you require from healthcare professionals is to become like a "stuck record" just keep on repeating what you require over and over.

Thanks Brices.

Pethedine isn't an option as it doesn't suit my personality (is about the only way I can explain it really).

I was given gas and air at about 2cm dilated with DC3. Within about 20 minutes I was bearing down a bit and about 15 minutes later the midwife realised she could see DS's head!

I would say if they won't give you pain relief do a few pushes or a few grunting noises during contractions and they will believe you are in labour

I needed gas and air at 2cm - as soon as I arrived at the unit, I pulled the tens machine off, and began sucking on the gas and air. My contractions were VERY painful though, LO was back to back. Ouch. Really hope the next one will be less painful.

Yep. Expecting back to back this time!

get it written in your plan that actually, if you say you need it in early labour, you need it

an explanatory note like 'i know that G&A is not great pain relief for hour on end, but i found early labour worst last time i had an OP labour, this will be the time i need it - i may well do without later'

that said, every birth is different, and you may decide on the night you don't.

you have a doula to advocate for you if necessary as it is really hard to string words together whilst in labour. (imagining you jabbing finger desperately in direction of canisters...)

have you got a MW appt yet?

Mw appointment on Fri to 'book in'.

Then I have to have a homebirth assessment. I asked what it involved and apparently it is to make sure I know the risks. Dunno when that's gonna be though.

I don't remember ever having to have a hospital assessment to make sure I knew the risks

Jesus, the thought of anyone being refused pain relief at any point horrifies me. I remember a contraction I had standing on the driveway about to embark on the trip to hospital for DD and I nearly fell over. Couldn't walk or talk. On examination well over an hour later I was only 2cm. By the yardsticks given here my pain would have been dismissed. Incidentally, I was holding DD 3 and a half hours after that examination!

Labouring women have a right to have pain taken seriously.

indeed, no one mentions 'you are almost four times as likely to have a emcs' before booking into a CLU...

Hooray for booking in appt though! finally! hope little starMac isn't looking to make any moves until you're sorted (though with this heat, eviction wouldn't be a bad thing)

IIRC - didn't you negotiate a really specific pain relief deal last time? Might be thinking of someone else. that one always impressed me!
I really hope they don't make it difficult for you though.

The problem with G&A at home is limited supply, they usually only bring an hour's worth, so you would need to arrange for extra to be brought, or they might have to leave to fetch more. In an MLU they have it on tap so there is no issue.
Getting in the pool too early can prolong your labour. I would suggest you use your tens, hypnotherapy etc until you can't bear not to be in the pool. I've found the right point to get in the pool is very clear without VEs, women tend to get restless and noisy at that stage!

Do they really only bring an hour's supply FutureNanny? I'm fairly sure that they bring a lot more than that round my way. Are you a midwife - sorry, not come across you before and it sounds like a professional comment rather than a 'when I had my homebirth' type one.

The 'getting in the pool too early' thing is a bit of a bugbear of mine. I know it can prolong labour if it is not established, but it can also do lots of positive things. Like let a woman recover enough to get out and get on with the dry land bit with fresh energy. Or, in my case, it relaxed me so much and reduced the pain so effectively that my daughter was born within about half an hour - I honestly don't think I would have progressed like that on dry land because I felt every muscle in my body relax and contractions that had been hard to cope with on dry land became so easy that they washed over me and I could go with the flow. Is there any research at all to show negative effects of the pool if women get out again if it seems to be slowing things down I wonder?