not allowed epidural. Choose induction or c section under general anaesthetic?

[GirlFromMars1]

Hi,

So I was diagnosed with a PE at week 30 (I'm now 36 weeks). (The scans are notorious for not being totally 100% definitive but they said it was highly suspicious)

Met with haem/obs team last week and they said I have to continue on clexane for remainder of pregnancy and 6 weeks post partum. (I expected this anyway so no shock there). If I go over 40 weeks they want to induce me and I won't be allowed an epidural as I'd have to be off the clexane for 24hrs before and after it. I have to see them beginning of August when I'll be almost 39 weeks for another meeting to discuss things.

In terms of a c-section I'd have to have it done as a general anaesthetic due to not being allowed spinal anaesthesia. I'm youngish (30) and normal BMI so should be ok with GA. Think the Dr's would prefer me to not have c section in case I'm more likely to get DVT or PE afterwards.

Ideal scenario i suppose would be to just hope that I go into labour on my own before I get to week 40 and avoid induction (still nervous about vaginal birth though). If however the baby hasn't appeared by my due date I am unsure whether to say that I'd prefer ELCS over induction. (Very concerned about the pain of induction, increased likelihood of assisted delivery and potential physical issues from that with regard to tearing and incontinence).

With a c-section it's the GA aspect I'm worried about, as obviously I'd like to be awake for the birth and for my husband to be there which won't be possible with GA. He has to wait outside theatre.

Hoping other ladies can share their experience of induction with no epidural or c section under GA!

Thanks!

Just to add, my induction was so difficult that I didn't get skin to skin for hours anyway - I'd had diamorphine, lots of drugs, lots of pain and somehow this all added together to make me shake uncontrollably for about 3 hours. Dr at the time said that was a fairly common problem after inductions. I wasn't safe to hold the baby as the shaking was so bad.

So a Caesarian under GE would not have been any worse in terms of missing out on those early moments.

I'm 34+4 and have recently been diagnosed with a DVT and put on Clexane. I've been told I will have to miss 1 dose before being induced or having a CS. I'm surprised they're letting you get to your due date to be honest, I've heard the norm is about 37 weeks. They mentioned about having a CS under GA but I'm sure there was an option to not which I think involved longer without the injections, maybe 3 days or something I can't recall, though that may be too risky if you've already had a PE.

I was induced twice with just g and a and a half dose of pethidine on one occasion. Although my induction progressed super fast so no pitocin needed. I hear that does make it worse.

I do like the sound of this short term stuff. I would go for vaginal birth induction if it were me. Just my opinion.

Farfromtheusual Do you mind me asking which hospital you're at? Are you on 60mg twice a day or 40mg once a day?

I think I'm going to ask if I can drop to 40mg once a day if I don't go into spontaneous labour and possibly ask for ELCS so that I can time my clexane accordingly so I'd only need a 12hr gap before an epidural. x

Whothefuckissimon Can I ask which hospital you're based at? (You can PM me if you like) Interesting to hear how some trusts are interpreting the guidelines. I'm on 60mg bd if that changes your stance. Thanks!

I was induced 3 times, all without syntocin and all with gas and air (plus pethidine for DD2 but that was vile stuff). Small 2nd degree tear with DD1 and no tears with DDs 2&3.

PEs are not trivial so I can understand their caution. The risks should definitely not be underestimated.

I was at Solihull as was classed as low risk but have now had to be referred to Birmingham Heartlands. I'm on 2x90mg a day but the dosage is based on your booking weight so I am obviously fat compared to you haha

Iougle I understand that PEs are serious but in my case it's still unclear whether it really was a PE. I had a partially matched defect on the VQ scan and chest CT was normal. They didn't do a CTPA so not really 100% confirmed more just suspicious in the clinical context so I think they've proceeded with extreme caution. Totally understand why they'd be cautious but my gut is telling me that maybe I shouldn't let them induce me without epidural. I feel like right now I'd rather wait for spontaneous labour before my due date and if that doesn't come then have ELCS booked for my due date with a plan for me to stop the clexane before that so that I could have a c section under epidural.

Could you plan to be induced with pessary /breaking waters etc but then if that doesn't work and they want to put you on the drip then opt for CS with GA - gives you a good chance of having a VB while avoiding the drip contractions. They can also feed in the syntocinon gradually which is supposed to be less of a shock to the system! I thought I'd have to have GA if induction failed due to HELLP - in the end the drip did nothing but my lovely anaesthetist decided my platelets were just ok for CS under spinal.

I went into labour naturally but then stalled (due to baby's position). So was put on the synto drip, which was cranked up to a pretty hefty dose by the time we all gave up and headed off for an EMCS. I managed ok without an epidural, just had g&a and a shot of diamorphine.