Pain relief options

[WombatStewForTea]

As due day looms closer, my original 'plan' as such has gone out the window and I'm a bit confused. First baby so no idea what to expect.

Sorry this is likely to be long!

I had ideally wanted a water birth. I'm consultant led which apparently means I'll need to be constantly monitored which means no water birth. Not the end of the world.

I'm more now concerned with pain relief options. I know the hospital offer the usual paracetamol, codeine, G&A, diamorphine (below 3cm), pethadine (above 3cm) and epidural.

I don't react well to various medications. Have a bad reaction to general anaesthesia and sedation, codeine makes me sick.

I really really hate feeling nauseous and want to avoid this as much as possible in labour so I wanted to avoid diamorphine/ pethadine. Mostly because of the nature of injections being that they can't be 'undone' if I do feel sick. I know they're given alongside antisickness drugs but in my experience these don't work for me. Past experience of being in hospital has had nurses tell me the antisickness drugs will definitely work and me promptly vomiting all over their shoes I've often felt ignored by healthcare professionals in the past when I've told them how I react to certain drugs and been pushed into having things that have made me feel awful. The idea of this happening in labour when I'm already vulnerable is stressing me out a bit.

I had planned to see how it goes and have an epidural if needed to avoid the pethadine. Only problem is I'm on Clexane injections and just read from another thread and checked in the leaflet that you can't have an epidural or spinal within 24hours of having clexane. This wasn't mentioned by my consultant or any of the midwives.

I've got a midwife appointment today but not seeing my consultant again until 40 weeks. It's a bit more confusing in that the community midwives are in a different trust to the consultant/hospital where I'm giving birth and there's no consistency - I've not seen the same midwife more than twice.

I think it's 12hrs between anticoagulant and epidural. I had my last injection at 7pm for a planned CS the next morning. Regarding pain relief. You can absolutely choose to have nothing. Conversely you may decide that nausea is a lesser problem than contractions. Labour really is like nothing you'll ever have experienced. Make sure you have an advocate with you, and discuss your concerns with them and the midwives before things get too intense.

It'll be fine, you'll be fine

I was high risk and I asked the midwives really nicely and they ran me a bath. I only lasted 10 mins though cuz I needed pain relief and the gas and air wasn't transportable to the bathroom.
Gas and air made me extremely sick but honestly in the the throes of labour you won't care if you're sick. My active labour was less than 3 hours though.

I didn't want pethadine as I have a huge fear of needles but the midwives and doctors did not push it at all once I had stated my preferences.

I was on gas and air for 22 hours and coped until I had to go for an EMCS and then had a spinal block sheer bliss

My labour with DS was horrific tbh, i had to be induced and was off my face on gas an air, they missed an epidural i didnt want 7 times and waited until i was loosing it to shove a form under my nose i still have no recollection of signing and ended up in theatre with a retained placenta is the short version. So naturally was worried with DD. I wanted a water birth and nothing more than paracetamol, i couldnt have the water birth due to premature labour (again) so got a tens machine, that and a birthing ball really helped and i did it with no more than 3 puffs of gas and air but im lucky i labour VERY fast and both my DC were either side of 5lb so not the biggest babies either but i did it how i wanted it x

Very surprised they didn’t tell you about the epidural/spinal with Clexane, mine have told me repeatedly! But as per PP’s post it’s 12 hours since your last injection, not 24.

At my hospital they like to induce if you’re on Clexane so they can manage the process a bit more (I’m being induced at 39 weeks). I’ve been told remifentanil is an option if I do find myself in need of something stronger and can’t have an epidural so that’s worth considering, though it apparently makes you very sleepy (and likely baby as well).

It sounds like you’re quite far on but it might be worth asking for an appointment with an anaesthetist so you can discuss the options?

Thanks all. I'm surprised they haven't mentioned it too Ronnie but I've seen that many different consultants and midwives across both trusts I feel like there's been no continuation of care.
I'm 38+4 so not long to go although been referred for another growth scan tomorrow as baby measured small this week so will be asking then.

@wombat
Can completely sympathise re not wanting anything that will make you nauseous I feel the same however just wanted to say I am consultant led and my dr has said I can have a water birth providing no issues at the time .. maybe each hospital has different policies on this?