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...

I was adamant I didn't want an epidural. That was before 33 hours of contractions and no sleep for 2 nights. Then baby needed to have a scalp monitor attached so as I was going to be confined to bed anyway, scuppering my plans to remain as mobile as possible, I asked for an epidural and got it with no problems at all. Lovely anaesthetist turned up 15 minutes later and I was blissfully pain free until I was fully dilated. I could still move my legs so wasn't completely numb and it wore off enough for me to be able to feel my contractions and push without direction. I was on my side for pushing until the last couple of contractions when I moved onto my back. DD was born 50 minutes from starting to push and no forceps/ventouse required.

For someone who was anti epidural beforehand, I wouldn't hesitate to have one again in the unlikely event of having another baby.

www.mumsnet.com/onlinechats/david-bogod

Hope that works. Good luck and hope it all goes well for you.

My midwives actually offered me an epidural when in labour with ds1. I had been in labour for a long time and they were worried that as labour was progressing so slowly I would be too tired to push if I didn't get a break from the pain. I agreed, then they told me it would be at least 4hrs before I could get one as the aneathatist was in theatre.

So all I would say is ask for one, but be prepared that there may not be an aneathatist available for a while. Sometimes if the midwives are trying to fob you off with other methods of pain relief it is because they know you won't be able to have an epidural for a while.

I am not sure it actually is that rare not to have a mobile epidural available cakes - my hospital was/is a major London hospital, and doesn't offer them. Nor does the next nearest hospital.

It's to do with the misconception about the name mobile epidural. Most women do not walk around with an epidural for a number of reasons such as monitoring, exhaustion, choice etc. However the actual drugs given in the epidural are almost invariably the low dose combination of local anaesthetic and opioid. The anaesthetist in that link addresses the question and I have several anaesthetist friends who've said they've never worked at a hospital where the standard epidural is not the low dose version.

I really don't think it is about a misconception about the level of mobility. I asked about whether I would have any mobility at all (e.g. to be vertical) and told no. It was true, when they gave the epidural I could not even move my legs, I literally had to pick my own leg up with my hands to move it. This was only three years ago, in a big London hospital.

I suspect maybe the key is in what that doctor said - the drugs may be the norm, but maybe the philosophy, and therefore issues like dosage, are what stops mobile epidurals being more commonly available in practice rather than in theory.

It's the drugs given that define classic as opposed to mobile. A classic epidural just contains local anaesthetic so is very dense and blocks everything. Mobiles contain both local anaesthetic and opioid. The dose is then adjusted depending on the level of pain the woman experiences. Obviously if you're still in a lot of pain you need more top ups and the denser and less 'mobile' the epidural. Also if you have it early on then the more the drugs spread in your cord, the more you have and the denser the block. It sounds like you were in a lot of pain youllwin so needed higher doses which resulted in less mobility.

I agree about philosophy though. I was told I might be able to walk around but it would be discouraged as they would be worried about 'health and safety' if I fell over.

Hhhm, I am not sure. I was in a lot of pain, but I had an OP baby and was coping as long as I could stay vertical. Lying down I could not cope at all. I would have thought the logical thing to have done would be to give me a low dose to start with to allow me to keep upright. But I was very clearly told that wasn't an option. Others I knew from NCT were also told no mobility was possible with epidural. Maybe it was a 'health and safety' thing. Who knows, but I do know that women at my hospital were being very clearly told epidural = flat on back, maybe semi reclining if you were lucky.

It sounds rubbish youllwin :(. As I say, they actually wouldn't let me lie flat on my back with the epidural as my blood pressure was too low and affecting the baby too. I had the same problem with too much pain when I lay down or even sat down (I'd spent 3 days in latent labour as she was back to back) though thankfully the epidural helped in my case and she eventually turned while I slept.
I think a lot of the policies and attitudes from hospitals around epidurals in this country cause a lot of difficulties and I wonder if they account for a lot of the associated slight increased complication rate. There are for example plenty of countries in the world who have massively higher epidural rates than the uk but the same or lower ventouse/forceps rate.

Yes, I do blame the epidural for the eventual forceps. DD just wasn't turning or coming out uphill. sounds like we have very similar labours - I had 3 latents days too - was practically hallucinating with sleep deprivation when I got to hospital. So sad if it's not the limitations of the medicine itself, but the attitude of the staff/hospital