Perineal Anaesthetic Injection

[CuppaTeaJanice]

I am due to give birth for the first time in a couple of months. I asked my midwife if I could have the perineal local anaesthetic (the sort they use before an episiotomy) as a form of pain relief, as my last smear test was agony and took me three days to recover from.
I think I'll be able to cope with the contractions and abdominal pains, but it's the last bit I'm worried about.
Anyway, the midwife said no, I should have an epidural instead, which I really don't want as I'd like to be upright and mobile (and definitely not in stirrups!!!).
I just wondered if anybody else has been allowed to have this injection, without necessarily having the episiotomy, and did it help at all, or will I really not care by that point?!!

ive been asking my mw this as well and she says no. its the head crowning that i find the worst part, though it is over quickly. with both of my previous babies though i definitly felt the whole thing and didnt 'numb out' till the very end. would hate to have to have an epi for this though as i manage everything else well on g&a/pethidine and my hospital doesnt do mobiles. am secretly hoping that as this is my third i now have (excuse the expression) bits like a welly top and should find the whole experiance pain free

It will anaesthetise the part of the perineum where you inject, but you can only inject a small area usually in a 'fan' shape between about 6 oclock and 9 oclock, and it only goes under the skin, so it wont work well although it may help this small area.

What it will do is swell up the skin on that area and will encourage tearing there, so there just are not the benefits to justify doing it (although if someone wanted it I would not refuse) A lot of the stretching and grazes that you may get are up at the top and sides of the labia (lips) and you cant really put local anaesthetic there as its too painful.

In another hospital I used to work in overseas, I used to empty a tube of local anaesthetic over the labia, perineum and just into the vagina, and this seemed to work as a lubricant and a mild anaesthetic, but we dont seem to have it in the NHS

Hope this explaination helps.

I just saw a pudendal nerve block mentioned in a book alongside the perineal injection. Anybody know what the difference is and are there any benefits, or is it just as pointless for general pain relief in the crowning stage?

pudendal blocks are only done by doctors for instrumental deliveries and as far as I can tell they don't seem to do a lot. That may just be that the ones I've seen have not been done properly, or more likely at that stage it is just going to hurt unless you have an epi or spinal.

Fundal pressure that should never be done to get a baby out, not even in an emergency.

Mintpurple, I was interested to read about the tube of local anaesthetic that you used in overseas hospitals.
Can you remember the brand of the anaesthetic, and do you know if anything similar is available here, perhaps something I could get on prescription or from the pharmacist?
Certainly sounds better than an injection that won't work and might make me tear!

cuppatea - it was in Oz that I used it, and it was just 2% lignocaine gel - Im sure we used it in the NHS when I did nursing in the '80s, but I have just never seen it for years. Im sure its still around though and your GP could prescribe it for you. You would still have to persuade the delivering m/w to use it at delivery though and some m/ws are a bit nervous of anything different TBH

Maxbear - we have a lot of Somali / Sudanese / Ethiopians having babies in London hospitals and often older African women will really push down on the fundus during the pushing stage and its just about impossible to keep them off! I know its frowned upon here, but it seems to be routine practice there. Im not sure that there is a real evidence based reason for not doing it apart from the anecdotal evidence of harm - Cochrane have a 'protocol' recommendation for a review but there has not been a full review done yet.

Starlight - was it an African doctor that did it?

Haven't been to work for 14 months (going back next week) and do feel a bit like I have forgotten stuff, but if I remember rightly it (fundal pressure) can increase the risk of a ruptured uterus, and is probably not particularly good for the abdominal muscles. Also I'm sure it would increase the risk of the mum having a bad tear. Don't think I have ever seen it being done, by anyone medical,mw or supporter.

I'm sure that the mc was nothing to do with the fundal pressure, if it had caused any big problems they would have happened at the time.

Anesthetic in a tube: I use emla cream, it is brilliant. I have a real horror of having things inserted into my veins, so freak at the idea of blood being taken or those things in the back of your hand for drugs to go in, but emla cream is fabulous! Takes 20mins at start working and lasts for several hours.

I get it from: www.expresschemist.co.uk/EMLA-Cream-Pre-Medication-Pack.html