Timely epidural access/birthing options/trauma

[Moonandstars143]

Grateful for any thoughts or experiences please. Very traumatic instrumental first birth, hours of suffering before I got epidural access. PPH , infections and long/complicated recovery etc. Years on, I still have a lot of birth trauma and now
expecting baby 2 , with flash backs when I recall first birth or when I am in hospital. I’ve realised I can’t go through hours of unbearable contractions again. Are these my only options to have/feel some real control:

1. Early induction to increase chance of fast/timely epidural access.
2. Elective c section

I don’t want a c section necessarily, without at least trying natural first - I still have a little hope maybe things will be faster and easier second time. However, is that the only way I’m guaranteed an epidural on time and a calm experience?

Is option 1 also worth considering ? Or are epidurals given generally quickly if it’s on your birth plan that you 100% need/want it, reiterate as soon as you get to hospital and the team know you’ve struggled with a previous birth?

I’m not sure if how fast and efficient the care will be is just luck of the draw , as I keep hearing stories about how understaffed services currently are and how there is no guarantee you may even get one if there’s no physical medical need to get an epidural instantly or if you’re not booked in for something like induction or c section . It doesn’t help that someone I know recently had a bad experience with drs not being available on time - this led to infection during labour, which then became a distressing emergency situation. Also scared of being in a situation where I’m told it’s too late for one and feel “forced” to go through motions !

Grateful to also know if there’s anything I have not considered. Ty!

I had an early induction. I was in Labour for 55 hours, had 2 failed epidurals and ended up with an instrumental spinal.

I honestly believe now that inductions should only be if they are absolutely needed. Mine was due to suspected macrosomia (large baby) - I was told he would be 11lbs, and I am 5 foot 3 and (was!!) 8.5 stones.

Baby was 8 pounds. Never again! I'm due soon and hoping for a ELCS.

@Itsjustsuchamagicaltime im so sorry to hear that ! You poor thing. I really hope this time around it’s better - is it looking likely you can easily get booked in for an elective ? Fingers crossed for you. Thanks for sharing your honest view. I’ve always heard inductions can be very painful and tiring , so wouldn’t have dreamt of considering . I don’t even know if it’s definitely an option at this point, I guess I’m just desperately trying to form some kind of plan where I feel I’ll have the pain relief support I need on time

C section is your best bet. Inductions can be more painful because your body hasn’t prepared. Also, once you are induced, hospitals do tend to keep pushing further interventions to move you along ime. Nice, calm planned c-section is the option that gives you the most control.

I would not opt for an induction if you want to avoid complications. Go in to labour spontaneously and discuss with midwives beforehand that you are absolutely sure you want an epidural due to previous trauma and also mention it when you arrive at the hospital. There's a possibility that they could allow you to come in a little earlier than the 3 in 10 minute standard contraction timings - especially for a second birth as they tend to be quicker. And also, just for your peace of mind, second babies do also tend to be MUCH less eventful.

I would really recommend you do a hypnobirthing course though because it's not fun having that fear throughout pregnancy and it could really help you with your decision making.

Thank you - I'm fine now but had a lot of birth injuries that took a long time to get over. Have a consultant appt soon to discuss birth plans.... I don't want an ELCS per se, but I cant have another massively over medicalised instrumental long birth, I know it will affect me for a long time.

I know this isn't what you asked, but second babies are generally extremely quick and straightforward compared to first babies, even if you've had a complete shambles of a first birth. By the time you are asking for an epidural, you're usually in transition and baby follows quickly after.

I would second the idea of a hypnobirthing course, it sounds like a great option for you. But also worth discussing the idea of an induction (bear in mind these can also go really fast). It doesn't sound like your heart is really in the idea of an ELCS, so in your shoes I'd explore other options first. What about a doula?

Gosh are you me? I felt EXACTLY like this all through my last pregnancy. Had an awful birth with previous baby that left me traumatised (due entirely to not being given a frequently requested epidural). So this is what I did this time round - and it worked out exactly how I’d hoped which i obviously can’t guarantee but here goes…

• at every midwife appt I discussed my previous birth trauma due to no epidural so it was all over my notes.
• the midwife wrote “EARLY EPIDURAL due to birth trauma” in a very obvious place on my notes
• I booked a c section whilst still preferring the idea of a vaginal delivery with epidural. C section date they gave me was 39 +4.
• went into natural labour the night before my c section. Rang up and said I’m due a c section tomorrow but think I’m in labour so I was invited in and allowed to stay because of planned c sec.
• i made it very clear to everybody I dealt with that if I could go round to delivery and have an early epidural then I would crack on with a vaginal birth. They bit my hand off because it is much easier for them to do a vaginal birth than a c sec.
• got a lovely early epidural at 3cm. Had baby that evening. It was exactly what I wanted.

Did your first baby arrive in week 39? If so you could ask to book a c section for 40 weeks so you’ve always got that to fall back on. I would have been quite happy to go ahead with a c section if it had come to it but what I wanted most was just an early epidural and decent pain relief throughout. Hope that helps OP and good luck with your wonderful baby’s arrival!

I had a very similar first birth and also ended up traumatised. Not from the instrumental delivery etc, but from the hours of agony where no amount of begging resulted in me receiving pain relief.

For my second, I strongly considered a c-section. But I’m a very squeamish person and the thought of this wasn’t necessarily easier for me, and also because I’d already had a vaginal birth at least it was a known entity for me.

I insisted on seeing a consultant about my birth plan and pain relieve plan. They agreed that that ‘in the unlikely’ event that I had an another very long latent phase, they would induce me after 24 hours, and I could have the epidural then. I also was prescribed codeine so I could have that at home as a back up. Everyone and their mother promised me that my second would be quicker than my first. Well…

It ended up being another very long latent phase. The codeine helped me to cope a bit at home, and I kept thinking, I only have x more hours before I can go in for induction. Then the hospital was very busy asked me to come later, and I was beside myself with upset. My DH explained about my history and they let me go in but said that I would have to wait until the next shift at least. Anyway, they did give me the epidural and break my waters eventually, I think probably something like 36 hours after I started contracting. I did end up in theatre but they were able to get DD out with forceps rather than c section. So not the best birth but the pain in the early stages was not as bad as my first.

I would definitely suggest you speak to a consultant about a pain management plan if you go for natural/ induction rather than c section. I also got my midwife and everyone I saw to write “EARLY EPIDURAL” all over my notes 😂

Wishing you the best of luck whatever you decide.

@Starcircle I think I might be you 😂😂

I also had a horrible first labour. 48 hours, al the interventions, ended with instrumental delivery and PPH. My second labour, I was in hospital just over an hour, my third labour I was in hospital just over 2 hours. Both completely different experiences and no pain relief needed whatsoever.

If you prefer the idea of an induction, could you have it written on your birth plan that you want an epidural after x number of hours so they are aware as soon as you get there? But baby could even arrive before that time really

@TaraHill right?! An epidural was the only thing I cared about! It really bothers me that they can just deny women requested pain relief in childbirth.

That's a good point, I had a lovely first home birth but I did tear badly, pregnant again now (quite shortly after!) And had a brilliant 'birth reflections' appointment with the consultant midwife to talk about my previous delivery and what I wanted for my next one. It really was fantastic and there is definitely that kind of service at all hospitals, although it may be called something else at your trust.

It really helped me feel like I was making informed decisions and that everyone was on board with me .

@Starcircle yep. My eldest is nearly 7 and it affected me for years. I haven’t thought about it for a while but when I do I get all riled up! There is a lot of misogyny in childbirth I think. There’s no fucking way men would be treated like that.

@TaraHill absolutely! I just thought “why am I having to do this ridiculous charade I just want an epidural and not to be told I’m too early, too late, no room etc etc!!”

I have had three labours and didn’t get access to an epidural for any of them despite wanting them. The last birth was an induction and I had a horrible experience due to lack of staff and lack of space on the labour ward. I basically had to labour on the induction ward in agony with nothing other than one codeine tablet and very little midwife care, experiencing hyper stimulation (contractions a minute and half apart for hours) almost giving birth there. There is no way I would ever request or allow an induction again because of that. Comparing labours the second was the best but mainly because the labour ward wasn’t overwhelmed and the contractions were no way as awful as the induction. I thought induction would get me care, access to pain relief quickly etc but that wasn’t my experience. I would recommend you talk over your concerns with your midwife and get them to note your previous birth trauma etc and see if you can find out how things work regarding induction and elective c-sections at your hospital etc. Good luck!

@OPTIMUMMY that’s terrible, I feel livid on your behalf. Denied an epidural 3 times?! That’s appalling.

@Starcircle Thank you! It was one of those things that were always explained by me making quicker progress than they expected but wasn’t it great that I did so well without one as if it was something I should be proud of, as if labouring and ‘coping’ with the pain is anything we have any control over, with the first two I was younger and just relieved it was over. I did complain about the third though as it was just awful and things need to change.

@Starcircle twins perhaps! 😭 i am so sorry your first birth was also so traumatic, but thanks soo much for sharing your story and second time experience. It’s so nice to hear that your plan actually went to plan !! That’s exactly my line of thinking, it’s not that I particularly WANT major abdominal surgery if it can be avoided, I just can’t go through such trauma and delayed pain relief again when I’m still scarred by the first time, so I’m desperately exploring all options. My baby last time came about a week late, what would you recommend for timing a pre booked c section ? From a lot of the comments, it seems induction isn’t that ideal, although the plan would have been to have the epidural first.

Thank you all so much for the suggestions and sharing your experiences. Im so sorry some of you had such difficult times getting support and pain relief, I totally agree it’s unacceptable that women are put in these situations and forced to beg/suffer for so long :( we shouldn’t have to consider c sections just to ensure pain relief is given on time.

@rfr so good to hear following births went better for you ! That’s actually one of my fears, being told there’s no time for epidural because it all progresses too quickly and being forced to go through the contractions again ! Which may be shorter and hopefully painful, but I don’t know if I am willing to take the risk in hopes of what could be. I actually did a lot of hypnobirthing practise on YouTube with my first birth , which only worked until a certain extent . You say you did not need pain relief after your first birth, is that because the pain felt manageable or
much milder or is it because it happened so fast ?

The second one, the pain was pretty manageable. I was offered a wheelchair from the car park but chose to walk. The last 5 minutes of labour I said I couldn't do it any more, but because I thought I was 4cm and had hours to go still but then got the urge to push and delivered her standing up. The third one the pain was very manageable. I had a water birth and actually preferred the water and hypobirth breathing than the gas and air. It was my husband learning hypnobirthing that really helped though so he could do the counting out loud. X

I had a similar first labour, denied epidural and the pain was horrendous. I truly hope you get the epidural OP.

I read a previous thread a few years ago where a woman asked for a c - section for the same reasons you are, and a consultant and her midwife guaranteed her an epidural as soon as she went into labour instead, she was listed as top priority, which she got. Might be worth asking about this? She asked at the time what would happen to other woman also wanting an epidural at the same time and was told that they would be connselled away from having one. Makes me so angry!

OP best of luck and please do update this thread for those of us jn the same boat, after you’ve given birth.

A few thoughts spring to mind...

have you have a debrief with a midwife/obstetrician after your first birth? - for
some people understanding why things didn't go to plan is helpful and can help
with planning to avoid similar problems again.

As lots of PPs have said - labour often goes more smoothly second time round -
your current midwives/obstetricians might be able to give you a better idea of
how things look nearer the time.

Re. epidurals particularly - do you know why it took so long? There are all sorts
of medical things that can lead to a delay and again knowing if there are predictable reasons (eg. waiting for blood test results) can mean it can be anticipated and managed. If staffing was the issue, the department should have a policy for escalating if the anaesthetist isn't able to respond in a reasonable time (however, if they're not able to respond quickly it does often means there's a complete $h1t-show going on somewhere else and the entire team is busy). The midwives should be offering other pain relief though if that is the case.

Having an epidural very early on can slow down progress - that isn't necessarily a contraindication, but is something women need to be aware of. It's also not that unusual with multips though to find that half way through siting an epidural their cervix has pinged to fully and all of a sudden they're pushing! That is why there's sometimes hesitance at siting an epidural later on in labour when a woman's already had a vaginal delivery before as it exposes you to all the risk but possibly with none of the benefit. There is also a failure rate with epidurals and they don't always give perfect pain relief (fwiw, there's also a failure rate with spinals used for sections too... it's much less common, but there is never an absolute guarantee).

Lots of people of mumsnet are very pro elective section. They are usually a nice
experience, but just every so often get more dramatic than expected.

With insight that that all probably sounds a bit gloomy, it's hopefully some of it
may help/be relevant. There often are no absolutes re. the best way to do
things, but hopefully your midwife/obs team this time will be able to help you
get a better experience and an insight to the options available at the
unit you're planning to deliver at (eg. it may be worth asking if the labour
ward uses remifentanil – not everywhere does, but it can be a useful bridge
whilst waiting for an epidural). HTH.

I am so sorry you had such a rough time.

It might be worth checking if your maternity team have perinatal mental health staff. If they do, they can offer specialist mental health birth planning intended to address and help trauma. They also also help advocate for you if doctors are being a bit resistant and can put in plan for aftercare and support too. Wishing you all the best.