Epidurals

[runnerbean2]

Hallo - first post.

How early is it possible to have an epidural (assuming a bed and an anaesthetist is available) and is there a limit to how long it can be topped up for?

I know an epidural does not work completely on everyone, but if it does work, is it theoretically possible to have full pain relief for the majority of labour and birth?

I also know about the pros and cons of epidurals and other interventions so please take it as read that I am not interested in having a "natural" birth!

I'd be very grateful for any information - thank you.

I vaguely remember you had to be in established labour so a minimum of 3 cms dilated. That was 20 years ago though so things could have changed.
It didn't work for me so can't advise what you should and shouldn't feel.

Whatever your local unit's definition of "established labour" is - usually either 3 or 4cm dilated and having regular contractions. Where I work they prefer to have it in for less than 24 hours but they wouldn't whip it out at that point if you were progressing well.

If it works well then it can give total pain relief for the contraction pain. It is less reliable for the pain down below when the baby is actually being delivered, and it is not uncommon to stop the epidural/not top it up any more once you're in 2nd stage, so that you can feel what you're doing and theoretically try to reduce the chances of needing forceps/ventouse. About 5-10% will not work adequately though, sometimes this can be fixed by topping up/adjusting but sometimes it needs to be taken out and re-sited.

If you are sure you want an epidural as I was, be very forceful about it, I arrived at 5/6cm and progressed very quickly and only just got the epi in time. I was having horrendous back to back labour with no break in contractions and it was a life saver!

However, it did stop working despite resiting and it did mean that pushing was very ineffective, I ended up with a spinal, ventouse, shoulder dystocia and a huge episiotomy. So 2nd time round I am going to try and do it au naturel or have a c section!

In theory, yes. In practice, unlikely because of the constraints on early admission. If you're particularly concerned I'd suggest an anaesthetic consult so you can discuss this. I ended up with EMCS, but at the consult it was written on my notes that the epidural was to be placed as soon after arrival as possible and I could start it off when I needed it.

You might also consider that if you end up being induced, you could refuse the drip until an epidural has been placed.

My understanding is that you need to be in established labour. My hospital took that as 4cm and it took me bloody ages to get past that. That was the longest part of my labour. I then progressed so quickly once past 4cm that I didn't even get a chance of diamorphine.

I'm not saying this to scare you but just to prepare you and see if there are any other pain relief techniques you could employ if it takes you a while to get past the 3-4cm. I had a tens machine and that really helped in early stages. Also breathing techniques.

Hmm yes think it has to go in when you're in established Labour, my hospital says this is 4cm with regular contractions. I would make it very clear from the start you want one. I've known a lot of women to be fobbed off. I didn't have one but needed a spinal cord block at the end in case forceps failed.

It was heaven. To just sit back and feel no pain after hours of contractions. Bliss.

You might be able to use remafentanyl in the early stages also.

I had dd2 14 weeks ago and asked for an epi as soon as I went in at 9am, it was eventually in by 2pm then another hour before the pain relief was at its maximum effect.
I think the 4cm thing is more to do with the fact that you will be moved to a delivery room and off the assessment ward once you reach 4cm and I dont think they do epis on the ward as you won't be mobile afterwards.

My epi with dd1 was for the last 4 hours of a 30hr back to back labour and gave me total pain relief, I didn't feel a thing but with dd2 it was one where I could top it up myself every 30 minutes or so and there was an area on the right hand side that didn't numb but it was still a heck of a lot better than without as I was contacting 7x in every 10 minutes pretty much from the start so the pain was relentless.
I had to push for 2 hours at the end and they didn't want me to top it up during that time so there were a few painful moments during the actual delivery but still not majorly painful.

With both epis I was up and in the shower about an hour after the birth so not bad at all.

Many thanks for this information, everyone.

I would agree that you need to be prepared for quite a long time before an epidural even if you have it ASAP. Also, there can often be a wait for the anaesthestist. If she is in back to back emergency sections and there is no one else, you have to wait.

I don't say this to scare you, but I think it is good to be prepared.

My experience of having an epidural was about 12 hours into a back to back labour. My contractions were awful but inneffective, I had to be given syntocin and they gave me the option of an epidural because they knew I couldn't cope with stronger contractions. It was amazing! It was one that I could top up myself so I was in control of it, I couldn't feel anything even when pushing and I didn't need any interventions. Afterwards I was up and walking around within 2 hours, did have a 2nd degree tear but I had the same with DS2 and didn't have an epidural with him so you could tear anyway.

I'd had it written in my birth plan and agreed with the consultant that I would have an epidural as soon as I arrived to the assessment unit. It slows down your labour, on average, by about 2 hours but I didn't want the same thing to happen again. However, there simply wasn't time and by the time I got to hospital DS was born in under an hour. It wasn't a bad labour, it was painful but so quick that it was bearable. Just be aware that you may opt for something that is not possible to have so be prepared to do it without.