Epidural or not to epidural - that is the question. Advice needed, pro & con from both sides please!

[oliveoil]

I had an emergency c with dd 18 months ago and have been umming and arrhing about my second due in August. Midwife and docs I have seen say that 'there doesn't seem a reason on your notes' not to be able to have a vaginal birth this time round, it was only dd being in distress that meant she had to come out pronto.

I am not sure whether to go for an epidural again this time round, I think it may have slowed down my labour and may have caused the problems I had (m/w reckons not however...).

Thoughts needed from both corners please - have you had two labours and had an epi for one and not the other? How do they compare?

Also thoughts from the experts Mears and Prufrock and any other midwives or doulas etc please.

Bearing in mind I have a VERY low pain threshold and am a wuss so this may be all academic reasearch in the end.

oliveoil, not having an epidural for my 2nd labour (dd2 was one last week) is my only regret about that birth. i had an epi when I got to 4cm the first time and yes, I think it slowed things down & brought my already lowish bp down too, so I ended up having a c/s. 2nd time I was booked for an induction, had waters broken manually and not much happened so had canula put into back of hand ready for drugs & bp plummeted (80ish over 40 odd) and had to have a crash c/s. if only i'd had the epi already before anything, I could have been conscious for the birth, but ended up with a general anaesthetic. i'd already agreed wtih my consultant that i'd only have a shortish trial labour (6 hrs) so was disappointed to have a GA after all that planning. I was a bit sick after the GA but breastfed dd2 ok & she had good apgars.

I had to have an epi with ds cos of pre eclampsia and it was WONDERFUL as I felt nothing!!

However I have been told that the hosp I am having the next one in is not equiped for epi births and so will prob have to have it naturally which I am dreading!!

That wont help you at all but the more I talk about it the more I can psychologically prepare myself for the horror of natural childbirth!!!!!11

I had an epidural with DD1 after being induced and I don't think things slowed down (she was born 12 hours after epidural) although they did use the max dose of cyntocin (sp?) to keep the contractions going. As you probably know, second labours can be very different - DD2 was born less than three hours after my waters broke (nothing before then) and there was no time for any pain relief (only in hospital for half an hour before she was born). It was v painful but only for an hour or so. Why don't you wait and see how things go ?

oliveoil
I had an epidural with both my dd and ds.
I think they are wonderful....At the end you can ease up on the amount so you can just feel the contractions.
I liken them to injections you have when you go to the dentist....why go through all that pain when you don't have to...would you have a filling without an injection if the choice is there?!!!no way!....thats my opinion anyway....good luck

my story is very similar to bundle. I had an epi, few hours later baby was in distress so i had and emergency section.
1 year 9mths later and decided not to have epi if possible. ended up with another emergency section and since no epi, had to have general so missed baby being born, couldn't believe it when I came around and baby was already 2 hours old! Aslo managed breastfeeding no problem after both epi and general.
anyway I'm all for natural childbirth, but would probably give in and have epi as am a bit of a woos (do kind of agree though that epi seems to slow down bith)

I had an epidural with ds1 after about 26 hours of labour - I had really not wanted to have one and only gave in as it looked like I may have needed a c-section. I have to say that it was brilliant - I can't believe I let myself go through 26 hours of bloody agony. With my second son, born 5 weeks ago, I was determined to have an epiural as soon as I got to the hospital - if I could have booked in advance I would have!! However, on arriving at hospital he was born 10 minutes later, so no pain relief at all!! I have to say I prefered the second birth as I didn't feel as crap afterwards. (although I didn't liked being stitched this time, as I could feel it)

forgot to say - Ihad the epi because I was exhausted from vomiting all the way through my early labour (up to 4cm) and had had enough. the pain wasn't the worst bit, the vomiting was awful and I became v dehydrated so had to have a drip.

I had an epidural, following 2 days of induction. And the pains that 2nd night were just too much and I was being physically sick. Had diaporhine first but epidural later that day once the drugs had worn off. Worked a treat, apart from a small circle in the small of my back.

bundle & gloworm - I had to have a GA too as my epidural wouldn't top up quick enough so I was out cold as well .

Am going to see how it goes but I think I can only have a trial labour anyway (?) so I don't want to have an epidural if it does slow things down as then I will deffo have to have a section again. Not that it matters too much but I want to at least try to have a vaginal delivery this time if poss.

Oliveoil
Do you have to make this decision now. I imagine it would be difficult to compare one pregnancy with another. Labour and then an emergency C can a very traumatic experience. If you keep the epi as an option if required - and I'm sure you'll know if you need it - and make the decision at the time. You obviously know what the epi does and how it makes you feel afterwards and if the pain does get unbearable there may be other pain relief that you didn't try last time.

No I am trying to plan ahead, not that you can with these things! I want to know is that if say, I am told that the epi would most likely delay things, then maybe I could fob it off as long as possible (ha) or try something else. I have been told that most things make you sick though?

I don't like epidurals as I don't like the whole 'needle in your back' thing (eeeek, just thinking about it)...

I had one with dd1 (nine years ago) before proper mobile epidurals and HATED it, as I lost all movement and feeling in the lower half of my body, ended up with the whole ventouse/episiotomy/blood loss thing.

With ds got to the hospital 7cm dilated and he shot out 15 mins afterwards with no pain relief. It was outrageously painful but over v. quickly and felt much better very soon afterwards.

With dd2 also had epidural after about 12 hours of induced contractions without any actual dilation taking place. In the event she was born v. quickly just as the epidural was due for a top up, so probably not much pain relief. Again felt fine v. quickly.

IME it's hard to tell whether it's the epidural that slows labour down or all the monitoring and drips and associated wires and cables that reduce your mobility. With dd2 it was only once they sent me off to the loo before they planned to top up the epi that the baby made her move, and I think it was definitely linked to the fact that I was walking around having been relatively stationary before.

Personally, I would play it by ear, not ruling out an epidural if it looks as if you'll be there for a long while, but definitely not ask for it at the first twinge.

Gas and air really scared me - a feeling of a total loss of control (which for some people is great - but not for me!) Diamorph didn't work for me as a pain relief but did make me sick which was difficult between contractions. The epi was used for the emergency C and I must admit within seconds the horrendously huge contractions were gone but so was all the feeling in my body. I didn't want to lose the feeling in my body I wanted to 'feel' the baby. Not having that feeling has been a great sadness to me. But the point I'm making is that we are all different.

Oliveoil - I think epidurals are wonderful when labours are long, slow painful affairs. However, when labour is progessing well they can disrupt the whole flow, leading from one intervention to another. Epidurals do not always work effectively, being better on one side more than another which can make the labour even more difficult to cope with. They can cause your blood pressure to fall which in turn makes the baby's heart rate drop and also causes vomiting. Being stuck in bed continuously monitored does not help the preogress of labour.

However, I have also seen them being really effective and women having lovely normal births.

In our unit, women who do not have an epidural usually have a spinal anaesthetic if they need a C/S, even in cases of fetal distress. It isn't that often that we resort to general anaestheric. You would need to find out your hospital's policy.

I always think that women who have had a previous C/S are best to be as mobile as possible. Units vary on how they approach things. In my unit, women who have had a previous C/S can make arrangements in advance to use the midwifery unit. There they can be mobile, do not have continuous monitoring and can use the birthing pool. I think that is the ideal scenario TBH when going for VBAC. If the labour becomes too much to cope with, then there is the benefit of having an epidural. You will need to find out what you can be offerred. You can insist on being mobile etc. but some units are resistant and you might not want to feel that you are in conflict. You do have the right to labour as you choose though.

If you are recommended to have continuous monitoring, you do not need to be stuck in bed. You can stand at the side of the bed or sit on a birthing ball.

I would advise being as mobile as you can - do not go to the hospital too early. Stay at home as long as you can, use bath/shower to get relax and ease contraction pain. As long as the baby is moving, you do not have bleeding or pain over your scar, you will be fine at home.

I think it is always best to wait and see if you need an epidural rather than opting for it as a first choice before the pain gets too bad. It might never get to that stage. Second labours are usually quicker (but not always). Find out what your hospital offers.

You are so wise, can you come with me? I could do it with you there barking orders at them .

I will be going to St Mary's in Mcr, they were fantastic last time with me, just my body that was misbehaving.

Do you have to take birth balls in with you?

Mears
what is the difference between an epi and a spinal anaesthetic. What difference would I feel? Thanks

This link is quite helpful to explain
epidural/spinal

Epidural is used for labour and allows movement of the lower limbs. Spinal is used for C/S and the local anaesthetic is injected a little bit further into the spinal fluid whick takes away all the feeling of pain and movement of the legs. A spinal is much quicker than an epidural but lasts for a shorter time. An epidural is 'topped-up' when a C/S is needed if it is already in place. That takes 20 mins at least. A spinal works as quickly as 5 mins depending.
The injection is into the same place on your back as an epidural. When epiduarls are not working well for labour, a spinal can be done in theatre as well. HTH.

Try the link again

epidural/spinal

Link not working - have cut and pasted.

EPIDURALS: YOUR QUESTIONS ANSWERED
story by Tina Otte from Your Pregnancy magazine
We answer the most commonly asked questions and concerns about epidurals...

Epidurals are without doubt the most popular and effective form of pain relief.

1. What is an epidural?
   An epidural is the injection of a local anaesthetic ? given at the level of the lumbar area of the back into the space surrounding the spinal cord.

2. Why is it referred to as a "regional anaesthetic"?
   An epidural numbs only a certain area or region of the body, unlike a general anaesthetic that renders you unconscious.

3. How does it work?
   It works by numbing the nerves of the lower half of the body that transmit pain signals to the brain.

4. What is the difference between an epidural and a spinal?
   The needle that is used when giving an epidural will only penetrate the skin and move between two vertebrae, but does not enter the spinal canal where the cerebrospinal fluid is found. The local anaesthetic is injected into a fatty area rich in blood vessels and nerves. A spinal involves a smaller, thinner needle that moves through the vertebrae and does inter the spinal canal allowing the local anaesthetic to mix into the cerebrospinal fluid.

5. Can I have an epidural for a caesarean or do I need to have a spinal anaesthetic?
   Usually this decision is made by your anaesthetist, but he will discuss this with you. In the case of caesarean, spinals are very popular as they act faster and are fairly quick to administer. They do not last as long as an epidural and you tend to get your feeling back a lot sooner. Should you need a caesarean during labour and you already have an epidural in place, this would be modified for surgery.

6. When should I have one?
   An epidural can be given at any time during labour, but it is preferable to be in active established labour first. This means that your contractions are strong and regular. It is too late to ask for one when you are close to pushing stage, although many women who make it that far without, have been known to ask for it then. Usually you will be coached and supported through this time.

7. How long does it take to work?
   The initial effects of pins and needles will be felt quite quickly, but FULL effect takes about 30 minutes. A spinal takes effect almost immediately.

8. How does it affect labour?
   If given before labour is properly established, it may knock the contractions off entirely. If labour is going strong and well established it has no apparent effect on the length of the first stage. Second stage (pushing) may be lengthened if the mother has no urge to push and cannot work with her body.

9. Will I be able to push?
   Pushing may be affected and the need for assistance in the form of forceps may be increased due to the fact that the mother cannot feel the bearing down sensations as the baby moves through the birth canal.

10. What are the after effects?
    Initially the only side effect is the continued loss of mobility until the epidural wears off. Sometimes women have experienced headaches, itching, a severe drop in blood pressure and bruising or tenderness at the injection site.

11. How long does it last?
    This depends on the dose of local anaesthetic that has been given to you if a single dose only has been given via the tube. You may however be attached to a continuous infusion that will ensure you have adequate "cover" for the entire labour and will only have feeling return once the infusion has been turned down or turned off completely. This is the more popular way of having an epidural today.

12. What if it does not work?
    Epidurals work in most cases, but there are a small percentage of women who experience hot "patches" of pain if the epidural has taken in some areas and not in others. It is usual for the mother to be turned from side to side in order to bathe all the nerve endings properly.

13. When should you not have an epidural?

If you have a clotting disorder that significantly delays the clotting of your blood.
If you have open lesions on your back
If you have had back surgery or trauma that makes it difficult for the anaethetist to safely access the epidura space.
14. How safe is an Epidural?
There are potential risks and possible side effects associated with epidurals. As with any medication, risks must be weighed up against the benefits. Provided the procedure is carried out under the guidance of experienced personnel in a unit that has appropriate protocol for the care of the mother, epidural is a very safe procedure.

15. How much does it cost?
    The anaesthetists fee is in the region of about R1 000 to R1 600 depending on time and circumstances. Hospital fee is about R540 to R600.

16. Who makes the decision to give the epidural?
    This should be a combined decision between the mother and her caregiver. She should be informed and guided, but not pressurised by her caregiver. In fact the subject should have been discussed long before she actually goes into labour.

17. Who gives the epidural?
    The epidural may be administered by the obstetrician or by an anaesthetist. In the case of a caesarean birth an anaesthetist will administer the epidural and be on hand all the way though the procedure.

18. What are some alternatives?
    When a woman labours naturally, without any intervention, the level of endorphins (see article on page 77) in her body will rise dramatically. These are the body?s natural pain killers that dull the sensation of pain.

19. What other intervention can I expect with an epidural?
    Before an epidural is given, the mother will have a drip put up to preload her with fluid in order to prevent a dramatic drop in blood pressure and to keep a vein open should she need emergency drugs or drugs to stimulate her contractions if they slow down. She will also need to have a urinary catheter inserted into her bladder.

20. What is a mobile epidural?
    The procedure for a mobile epidural is exactly the same as for a traditional epidural. The difference lies in the mix of drugs used. The advantage is that women may continue walking while in labour, thus assisting their baby?s passage through the pelvis. With a mobile epidural no urinary catheter is required and although a drip is still needed, a mothers pushing urges during second stage will not be diminished

Thanks mears. Reading it makes me think I won't have one, but then I had one last time. Wasn't mobile to begin with in labour though, will have to try to move about more and get things going that way.

Also, how do you know what stage you are at, ie 1st and 2nd? Is is something that you will just know and your body will tell you?

Your body usually tells you when you are getting to second stage. Firts stage is when the cervix is dialting and your contractions are very regular and make you stop what you are doind to breathe through them. When you are well established in labour contractions are 3-4 every 10 minutes.
Nearing second stage you can feel increasing pressure as if your bowels need to move. This is the head coming further down. Transition is when the cervix is nearly fully dilated but not quite. That is the point most women want to go home and forget about it It is often when women think they need an epidural.
Second stage iswhen you are fully dilated and your body is telling you to push. Much better to push when your body tells you to rather than the midwife telling you to take a deep breath and hold it as long as you can.
It is easier when the baby's head starts coming down and you can feel it moving. Such a relief when the baby delivers - the pain disappears.
Different with an epidural in that sometimes you feel nothing at all. A good epidural will mean that you can feel the pressure. With an epidural you probably will need to be guided by the midwife to push as the natural sensation usually isn't there.

oliveoil, I loved the freedom of being able to move around while I was in labour and I know that's what got me through a drug / assistence free birth. I could pace the room while having contractions and had her standing up which just felt so right. I had wanted a water birth but couldn't bear the thought of being kept still / sitting down let alone being made to lie on a bed - no way. I made the midwife examine me standing up, I was not getting on my back for anythig or anyone!

I went to active birth classes which I thought were great, is that a possibility for you? They help get your head in the right place for not having an epidural, but don't steer you away from other pain relief. They show you exercises and ways to use birthing ball etc.

Have a look here

mears re your comment below on continuous fetal monitoring, why is it that when my sister gave birth (i ended up birthing partner by accident) that they insisted she have continual fetal monitoring (as her waters had broken 24 hours beforehand) and had to stay prone on the bed. this made it much more painful for her (and made me v angry, altho i didn't show it at the time). when i asked if it was strictly necessary they insisted it was. she had a comparatively short labour (4 hours of full on contractions) and gave birth without pain relief, but i feel that she would have had an even easier time had she been able to do what we had been doing together all afternoon: namely lean over a birthing ball/against a wall and have me apply pressure to her lower back/massage her. grrrrr. any idea why they insisted on her being in bed?

Think the only thing an epidural did for me was allowme to have a rest halfway through after so long coping with contractions 3 minutes apart I though I was going to die and without it I most certainly would not have had the strength or energy to push DD out.

Am gonna try and do without it this time - but I am the sort of person that does not write birth plans and has a sort of we'll see how we go approach!!