Epidural resistance?

[jmap81]

I am likely to be induced - FTM and age 40 - so there's a fair bit of pressure for baby to not be too delayed. I will likely agree as I am quite risk adverse. There's a higher chance for me than others that there may be some resistance to local anaesthetic which may mean that an epidural may not work. I am anxious about this as I want the option if I need it. I was just told that other pain relief would be suggested but clearly it won't be as effective. I asked if, at that point, they would be willing to flip me to a CS but they have indicated it would be up to the team on the day and unless there's a clinical reason, they may not be keen. Has anyone any experience of this?

In your position I would ask for an elective CS. I was a FTM over 40 induced on due date after being talked into accepting induction instead of CS. My induction went a bit wrong ( as I'd predicted but been ignored) due to a reaction to the pessary and was in a lot of pain and ended up with a section anyway due to foetal distress. I don't think I would have coped without the epidural when it finally came.

OP, what do you mean by “resistance” to local anaesthetic? I’m a retired anaesthetist, and curious as to what exactly you are referring to.

Yeah I'm also curious about why you think you might have "resistance" to an epidural. I've never really seen that happen (what's. MUCH more likely in my experience is drug users who pole through postnatal pain relief because they've got much higher resistance to THAT, not the epidural)

@Babdoc i have joint hypermobility syndrome and previously had a tooth out and the local didn't work. So today, the anaesthetist confirmed that the epidural may not work(same may be true with a spinal of course). It's a small chance but higher than with the average person. Grateful for any info you may have!

Can’t add to this but following with interest as I am in similar position (1st time mum, 39, joint hypermobility and history of needing more anaesthetic at the dentist…)

I’m interested in this, I have true local anaesthetic resistance which proved a challenge when I had my DC. I won’t discuss dental work or having a central line inserted

I hoped I’d be able to tolerate the spinal being sited for my LSCS but unfortunately I ended up with a GA section. It wasn’t that bad in hindsight.

Certainly not as bad as the spinal attempts which were, sadly, mind blowingly painful my anaesthetist did put in enough local to fell a horse but to no avail. I was also unlucky in that my anaesthetist was incredibly unpleasant (I worked with her today & can confirm she remains unpleasant) - it would have been slightly nicer if she had been kind. Are you resistant to local anaesthetic OP?

Following a successful clinical trial many Trusts now offer remifentanyl infusion. It’s like marmite for midwives but when you are guided by an experienced anaesthetist & midwife it is excellent.

Good luck OP.

How far gone are you? I'd start a get baby out early plan from 36 weeks and aim for a natural birth with gas and air. All the woo- nipple tweaking, raspberry tea, dates, acupuncture, sex, pineapple, clary sage etc.

Schedule a CS as back up for due date.

Sorry I can’t add much op but really interesting thread as I had2 failed epidurals and am hyper mobile

@JustWonderingIfYou I am almost 35 weeks. Yes am going to ramp up on the woo woo soon although no idea of course if any of that works!
@AgathaMystery this alternative sounds interesting - no mention from the anaesthetist yesterday though. If it's new/experimental/expensive, I am not surprised they haven't said anything. Will mention to my midwife.

What I would like to do is obviously hope he comes of his own accord early. Potentially say ok to an induction but not allow the drip (don't think I could birth with that, without an epidural) and also have a back up CS date. It feels like I am keeping all options open this way but I can't see them agreeing...

@Bushkin can I ask how you delivered and what your labours were like? I know hypermobility affects everyone differently

I had an Induction with drip recently with no pain relief (tried gas and air but it made me feel sick). It was intense but over quickly with both baby and I coming out of it happy and healthy. It may be worth keeping induction with drip as an option.

Just to add you are within your rights to ask for a CS (if that is what you want). If you look on the Birth Rights website, there is a section on asking your medical team for a CS.

I'm 36 nearly 37 weeks and happy I've come across this post...thank you!

I have Ehlers Danlos Syndrome and actually seeing my consultant today in regards to CS and this is one of my questions as I know we are more resistant to medication. May end up seeing an anaesthesiologist before to discuss but will let you know!

I haven't had any operations or teeth removed so have no previous knowledge on how I react x

Tbh I would try avoid epidural if you're likely to get ineffective pain relief from it, especially if you still get the numbness and reduced mobility effect. You're increasing your risk of instrumental delivery (forceps/ventouse) and C section from about 18% to 66% by having an epidural, for potentially ineffective pain relief. I don't know much about hypermobility syndrome though so I would see if you can get more info from your midwife/obstetric team.

I do have experience of working on obstetrics and will say you are at a higher risk of complications given your risk factors of no previous successful deliveries and age, so I would be reluctant to go for induction, or at least have a clear plan of what you're happy to agree to before going in. E.g. happy to try one pessary if keen to try vaginal and if that's ineffective and setting you up for days of prolonged induction I would probably want a C section at that point, no point dragging out labour for days and exhausting yourself to end up with an emergency C section.

I would advise you read up on Bishops score and ask the midwife what your score is, that may help you make your decision.

FWIW I had the induction drip without an epidural with a back to back baby and would still go for vaginal again. You know your own pain tolerance and can see how you get on with labour pains, you don't have to make the decision now but I agree It's good to find out about it ahead of time so you can make an informed decision.

If you need more pain relief then you need more pain relief, so if you're really struggling then that stress will prolong labour so don't go in thinking absolute blanket refusal for certain options - unless you find out an epidural will do bugger all ofc!

@Ihatewinding I'm sorry but that is complete rubbish - where on earth did you get your stats from?

This recent Cochrane review (Cochrane reviews gather information from other studies and statistically collate them).

This is a brief review of their findings:

Although overall there appears to be an increase in assisted vaginal birth when women have epidural analgesia, a post hoc subgroup analysis showed this effect is not seen in recent studies (after 2005), suggesting that modern approaches to epidural analgesia in labour do not affect this outcome. Epidural analgesia had no impact on the risk of caesarean section or long-term backache, and did not appear to have an immediate effect on neonatal status as determined by Apgar scores or in admissions to neonatal intensive care. Further research may be helpful to evaluate rare but potentially severe adverse effects of epidural analgesia and non-epidural analgesia on women in labour and long-term neonatal outcomes.

This is the full report

www.cochrane.org/CD000331/PREG_epidurals-pain-relief-labour

@Ihatewinding crumbs where did you get those stats from?! They are absolutely not accurate.