What can you tell me about mobile epidurals?

[Buckets]

Do all hospitals offer them? Do you have to fight for them? Can you have one for a VBAC? Can you be monitored while one one?

No not all hospitals do them, but if the hospital does mobile epidurals, then that is the routine and no need to even ask for it - thats what you get. If the hospital does not do them, I dont think any amount of fighting will make any difference. Ask at the antenatal clinic.

They are basically just low dose epidurals where as little anaesthtic as possible, and using a slightly different formulation, keeps you mobile as it takes away the pain without losing mobility. After 4-6 topups (roughly 4-6 hours) the legs start to go for most women and you cant walk safely.

You can have one with a VBAC and have to be monitored more closely, but you would probably be monitored with a VBAC anyway.

I had an attempted VBAC. Was very anti- epidural until I was in labour

Consultant told me I could have a mobile epidural. When anaesthetist arrived she laughed and said "we don't do those here". Had the full- on numbing version instead- not what I wanted. IMO it contributed to the failure of my VBAC.

Lesson- find out in advance from the hospital what they offer (and don't take the consultant's word for it!)

Also, bear in mind that with every top-up it will become less mobile and more like a full-scale epidural. I had a mobile epidural, and at first I could walk but it just killed the pain: fantastic! But I was told to ask for a top-up as soon as I regained any sort of feeling (about once an hour) and after the first 3 or 4 top-ups I lost the feeling in my legs.

I am a big fan of epidurals and would still have had one, but it's worth knowing in advance that "mobile epidural" doesn't always leave you that mobile"!

Had mobile epidurals with first 2 DC, and wasn't mobile at all my legs turned to jelly after the first dose. Spent the entire time on the bed. Didn't have any pain relief with next 2 dc, coped much better with labour by being able to move around freely.

1. They use a combination of a local anaesthetic and an opoid so you don't get such a full motor block as you got with the old style epidurals. The downside of this is that most use fentanyl which goes through to the baby and is known to affect breastfeeding.

1. You may have quite good mobility or very little - depends on the number of top ups and individual factors.

1. They still turn your pelvic floor to mush so you're just as likely (according to the research) to end up with an assisted birth as you were with the old style epidurals.

1. People I know who've had one have generally been very happy with them and many have been able to give birth in a kneeling position - but only with good support and a proactive midwife.

Havent had any type of epidural myself for VB (only for CS) but I know from friends that as sabire says, you seem just as likely to end up with forceps/ventouse.

I would say that they are slightly better than traditional epidurals as you can move around the bed better, but most women are not mobile enough to walk. Sometimes they think that they will be and discover that they are not when they land on their knees and therefore have sore knees as well as everything else the next day! As for delivering on all fours, I have looked after some women who have delivered on all fours after a mobile epi, but more often than not I do not feel that they are mobile enough to be safe to do that. If you are really keen to have a successful vbac you are more likely to if you don't have an epidural and remain mobile. As someone else said, it turns your pelvic floor to mush, which does not help the baby's decent and rotation in to the correct position and therefore you are much more likely to have an instrumental vaginal delivery.

TBH none of my MWs have ever mentioned mobile epidurals and there's nothing on the hospital's website so I'm guessing they don't do them.
I'm just worried that if I have pethidine or something mind-altering I won't be able to argue if they want to keep me monitored on the bed etc.

Write a birth plan, and stress to your birth partner that you really dont want to be strapped to a monitor on the bed unless absolutely necessay. Though tbh, there is far more likelihood of that scenario if you go for an epidural,whether mobile or traditional, so you're best off mananging without one if keeping mobile is a priority.

My mobile epidural for my c/section did not work on all of my stomach and twas very painful.

I am planning a VBAC in April and have had appointment with anethestist he told me and I quote 'there is no gaurantee that any epidural will work' and he also told me (which frankly shocked me) that if the tube attaced to the needle gets pushed to one side or the other then its quite possible that the side its pushed away from will not be covered.

After telling me this he then advised me to have a epidual (mobile) in case I need a c/section again. To this I said 'no way' Now I will only have a spinal, as he said that they are more reliable and predictalbe than a moblie.

beeper, I had a VBAC. There is no need to be pushed into having an epidural or spinal 'just in case' you need a CS. A spinal takes effect really quickly if you do need one. But the chances are you'll be fine - I managed my VBAC on gas and air.

My unit does not have mobile epidurals but have changed recently to PCEA - which means patient controlled epidural analgesia.

Women may be able to stand, sit on a pezzi ball or deliver on all fours. It depends on how often the woman presses the button which tops up the epidural for her - it can be done every 30 minutes and it is much more dilute than the standard top-ups.

The labour is continuously monitored but you don't need to be stuck in the bed if you maintain mobility. Every woman is different though and some don't feel able to be out of bed.

IMO - VBAC has the best chance when a woman can be fully mobile which means being able to use the birthing pool too.

Agree mears. I think a lot of it is about the medical staff having confidence in you too. I hated even having the needle sited in my hand (which the doctor insisted on) because the very fact of seeing it there made me think 'Are they expecting this to end up as another CS?'
But I would stress again, you DON'T have to be bulldozed into having an epidural 'just in case ' you need another CS. In the event that a CS is needed, a spinal can be given which takes effect more quickly than an epi.

Totally agree about 'just in case' epidural - no need to do that

Thanks Alifiesbabe,

I have said 'no' to all epidurals except in the event of a further c/s in which case I will only accept a spinal. should have made it more clear in post.

My hospital's info sheet says you can't have water for pain relief or even eat during a VBAC.
Am putting in a clause in my birthplan that says 'no ARM without epidural/spinal in place' because that nearly killed me (pain-wise) in my previous labour attempt. But generally, think I'll just see how it goes - I'll be in labour ward anyway so should be able to change my mind if I chicken out. And will be booked in for an elective CSec anyway so all this is just in case - having to write 2 birthplans.

It is a controversial issue. In my unit women who request to use the birthing pool are supported to do so. In fact, any woman in any hospital can actually do whatever she likes in labour. The hopsital guidelines may not advise it but ultimately the choice is the womans.

Does your hospital have a pool? Does it have a consultant midwife? She can help when wanting to use the pool

Mears with the mobile epi/PCA in place do the women need continuous support eg. from a midwife if they decide to get up and wander around? I know some places object to mobiles on these grounds i.e in case the woman in question keels over or something (!) but I was just wondering. It sounds like a pretty cool solution.

Oh and does continously monitored mean literally strapped to the CTG or monitored via doppler? I am assuming the first in which case I guess she is not actually wandering around as such, just standing by the bed? Actually thinking about it I have seen people wandering around with IV's in place but now I think about it I can't see how it could work with an epi as presumably they have to remain attached to the pump...

Yes you need midwife there. With continuous monitoring you are attached to the machine to monitor the baby so you can't get very far. If able to walk around though it would be with the midwife there.

Buckets that sounds like a badly mismanaged labour. I had ARM and yeah, it hurts, but for you to feel you have to put in your birth plan that you won't have it done without a spinal, suggests that it wasnt done properly.

It wasn't the ARM itself that hurt, it was the speed and strength of the contractions it caused. Foetal heartrate was dropping during expulsive contractions, they broke waters to try and speed things up but the pain became totally unbearable for me (DD was back to back, had not slept for 48hrs, contractions for 24hrs etc etc etc). Still think my distress caused the foetal distress to worsen. I just wanted an epidural and a rest but ended up with a general aneasthetic fairly soon after which suited me fine!