Doctor needs help!

[drtimmeek]

A confession: I'm not a mum. I am a dad however, and I do hang around with lots of mums because of my job as a maternity anaesthetist. One of my extra jobs is as a member of the Executive Committee of the Obstetric Anesthetists Association (OAA). One of my current tasks is leading the major upgrade and relaunch of our website, including a major revamp of our public information pages. One thing we would like to add is an FAQ page. We need your help to come up with the questions. Imagine you had one of us to yourself. What would you like to ask us? Anything in the realm of pain relief or anaesthesia is fair game. Simple or complex, please be honest about what you want to know. It's not always the same as we think you want to know! Thanks in advance for a torrent of questions...

I wish I'd been told that having backache after childbirth was common - I thought it had been caused by the epidural, was only after having dc4 I discovered it was just from having being pregnant and then giving birth!!

That epidurals aren't often/always (???) fully effective. My first 3 births still hurt despite having had an epidural.

How long you may have to wait from request to receiving...

Does having an epidural hurt? My response would be - not compared to the contractions I was experiencing

I'd like to know about different epidural options, e.g. I've heard about mobile epidurals; are there other options it's worth considering?

Why does it seem like epidurals are hard to get? I know plenty of women that asked for them and weren't given them, with no apparent reason why not! It feels like a lottery.

how quickly do they take effect? what effect does it have on baby? What's in it? how quickly will wound heal? Some of these may be obvious but for 1st time mums I think you need to really cover the basics

Is there a relationship between having an epidural and instrumental birth/emcs? I was told there was and had a very difficult ventouse and forceps delivery of a 9lb12 stargazer dd, because I was afraid an epidural would mean surgery I didn't want.

Interesting idea! Well done for seeking out opinions from us!

Off the top of my head:

What's the difference between a spinal block & an epidural? When would one be used and not the other?

How long does an epidural/spinal block last?

When and why is general anaesthetic appropriate/necessary?

Why can't I have an epidural at 1-2cm dilated if I'm contracting at 3 or more in 10 mins?

What are the risks/benefits of pethidine/gas & air/epidurals?

General tips for women having inductions (as my first birth was, ended in a emcs), eg don't wear contact lenses. I wore mine and removing them before surgery (while contracting furiously due to hyperstimulation!) was one of the lowlights/black humour highlights of the whole thing! For my second birth (a vbac) I made sure to wear my glasses just in case...

Personally, I could have kissed the anaesthetist who gave me the spinal for my emcs. I chatted away to him throughout as they rummaged around and delivered DS, much to dh's bemusement (he was paying more attention to what was going on behind the screen than I was!).

I have a lot of respect for anaesthetists, not just for obstetrics but all surgeries. Pain management is a real mark of our medical progress! When I think of what surgery was like before anaesthetic or where people can't access it [shudder].

What's the ratio of anaesthetists to labouring women in other countries compared to the UK?

How often do the clinical leads of anaesthesia and midwifery get together in the average Trust?

Have the RCAA/RCM surveyed mothers jointly to look at access to epidurals in labour, both by policy and by experience? What were the results?

Do you require Gastric Bands to be emptied prior to a General Anaesthetic ? Why ?

Why isn't there an on call system that would cover the requirements of the maternity Unit ? I was told that i couldn't have an Epidural because the Anaesthetist was busy with another lady who had a retained placenta. Very frightening and consequently painful and traumatic for me. Neglectful ?

If the feeling in your legs doesn't come back within x time, to tell someone when having a spinal block.
That getting an incredibly itchy face after a block is 'normal'.
I didn't know either of these. The drip wasn't in the right place, so wasn't doing what it was supposed to do. Nobody told me, nobody checked on me.

How do a I ask for and get a family centered/natural Cesarean?

Can the family centered/natural Cesarean procedures be used in an emergency?
What is the anesthetist role in the above?

What are the differences in procure for Planned, Emergency and "Crash" Cesareans?
Do I have a choice in the analgesics used? What are they?

Is there a 'right' way to use gas and air? I just kind of hyperventilated on it until I was so woozy I had little idea what was happening. I've since read about a method of using it where you breathe in at the start of a contraction and use that to take you through the peak of the contraction - is this right? Should women be coached to use gas and air til we get the rhythm?
What are the risks of an epidural when you have bad SPD?
I've read water is the second most effective pain relief to epidural - is this true? What % of women get to labour in water in hospital/MLU, what % give birth in water?

Think this needs reporting so it can be stickied by MNHQ as a very valuable thread.

Dr, you may get more responses by posting in the Pregnancy topic but good form would be to report your own thread to MNHQ to ask them to move it and to check they are happy with this request for input from Mumsnetters (I think there is some sort of policy about research requests).

Great idea though and I hope lots of people continue to add their questions to the thread!

My questions:

Does having an epidural increase the likelihood of intervention (forceps/ventouse/CS)?

What does an epidural feel like? How likely are complications?

Oh yes, I'm really keen to avoid pethidine as it sounds awful to give birth to a sleepy, drugged up baby who needs yet more drugs to wake them up. Is this a reasonable fear? What are the other injectable options, how do they compare and how can I get non standard ones? Could being slightly woozy make being born less of an ordeal for the baby?

I hope you'll be able to post some answers on this thread or at least post a link when the page goes up!

This is not so much a question, as an issue to be addressed, and advice on how to address it would be good. In my first labour I had an epidural that worked on only one side. The anaesthetist told me to lie on the other side when I had a top-up, to try and help disperse the drug to that side. When the time came to top up, however, he was not in the room and the midwife over-ruled him and refused to let me roll over because that might cause the monitors to lose contact with the baby.

Now, had this been one of my subsequent labours I would have said "You can regain the trace afterwards", and rolled over. But, first labour, inexperienced, exhausted and overwhelmed by it all, I submitted. Naturally, the epidural continued not to work, despite several top-ups.

Advice on your FAQs on how to handle such a situation would be very good.

I second the suggestion for advice on how to use G&A.

Please pass this message on to anaesthetists: have you any concept how difficult it is to sit stock still for the epidural to be put in, while you are having almost back-to-back contractions? Please do not get shirty with me when I struggle to comply!

(Actually, that's the only even vaguely negative experience I have ever had with an anaesthetist. The other have all been excellent.)

I've reported as a very worthy post, but should be okayed by MNHQ.

Why did epidural damage my back?
I was given, by my midwife, a few of the more common risks and told the severe risks like paralysis almost never happened. I wasn't told that I could have any long term problems.
With my first child I had an epidural, had no previous back problems, I'd just turned 17. I've had disc issues, sciatica, numbness and often limited movement for 19 years since.
While getting the epidural something happened in the first space the anaesthetist tried so he went lower where he managed to insert the needle and the catheter but it still didn't work at all as a pain reliever.
My MRI scans show my back is damaged between L3 and L5.

Was I simply unlucky?, could it have been a complication due to my young age? (spine not fully developed)
Does it happen more than people are told about?

Thank you so much to all posters so far. This is a great start. We can use these questions as a launch pad. We may adapt and generalise some of the questions if they refer to unit-specific issues and/or if it helps us to create a more comprehensive or generally-applicable answer. Please continue to add questions if you wish. Many thanks again. Tim Meek.

I would like to know what measures are in place to help women avoid anaesthesia.

Pain relief is not without risks and drawbacks;but fear, trepidation and panic compound pain. Many women- especially first time mothers and often shocked by the intensity of pain, but emotional support can go a long way to avoiding the need for drugs and blocks.

I know for me during my first labour I felt panicked by the whole situation, was left alone for long periods and eventually accepted diamorphine "to help me relax".
Although ultimately a good outcome my labour was prolonged as a result, my baby had a low APGAR score and I felt that the diamorphine would not have been necessary if I had someone to support my emotional needs.

With my second labour the pain was just as intense but I felt more in control , less traumatised by the process and more able to cope.

I understand staff pressures and I am very glad we have the option of pain relief but wonder if we jump to analgesia too soon when in fact more staff would help Mums have easier births.