Epidural refusal

[PinkDucks]

Wondering if anyone who knows more about epidurals can help with this.

Had DD just over a year ago. Labour got induced as my waters broke but no contractions started at 40+10. Labour went from 0-100 pretty instantly and I progressed to 4cm really quick. I requested an epidural as things were.. intense.. and midwife went to get it all arranged. I was prepped with the cannula, gown etc and the relief just knowing it was actually happening was amazing as I'd been worried during pregnancy that for whatever reason I wouldn't be able to get an epidural.

The anaesthetist arrives with the doctor and tell me that mine and babies heart rates are too fast and things need to stabilise before I can have an epidural. I remember thinking of course my heart rate is rocketing with this pain (and adrenaline) but I wasn't getting enough of a break between contractions to discuss it with them. After a while they gave me something to help slow down the contractions and this provided some relief but it only worked for 15minutes and they continued to say my heart rate was too fast. I remember feeling like I was just being fobbed off as they knew things were progressing quick and my husband said he picked up on this too.

In the end DD started to get distressed and they wanted her out quick so it ended with an episiotomy and ventouse delivery (with a lot of local anaesthetic thankfully!!).

Just to add I don't look back on the birth with any trauma. It was all over with pretty quick and once I knew I couldn't have the epidural I kind of got in the 'zone' and just got on with it but it still bothers me that it was never properly explained and I just felt totally fobbed off at the time. We're hoping for no.2 soon so if/when that happens I may consider a debrief to find out more but anyone have any more knowledge about this?

I'm by no means an expert, but I've done a lot of research and also had advice from other medical professionals. One thing I will say is that epidurals are an extremely strong drug and they absolutely will not take the risk, no matter how small it is, of giving you one if there's any question mark at all. This isn't just for the baby and general childbirth, but also for the health of you. One woman I know (a very healthy young woman, might I add) had a mini stroke which was put down to her having an epidural when her heart rate was all over the place and she basically had a "bad reaction".

Thanks @FarmhouseLiving22 I suspect this was probably the case. I think I just wish it was better explained at the time so I understood why. Interestingly it nearly ended in emergency CS so I would have had no choice in those circumstances, but I guess that's the difference between wanting and needing an epidural and the level of risk involved.

Interestingly should say ironically*

But I did wonder at the time what they would do as I'd have to have an epidural if they were going to do a cs and just felt more annoyed that they wouldn't give me one before. But I can kind of understand/see the difference in those circumstances

You should be able to organise an appointment with an anaesthetist to discuss things if you’d find that helpful.

A few (obviously generalised) thoughts though….
If your heart rate was unusually high they may have been concerned about what was causing that (and we know that pain causes a high heart rate, but there’s a lot of other stuff that can go wrong in labour that can cause a high heart rate too). Epidurals can make things more unstable so if there was any concern about sepsis in particular then not siting an epidural until they’ve worked out what’s going on may be reasonable.

If labour is obviously cracking on very fast then there may not be time to get an epidural in and working so it exposes you to all the risks of a big needle in the back and none of the benefits.

Finally if the baby’s not looking great and there’s a chance they’re going to need to do an emergency section for fetal distress rather than continue with labour it’s much quicker to whizz into theatre and do a spinal rather than spend 20mins putting an epidural in, have no time for it to work and then go into theatre to do a spinal. HTH

@Greybeardy what's the difference between a spinal and an epidural? I thought they were one and the same!

Op, I'm sorry you went without pain relief :( there does seem to be a real want to adequate pain relief for many women going through labour and lots report being fobbed off. If you can, when you're expecting your next child I would seek an appointment with an anaesthetist to explore what they can do if an epidural isn't possible again. At the very least, you'd hope to be offered gas & air.

I have had an epidural for all 3 of mine. i was 6 cm with my first 2 on arrival and 8cm with my 3rd (I went from 4/5cm -8 in 2 hours and 8-10 in 45 minutes) , i was able to have the epidural but i felt everthing as i was progressing so fast. your high HR may have indicated another issue and they wouldnt want to risk that I assume. Also with speedy deliveries it may not have made a difference. Hopefully you get the lovely chilled out birth I had with my 1st 2.

@Greybeardy I did wonder if they were worried about sepsis as my waters had broke 36hrs before they could start the induction. But no one mentioned this and there was no monitoring/checks after the birth.

Labour was fast but not unexpectedly quick - 6hrs from the gel being inserted to dd being born.

@MsGrahamCheese I think a spinal is literally an injection in your spine that lasts for a limited period of time. I could be wrong though!

I think an appointment with an anaesthetist might be helpful, I just hope they don't feel I'm wasting their time! I don't want to be anxious about labour and I think I have more questions than answers now and it would be good to know what they were worried about and what would happen if the same thing arose again.

It's quite scary to think there were potentially more complications, or they were worried about more complications, than I was aware of at the time. I just kept thinking (and said out loud) wouldn't everyone's heart rate skyrocket in this situation!

@MushroomQueen thanks, I hope so too! I certainly don't look back on it as a bad experience despite everything I didn't want to happen, happening! But maybe that's post baby amnesia and hormones making me forget so I have another 😂. hopefully next time can only be an improvement 🤞

@MsGrahamCheese Epidurals and spinals are really quite different, which does sound a bit bonkers when, from the patient perspective, they probably both feel pretty similar in terms of the procedure.

Epidurals for pain relief broadly are low concentration, high volume infusions/injections that go in a couple of layers away from the spinal fluid. A big needle’s used to insert a very think plastic tube that the epidural runs through continuously. They can often be topped up to give dense anaesthesia if we know they’ve been working well, but about 1:8 don’t give great pain relief and they’re less likely to work well for anaesthesia. Spinals are deeper injections (into the spinal fluid) and use small volumes of local to give really dense anaesthesia and usually work more quickly than topping up an epidural (and can give a more reliable anaesthetic). They use much smaller needles, and are usually just single dose injections which last long enough for most operations on labour ward.

Both can cause your blood pressure to drop and if there are concerns about sepsis/heart problems/severe bleeding then that may be a contraindication (to both).

To use an epidural for a c-section/forceps/tear repair you have to be pretty sure it’s been working well and the way we know that is if it’s given good pain relief over a period of time in labour. If it’s only just gone in & hasn’t had time to give good pain relief and someone needs to go to theatre then it may be safer & quicker to take the epidural out and do a spinal. If someone’s just had a big dollop of local into an epidural (like we might do at the start of an epidural to get it working well) and needs to go to theatre it can make doing a spinal more unpredictable too. However, if someone has a cracking epidural that’s given good pain relief over a period of time in labour then often it’s quicker to top that up for surgery than taking it out & doing a spinal would be (and that’s why we sometimes talk to women who we think may be difficult to get a spinal/epidural in to about having an epidural early in case they need to go to theatre later, as it may give the quickest anaesthetic option if things get hairy later).

It’s really not much fun to sit still for however long it takes to have an epidural sited and there are some risks to having the procedure. That’s probably worth going through if you’re likely to be in labour for ages longer and get good pain relief from the epidural, but if there’s a real chance that a lady’ll be going to theatre or will have delivered before the epidural’s had time to work it does possibly alter the balance of risk & benefit. We do still sometimes put them in these circs, but it’s important for the lady to understand it may all be for not much benefit.

There are a whole bunch of other things we have to be aware of and think about when making decisions about whether it’s safe/advisable to do either technique, but those seem to be the ones most relevant to the OPs original post. HTH :)

That ended up being more of an essay than intended! 😳

That was really interesting, thanks @Greybeardy

Thanks @Greybeardy very informative!

Wow thanks for that @Greybeardy !