'mobile' epidurals

[Catz]

Sorry if this is an odd question but do mobile epidurals exist?!

Lots of people I know have talked about them enthusiastically saying pain is taken away but you can still change position, move around to an extent and feel enough to know when to push. Sounds perfect. I went to the NHS class at my local hospital and the midwife running it told us that mobile epidurals were a myth, it was just that epidurals had different effects on different people so when you ask for an epidural you don't know whether or not you'll be able to be mobile - just good luck if you are. Friends of mine tell me that they went to same hospital, asked for mobile epi and that's what the got.

Am confused, anyone know the answer or have any exprience of them? I seem to be drifting away from 'home birth with whale music' towards 'all possible pain relief immediately' as things get closer!!

Catz (36+2)

Why are you drifting towards all possible pain relief honey?

hmm - with my first I had an epidural that took the pain away but still allowed me to feel the contractions, I could move my legs, and changed position to kneeling part way through. I wasn't going anywhere much though as I was hooked up to drips for the epidural and also syntocinon.

ah.... you have the 'fear'! gets us all, a few weeks before birht..the realisation that the baby has to come out and it will hurt !!

there are lots of options to explore between home birth & music to all poss pain relief...

I had a mobile epidural... they're not really mobile in that you are still restricted to a bed - but I had to be restricted for monitoring purposes (I had complications) and I have to say it was FANTASTIC ... much better than the "ordinary" epidural I had with ds1 (where it took ages for the numbness to go away).

I could feel to push and it still hurt, but much more bearable, if that makes sense? I.e. it didn't remove all pain. BUT I was up and about within half hour of the birth and having a nice bath First time round I was still unsteady on my legs from the numbness on the 2nd day.

I think the difference is that the mobile is a constant drip thing which can be modified, but the ordinary is one large dose which keeps having to be topped up?

Erm I think I had one

as I recall, they gave me a little tiny bit to kind of test it, and I said "fine, that's great, stop there"

it made a BIG difference to how bearable the pain was but I was still able to move and still needed gas and air to cope with the contractions

(ok, I admit it, my pain threshold is not marvellous )

However I did find in retrospect that it took a lot away from my ability to push, and I would have preferred to have had more sensation for the actual birth (not the ventouse, forceps and episiotomy, though) Possibly irrelevant as ds was quite large and OP, but maybe all those interventions would not have been necessary if I had not had the epidural, however mobile

think it depends on your aneathetist, TBH if the midwife doesn't know about them then I don't hold out much hope of them being available (but then a lot of m/ws are cluless ). In theory you get a different mix of the bupivicaine/fentanyl mixture via the epidural catheter that will be fed through a pump, because it is a "lighter" mix you should be able to move, even walk round with it, it shoud mean you can feel the sensation of contractions but not the pain. Most aneatatist I have spoken to about them have said they don't have them available in their unit as there are a lot more obs to do with them (such as height of block) and it's a time management thing

I had a mobile and it did just what it said on the tin!

My only issue was the midwives didn't really want me straying far (probably just as well, I was up for a tour of the hosptal). I couldn't feel the contractions really, I guess I felt twiches so I knoew they were happening. I was augmented for delivery so couldn't feel the contractions, I had a midwife with her hand on my tummy to tell me when one was happening so I could push.

I recommend them if you're going down that route.

Don't be scared though 'the fear' is real but bonkers! I remember watching Alien when it was reissued for some reason in 2003 days before delivery and thinking the chest exit seemed preferable to vaginal or caesarian.

Seriously!

I rest my case.

Many thanks for the replies. It's helpful to know that they do exist in practice!

snugglebum- the midwife was a community midwife so hoping that she just isn't that familiar with this hosp's procedures...(perhaps wishful thinking!) Certainly several people I know claim to have had them at the same hospital that I'm booked in to (John Radcliffe in Oxford).

Marslady - OK I'm exaggerating a bit. I was feeling very positive about trying with pool and active labour and thinking about being at home. Then my mw told me that she didn't think I'd be able to do any of that because I'd had a small bleed at 27 wks so would be on continuous monitoring (I posted about it on here a couple of weeks ago). That demoralised me and I essentially thought that in reality 1st baby + continuous monitoring = epidural of some sort (and probably other intervention too) so started looking at that. Actually I spoke to a hosp mw a few days ago and she said she thought I could still do the pool but I now seem to have lost my confidence...

catz, I know John Radcliffe has a good complemebtary therapis option for ther women, they may be able to offer you a therapy that helps with your anxiety

Thanks snugglebum, I'll look at that. Perhaps confidence is the wrong word. More that I've lost momentum. Don't want to focus on active birth in case original mw is right and not poss. So many people are so positive about epis that seems increasingly attractive.

Also Catz as soon as you set foot into hospital it becomes likely that you will have an intervention.
As soon as you have had one intervention another one becomes likely.
The second sentence is especially true, this is what psychobabble is explaining.

If you end up on your back, you are more likely to go down the route of: ventouse/episiotomy/forceps

It's not a foregone conclusion, merely that the cons of one intervention can require another intervention depending on your labours reaction to it.

I am pro-active birth (I've never had one but an hoping for one in november) however don't pin all your thoughts on getting one or you could feel awful when it doesn't happen (I was gutted when I had an epidural for weeks afterwards, it took a stiff talking to from my active birth teacher to point out to me that having an epidural (or anything else for that matter) is just as good as an active birth so long as you get a baby at the end of it.

i am sad to say i foolishly paid too much money for Janet Balaskas Active Birth classes in archway with the great psedo-guru herself and they were absolute rubbish^ ill advised lentil munching tosh...this is someone who advocates tracing a maze pzzle with your finger to alleviate labour pain. i really would avoid this class - i wish i had

expensive rubbish - i panicked cos NCT local was fully booked

I asked about mobile epis when I was pg with dd1 and the midwife at my antenatal refused to acknowledge they even existed and treated me like a subversive for bringing them up at all. But dh works in theatres (operating not thesp!) and told me that the anaesthetists know full well that a lot of midwives try not promote their use and try to encourage more natural births.... which is fine I spose but knowledge is power and I think if you have as many options in mind as poss then you can make an informed choice. good luck

Hi Catz

Agree with lulumama it's normal to have the odd doubt at this stage. I remember being convinced a cesarean would be cool and then a week later having a home water birth. It sounds like you are just covering all your bases!

An epidural basically consists of two drugs - an anasthetic which takes away the sensation and an opoid type drug similar to morphine which makes you feel more detached/relaxed. Usually the anasthetic is a higher concentration than the opoid but yes the concentrations and the dosages can be changed. So it's not really just luck, there is also an an element of skill/experience on the part of the person placing the epidural. The midwife teaching your class is right though in as much as the effects of epidurals generally can vary between individuals though - some people absolutely love them, others dislike the feeling, and others find that the pain relief is patchy or not what they were expecting.

With a "mobile" epidural there is a lower concentration of the anasthetic which means in theory that you retain some sensation in the legs and can move about i.e stand, squat, maybe even walk about a bit. But because it's still an epidural and you still have some narcotic in there (albeit a small amount) you will still need to be on continuous monitoring and will also invariably have an IV (drip) to counteract the effect that epidurals have on your blood pressure. So although in theory you are mobile you still need to have a nurse with you if you want to wander about and have to contend with the drip stand as well (although in theory the IV could be disconnected for short periods). So basically from the midwives' perspective it's a lot of hassle and there is not really all that much of a benefit to you compared with a regular epidural.

But you could still talk to your own midwife about it as practise will vary from hospital to hospital. You can also specify in your birth plan that you would like to start off with a low dose and see how it goes - it can always be turned up.

Another option would be to request that an epidural be turned down for the pushing part. I have seen this work very well and it is then possible to adopt kneeling or squatting positions (on the bed) and to have more feeling back in the pelvic floor which makes it easier to push with the urge - less likely that way to need ventouse etc. However they need to keep a close eye on you as it would need to be turned down a little while before you actually started pushing to give the drugs time to wear off.

Absolutely though agree that it would be worth exploring other forms of pain relief -TENS, water (bath or shower), for example. Agree there are a lot of other options between whale music and an epidural!

Are you having a doula? If so then this is something you can discuss with her as part of your antenatals. There is also a book called Birthing from Within which is really good for exploring fears etc in relation to birth.

Good luck!

Many thanks for your replies and esp Mrsmalumbas for such a detailed explanation, that's really helpful and I will think about what you've said before I next see mw.

Moomin - that's exactly how I felt - a bit of a renegade for asking about them and I didn't quite understand why. There seems to be an attitude amongst some mws that epidurals are "a bad thing" but many women who've had them rave about them. Encouraging natural birth sometimes seems to be an end in itself. I can see that it can be the best way in many cases (possibly including mine) but equally I suspect that there is some mws vs drs politics behind it...

As far as I can see (from my zero experience!) epis are not bad in and of themselves but because they restrict movement and feeling (and that in turn can lead to further intervention, tearing etc). I'm just trying to decide (1) if I need continuous monitoring anyway, does a low dose epidural increase these risks much? and (2) how great are the disadvantages in any case? Much of the horror research that is cited seems to be fairly old and the statistics on number of women going from epidurals to futher intervention are difficult to interpret because it's likely that people with difficult labours are more likely both to have an epidural and to require further intervention. Sigh - perhaps I am looking at this in too much detail.

Many thans for your experiences and I will let you know what happens!

just wanted to add, although I'm sure there are other people on here who know more, that I don't think it is a mw vs dr thing on the epidurals, and there are many genuine reasons why an epi is not a risk/side effect free choice but childbirth is, like the rest of life, all about balancing pros and cons and taking calculated risks so they're not all bad either.
friend of mine had a proper mobile epi btw and said it was ace!!

Hiya, I have worked at a unit that had 'mobile epidurals' for a few years, and I would say that they don't exist. The difference is the concentration of drugs that they give, still enough to pretty much take the pain away but most people are still able to walk...at first. I found that the more top ups women had the less mobile they became. In the unit I worked in if the initial post epidural fetal monitoring was normal it did not have to be continuous after that, however most first time mums with epidurals ended up needing a syntocinon drip and therefore monitoring, most still could not feel enough to push and therefore had long second stages and many had to have ventouse and forceps deliveries. I would say that they are slightly better than 'normal' epidurals but only in that it is generally easier to move around the bed. I worked in the John Radcliffe when I first qualified (1997 - 1998) and they were certainly keen then to encourage women to use the pool and complementary therapies and at the time had a good number of midwives to women in labour. Having said that I don't have a clue what it is like now as I don't know anyone who works there now. I personally was desperate to avoid an epidural when I had my first baby as I have seen so many first time mums with epidurals and not very many of them have normal deliveries, it affects the whole of labour and is a major intervention. I would never recommend one to a woman who does not have any complications and I don't think that many midwives would.
I had waterbirths with both of my children and although it hurt a lot they were two of the best days of my life, both wonderful experiences.

nonscareymidwife you sound lovely! I had a midwife like you with my first baby, and I was so proud and pleased that I managed a pretty natural birth on just gas and air. I agree that an epidural of any kind is a major intervention. Nothing wrong with that as long as the woman understands this and accepts that it makes for a medicalised birth with a greater likelihood of further interventions. Yes, I also agree that most women who have epidurals seem to rave about them - but I believe the percentage of women who DON't have them is about 66 % - definitely a majority. And the feeling of empowerment you get from giving birth naturally is just out of this world.

Personally, I am totally against someone sticking a needle in my spine and will not consider an epidural for pain relief. I have known someone have months of numbness in one of her legs because she could not feel a trapped nerve when her legs were in stirrups.

I looked into the risks of epidurals and that sealed it for me too. Here's a site with info on risks and side effects

Try to have an open mind about pain relief and don't beat yourself up if you end up having something that your head decided against before labour. But I believe it will help to make an informed choice about the various options open to you. Have you researched all your possible options? TENS, G&A, Water, Hypnobirthing, Diamorphine/Pethidine, Epidural, etc..... (the last two I wouldn't recommend, but it's YOUR choice )

Would it help you to understand how your own hormones work to minimise pain? If so have a look at Dr Sarah Buckley

Many thanks again for the replies. nonscareymidwife, that's very useful. Yes the JR still does do a lot of ecouraging natural birth and I was v. impressed when I went round (it's just that my midwife has told me that I'm unlikely to be able to use the pool or move around a lot anyway so I'm trying to work out what my options are if that is the case).

Klaw- yes I've looked at the others (wouldn't have pethedine) but am finding decent research on epidurals very difficult to find. What did you find most useful? So much of the information on the internet simply cites 'studies' or refers to other books so it's difficult to be sure of the provenance of the information (how much research was compared, how other factors were controlled for etc). Also, my medic friends tell me that a lot of the reseach was done before recent advances in techniques so old literature is misleading. I'm finding it difficult to get info that's recentish and detailed enough to be useful without being incomprehensible!