How can I make sure I get an epidural without a fight?

[redheadedleague]

I'm 40+8 with my second child and my mental health is crumbling. Up until a few weeks ago I was looking at an MLU birth, or even a homebirth, and was feeling fairly calm and confident. Then I started having panic attacks and flashbacks to my first labour (a 36-hour back to back ending in forceps delivery under spinal anaesthetic). The panic attacks have become daily, and nightly. I can't sleep. I cry all the time. I can't think about anything positive. I'm terrified of the labour pain that I know is coming. I overwhelmingly feel that I cannot, cannot at all, do it again. I'm aware that this is not good and if I had the time to I would get help from the GP, but there is no time.

Today I caved and decided that the only thing that would bring me any mental peace (and possibly let me sleep and stop panicking and crying) was planning to go to the hospital and have an epidural as soon as possible into the labour. I had intended to have one last time, but was checked so infrequently it was too late. This time, I decided, I would ask for one ASAP. Because I'm not sleeping I have no reserves, either mental or physical, to ride out a 'natural' labour. I've done all the hypno and active birthing prep stuff and the fear has eaten all my good work. I'm so low.

I've just been to the hospital to check out the birthing unit - the delivery suite is adjacent but you can't tour it. The midwife asked why I was looking at changing birth place so late, and I said because of the availability of epidurals. She then gave me the standard chat about second babies being different, keeping an open mind, and asked me to understand that they would 'try other options first' if I asked for an epidural. Like aromatherapy. Fucking aromatherapy. One of my flashbacks is being in transition with DD and someone clipping a stinking strip of jasmine paper to my bra without asking, and me telling DH to GET IT OFF ME. Gas and air did nothing for me. Water slowed everything down and they had to get me out. The only positive thing I can recall from DD's birth, apart from her being given to me, was the moment 30 minutes before the end when the spinal took effect and I stopped feeling the contractions.

I am in pieces. I've been crying in the car on the way home. I just want to feel safe, and be able to look forward to the arrival of our little one. I want to feel listened to. I feel fobbed off and unsafe, like if I go into labour and go to the hospital they'll try and stop me having an epidural and then I'll have to argue with the people who are supposed to be looking after me. While I'm in labour.

How do I get anyone to understand what I need? How do I get them to take me seriously? What the hell do I need to do?

Pain relief shouldn't be withheld from you. I know it did happen to you though so I can imagine you're very worried about this. If I were you I would phone the hospital once contractions start, say I am coming in now and want an epidural. When you get there ask for it. Ask them to put In your notes that you've asked for it and the time. They should have a target of giving it to you within one hour of asking for it. Have your birth partner stand at the nurses station to wait for them to get it. Don't just ask then let them do it in their own time. When I had mine, they didn't examine me first or check I was far enough along or anything like that, they just gave it to me. Luckily someone In The next room was getting one so I didn't have to wait long.

I understand why you're worried though, I had a traumatic first labour. I had ventouse delivery without any discussion, no attempt to gain my consent. I have decided I can only do it again if I have a c section but I am still terrified that I mit go in to labour early or something... And I'm not even pregnant yet.

Can you phone them now and discuss it, tell them you need it written in your notes so they know about your pain relief requirements before you even phone to say you're on your way to the hospital?

Hope it all goes ok.

Hi OP, find out if there is a midwife counsellor in your unit and speak to them about your fears and concerns about the epidural being withheld. I spoke to one prior to DS2 as I was feeling like you but about staying in hospital after being in for a week after DS1. She wrote a care plan in my notes so things like post birth checks etc were done on time and had a plan for early discharge as long as I was clinically well and it really made the difference.

chiki an epidural as soon as you arrived . . . that sounds amazing. That is what I want. I'm scared of being bunged in a birthing room to 'wait and see'. When you say tell them to put it in my notes beforehand, which notes are those? Notes held by the hospital, or my yellow book thingy?

I'm sorry you had a crap time too. It can really feel like you have no control over decisions about your own body and that's just plain wrong. Where is the care? You should feel safe in a birth unit/hospital.

glitter that sounds great but I've had a look and there is no sign of a midwife counsellor on the hospital's website. Are they common?

I don't see why you couldn't ask for one but ny first epidural only worked down one side. And my second labour they tried to do it 3 times and then I suddenly had to push and ds was born a minute later with no pain relief.
Not trying to worry you but just to draw attention to the fact that you need to be prepared just in case things don't work. Have you got a tens machine? I found it brilliant and got to 7cm with just that before I asked for the epidural

Dont be scared! Unless you progress very quickly they will certainly give you one if you are adamant you want one.
I got one straight away. I wasnt progressing fast though and there was plenty of time for me to have one.
You just have to be firm and write it on your birth plan and tell the midwives when you get there that that is deffo what you want.
Dont worry just be assertive and dont feel bad for demanding what you need. No one will purposefully keep any pain relief from you just for the sake of it. Just because they do not seem enthusiastic does not mean you will be denied it. Its just a matter of being assertive and making it clear that that is what you want. Try not to get too worried about this as they have to say 'wait and see' because there is a slim chance that there wont be any time for you to have one so they cant completely guarantee you getting one. It does not mean that they wont give you one if there is time and that is what you really want.

I don't want to exacerbate your fears but I'm afraid there are a few things you need to understand. Epidurals are not available on demand. A. you need to be in established active labour and B. it has to be sited by an anaesthetist. If they are busy dealing with emergencies you have to wait I'm afraid. You need to have a backup plan to keep you calm and as in control as possible if you are not able to go for an immediate epidural. Wishing you all the best for a calm and stress free birth.

Thank you windchimes, that is what I need to hear. I have written an adamant birth plan!

PP, I know they don't always work. Trust me I've considered all the other options. I have a tens, yes, and will use it in early labour. I know you mean well but please no more stories of non-working epidurals because I need something to cling to right now.

I’m all for being assertive and advocating for yourself. But. You need to be realistic as Grumpy has said. I think it’s policy in most NHS maternity units that you need to be in established active labour before you can get one. Also, you are reliant on the anaesthesitist (sp?). If they are available, then you may get one very quickly. But if they are dealing with a situation (or a series of situations) where there skills are needed to tend to people in life threatening situations you may have a longer wait. This is not a case of the hospital ‘withholding’ an epidural, it is simply the reality of the NHS.

Yep I know grumpy, you're not exacerbating fears. I am hoping that I'll be established when I arrive and that an anaesthesiologist will be available. I understand they might not be, immediately. That's not something I can control.

You could ask for a meeting with the obstetric anaesthetist at your hospital, and get your wishes discussed and documented.
However, second labours are often a lot quicker and less traumatic than first ones, and you might find it all goes really fast and well, with no time for an epidural, or even need for one. I was often called to labour suite for patients in your circumstances, only to find they were ready to push before I'd scrubbed up! Try not to obsess over your bad memories from last time, and be positive about meeting your new baby. I think you'll be pleasantly surprised, whether or not you have an epidural. Good luck, and best wishes for a happy outcome.

Aromatherapy? Did you laugh at the midwife? You’d never be allowed to suffer that much pain for any other condition. This attitude to women’s pain makes me furious. I’d stage a sit in in the waiting room till they hook you up with the epidural. Be firm and make sure your birth partner is bolshy.

I had both my babies in Spain and had the epidural within 10 mins of asking both times. The thought of being denied it is horrific. Have you spoken to your MW about it at all? I do know someone who had a planned cs because of fear of birth after having such a painful first one so they should listen to your concerns x

Point is if it is possible for you to have an epidural you will not actually have to FIGHT for one. There is no way that they would deny you one if it were possible for you to have one and you wanted one. What you are thinking is fighting is just a lack of enthusiasm but you need to not focus on that. It doesnt matter if they arent super enthusiastic about it, that will not effect whether you get one or not. Only medical issues or the anaesthetist being unavailable will prevent you from having one so please do not stress over seeming lack of enthusiasm from any particular midwife. Just because they may suggest other types of pain relief doesnt mean they wont give you what you actually want. So please dont stress about that, you wont have to have some kind of showdown you just need to clearly say what you want and say 'no thanks' to other suggestions.

Hi OP, the Midwife counsellor wasn’t widely advertised, I only found out about her as I broke down in hysterical tears in one of my diabetic midwife appointments . It maybe described as a mental health midwife.

I have a meeting with the MW on Monday, oftick. If I get that far I'll talk to her about all this.

She knows of my fears and my history and has been very supportive about my changing ideas of the kind of birth I'd like to have, so I'm sure she'd be helpful.

I agree with your comment "where is the care".

I wasn't denied pain relief but regarding the actual delivery of my child, I was treated but not cared for at all. Seems to be very common and I find that very sad.

A few suggestions- as PP have said start asking as soon as you get there. Bear in mind about availability of anesthetists but be totally firm and remind them you have given birth before.

If you can, avoid travelling to hospital too ‘late’ as that is when the panic can set in... could you explain how anxious you are and say you want to walk around outside the hospital / be near the hospital in early labour?

Ask to try the gas and air early on before you start to panic. With my first I was offered it when I was already freaking out and could only bite on it. If you get a chance ask someone to show you how to use it when you’re calm in early labour and see how it feels. It doesn’t kill the pain like an epidural obviously but might really help bridge the gap if you have to wait a bit for the epidural.

I would definitely mention how you are feeling to your midwife or even ask to see a consultant as it sound like you had a very difficult time last time.

Good luck!

Just to reassure you with a positive story, I only have one DC but I was induced with him and having had quite painful braxton hicks contractions I was absolutely petrified of those that would come from a pitocin drip.

They gave me a pessary first and those felt just like very bad period pains.

But I told them I was absolutely refusing the drip until I had an epidural. They said wouldn't you like to see how you get along with other things, epis can lead to instrumental births etc. I just put my foot down and said no, give me the epi.

My partner also did the whole stay by the nurses station and pestered them quite relentlessly until the anesthetist turned up. That tactic shouldn't work but it did.

My labour after that was a breeze even though it was long. I honestly could have kissed the anesthetist. He was my favourite person in the world once the spinal was working. I even had a nap.

All I'm trying to say is don't let them fob you off if you feel an epidural is what you need for a calm birth.

And good luck! Soon you will have a beautiful squishy newborn to gaze at 😊

Maybe you could arrange an appointment with the supervisor of midwives to go through your experience of last time and make a plan for this time. I’m hoping to do the same - I was similar totally freaking out about giving birth again.

One other thing that has helped me has been reading this book. Birth Skills: Proven pain-management techniques for your labour and birth www.amazon.co.uk/dp/B006K1Y4UA/ref=cm_sw_r_cp_api_MGMVAb93E1WTR?tag=mumsnetforum-21

I feel like it might give me some good techniques (beyond the hypnobirthing I didn’t before which didn’t cut it in a back to back labour which had gone on for ever!). Definitely ask for the epidural as soon as you can and make it clear in your birth plan that is what you want, but this might help you get through the bit before that.

• I did before

temp re gas and air, with my first I had very regular, very strong contractions from within an hour or two of starting labour(one every 4-5 minutes), but didn't dilate. I went to hospital after 10 hours and I was 1/2cm dilated. I couldn't even have gas and air. I eventually got a shot of diamorphine.

I recall being unable to inhale the G and A properly later on because the contractions were so strong and like you I was freaking out. I just bit the mouthpiece.

It's a sign of how horrendous the whole thing was that I couldn't remember a single detail of the birthing centre when I visited today. Not which room I laboured in, not the layout, not how you got there in the hospital. I was out of my head.

People keep saying to me that the second time can be really fast like that's a good thing, but the thought of it being too fast to have any pain relief makes me feel sick with fear.

billy if I have to be induced I will also be asking for an epidural before the drip. No way I'm trying that au naturel.

I've got that book double! That is what I'm relying on to get me through the early bit.

See THIS is why I’m fighting for a c section. I have nothing to add op, just to say I understand your fears.

OP I had exactly the opposite in that they were pushing me to have an epidural and I didn't feel safe having one.

I briefed DH and we both did a broken record technique: "I do understand why you're advising x but I've made an informed decision to do y. I am doing that because I have serious concerns about how it will affect my mental health after the birth."

Can you do similar? Make them document your concerns and I think they are less likely to stall you.