how to increase chances of getting an epidural?

[satinandsilk]

I'm 39weeks pg with my third baby and would really quite like an epidural this time if possible. My first labour was a terrible, long drawn out experience, very negative and stressful, with a very disappointing standard of care. I had gas and air and pethidine, episiotomy and multiple ventouse attempts before my son finally emerged. Despite me asking for an epidural on multiple occasions by the time anyone listened to me it was too late.
My second experience was much more positive, at a different hospital - they broke my waters to induce me and two hours later, my daughter was born. This time I had just gas and air, and once again, by the time the epidural team arrived it was too late.
I have been left with the impression that midwives do their very best - no doubt for really good reason - to pressurise women in labour to manage without an epidural till they are beyond the point of no return (too dilated) and it's genuinely no longer possible. Which leaves me wondering how anyone ever manages to get one!
Does anyone have any views/experiences of how to increase my chances of getting an epidural? I have a reasonably open mind and will try to manage without one if I can, since I do understand that it can slow down labour and may lead to an escalation of interventions. At the same time I'm scared at the thought of that excruciating pain again...

Hi, I've only had one baby so far, but I was never in the 'i'll try to manage without one' camp.

I put it in my birth plan, asked as soon as I got to hospital and got one at 7cm.

Perhaps it does slow things down, but Zoe Williams says something along the lines of 3 hours without pain is much better than 30minutes of excruciating pain, which I agree with!

Hope you get one with dc3.

I had one in my birth plan and it was ignored and I had pethadine.

I thought after that was perhaps a good thing as it didnt ....slow labour down, however my consultant said my pushing was so short for first time mum, it wouldnt slow me down anyway - she reckons alot of labours where its slowed down would have happened anyway.

I would prepare before hand, ask at hopsital - what are they like at giving them out - perhaps ask to see someone about it - to make it more offical, or register your concerns....so you become someone who is going to be less likely to be fobbed off etc, but do it all before

i was so naive last time, it never in a million years occured to me I would ask and not get one, it was always offered as an equal drug of choice like pethadine and G and A etc..

I was refused twice too I jus think they prefer to not give them which is a scary thought and uncaring in my opinion!

I had a very bad experience with an epidural and hate the things with a passion...

But if you want one I think the most important thing is checking out the staffing in your hospital. What is their cover for anaesthesia? What is their midwifery staffing like (once you have had an epidural, a midwife has to stay with you at all times)? That kind of thing.

This is probably normal practice but when I had DD I was in agony before I even got to labour ward. The midwives kept commenting on how strong my contractions were and I was literally panicking with the pain. Ex mil was there. Shes a mw but was there on a purely personal basis. Even she kept asking for them to give me something, anything at all. They refused. I didnt even get G+A until I went to labour ward hours later.

Maybe thats just normal. But this time (if I dont need a CS) I will be writing a birth plan and discussing with them from the start that I want pain relief.

Thanks all. youlllaugh are you willing to share a bit about your bad experience with the epidural? Perhaps I should start another thread...

Sure (tis me with a new Olympic name).

DD1 was OP and slow progress, so I was advised to have synoticinon. So I said I wanted an epidural. Problem was, although in theory it 'worked', once it was in I couldn't let it wear off even a teensy bit because the back pain was so excruciating lying on my back, and I would have had to get through that pain barrier to get to the point where I was mobile enough that I could get vertical again. When it came to pushing, I would feel nowt, nothing happened and I had forceps. Oh and I was also in pain at the end because (even though my legs were so numb feeling didn't return to one for about 6 hours) DD was pressing on some internal nerve or something and my back hurt like hell.

As I said, I am not personally a fan these days! DD2 was nothing (not even gas and air) in the pool. Probably same positioning, but I think the overall pain was less than having an epidural!

You need to be very firm and when they fob you off say "no, I was fobbed off last time, get it organised now, I want it now!" keep saying it repeatidly as long as you're passed 3cm - if you keep repeating it like a stuck record and "why aren't you going getting that epidural sorted?" they will do it just to shut you up.

It's horrible but many midwives have their view about how you should give birth and will delibrately stall, you will have to be firm and be 'hard work'.

(BTW - I only had to ask twice, but then I gave the midwife what DH calls my "about to unleash hell look" and she didn't bother arguing, I guess sometimes being a bit of a bitch is a good thing)

sorry,'were so numb that feeling didn't return...'

I asked as soon as I got onto labour ward and they were going to give me one (was induced and they just broke my waters) - but the anaesthesiologist got called into an emergency c-section so I had to wait.

He came to my room when the midwife wasn't there. I cried and told my husband, very loudly, not to let him leave again! My midwife was lovely and wouldn't put me on the drip until I had the epidural as she said the pain would get worse.

So just beg, keep begging and then start shouting! Worked for me good luck, hope it all goes well

Ok, firstly nobody should deny you an epidural. You need a supportive birth partner to fight your corner too. Whenever I asked for an epidural I was told of course I could, no questions asked.

However I do feel that epidurals do come at a relatively high cost to you as you are then lying down which is not a good position to help the baby come out. You are then having to push uphill. Once you've had one you also have to resign yourself to an artificial placenta delivery (which for me caused additional problems). I also had side effects from the epidural for 6 years!

For me the best thing I ever did was hypnobirthing - have you considered that? I had a much easier, less painful delivery having done a course in hypnobirthing. It really does help.

Are epidurals easier to get in hospitals as opposed to midwife led centres?

I was in Liverpool women's and spent the night in an ante ward cause they had no space in dr led suite and I needed monitoring. Ended up having to give birth in mw led without monitoring (and then mw missed delivery while she was on coffee break).

There just wasn't the room in the delivery suite for the 24hrs I was waiting for a bed, I even offered to bring my own anaeathetist ha!

Midwife led centres don't do epidurals at all RugBugs - they don't have the facilities/personnel. To have epidurals you need to be consultant staffed.

Ahhh, in LWH they are just on opposite sides of the corridor and anyone who needs going over to dr led delivery suite does so (if they have room).

Yes, that's the case in lots of places. The MLU is next door to the CLU and you can walk/be wheeled across the corridor. The MLU itself never does epidurals. And in a freestanding MLU you would need to transfer, probably by ambulance.

Agree with checking out the staffing levels - in order to get an epidural, there needs to be an available anaesthetist, and a spare midwife to stay with you.

If they've normally only got one anaesthetist on call, and they need to do an emergency cs, then no-one else is going to be getting an epidural until they've finished with the cs.

I never had an epidural and still layed down when it was time to push ?

Consider labouring in water instead. The pain relief is amazing and you don't have the risks of on epidural and the likelihood of further intervention.

Wow sorry to hear you had problems I said I wanted one when I arrived on birth ward at 4cms but we decided to see we got on, next time they checked a few hours later I was 8cms. Even then I got 1 with little fuss.

I would be clear from the start and keep asking if they reluctant

Can I just add that you don't need to be on your back for an epidural at all. I gave birth upright - and the whole experience was painless and a million times better than birth without an epidural.

Ushy - Isn't that only the case if your hospital has the ability to offer a mobile epidural? Mine didn't (and still doesn't). No way could I have been in any other position than lying down as I had no feeling at below the waist.

Well I have a terrible fear of needles so avoided the epidural like the plague!! However I am shocked that it would be denied to someone who obviously wants it, what right do they have to decide it is ok for you to be in pain when the means to relieve it are right there? I agree with those that have said put it on your birth plan, ask on admission (or at 3cm if not already dialated) then keep asking over and over and over where it is.

Also be wary of counting on alternatives such as water. I planned a hospital water birth with my first and home birth with my second and ended up with 2 hospital births (nice ones!) Both times due to lack of midwives.

PS. Dilated not dialated. Obviously.

I asked for an epidural in two labours and never got one. Both times I wad told to try something else (pethidine first time, diamorphine second time) first and see how I got on. Of course after trying the alternative first it was then too late for an epidural when I kept asking. I was told oh but your doing so well, see how you get on, we wouldn't want to slow things down. Those labours were 7 years apart too so seems to have been the case for a long time.

I put it in my birth plan as 'i am likely to want an epidural' along with 'no pethadine' and this was followed. I also requested an appointment with the anaesthetist and consultant led care to ensure I had one if required. It is very rare not to have a 'mobile' epidural these days (as long as they do epidurals of course) but the term is misunderstood. You are highly unlikely to be able to walk around for instance but you should be able move around the bed and get into different positions. I couldn't lie on my back for instance as my blood pressure drops too low in my last trimester. I gave birth on my side and had a 18 min second stage after 72 hours of pain in latent labour as she was back to back. I would have been too exhausted if I hadn't have had the epidural. Try looking at the NICE guidelines for epidural anaesthesia in labour and quote it at the midwives if need be. I would also get someone to pointedly note down times when you request pain relief and ask for the anaesthetist themselves to explain why you can't have one if turned down (in case they've not been called). There is a good question and answer session with an anaesthetist on mumsnet which I'll try to link to for you.