Epidurals and VBAC?

[pollyblue]

Just a quick query - is it possible to have an epidural during a VBAC? A friend has said no, as you need to maintain sensation in case your scar 'blows'. Can anyone tell me for certain?

you can,in fact most hospitals will, but it's not really advisable to numb sensation -the reason hospitals do offer epidurals is that they rely on continous monitoring to tell them if there's a problem - trouble is,by the time the baby and mother decompensate enough for it to show on a CTG things have got very dangerous indeed. According to Mary Cronk (midwife superstar!) it's best to have someone check your pulse regularly ,by hand, not just using the BP machine and for you to 'walk' your fingers over the scar line regularly to check for any change in sensation, she doesn't feel epidurals are appropriate. Anecdotally, women seem to be the first ones to know when somethings not right, as long as they don't have an epidural in! The best chance for a sucessful VBAC is to be active,mobile, not on continuous monitoring and give it time and also to be well supported by your midwife and birth partner - I've had 2 out of my 3 at home, and i was more relaxed and better able to cope there than with the one I ended up in hospital for.

I had a mobile epidural during my VBAC. It worked really well for me - I was able to feel my legs and move around for nine hours of the labour. Whatever dose I had meant I had to top up a bit with gas and air, I knew when a contraction was coming for the most part.

I personally know that I would not have achieved the delivery w/o adequate pain relief which made me feel in control of the situation, although my midwife did note some of the concerns that jamila mentioned, which are important. I think there are different doses you can get - the midwife said something about 16 and 20, I have no idea what but you could ask about this. Sorry, it's just a haze, I can't really say but it's to do with the dose in some way.

In my experience you have to be careful if your labour is prolonged, because the epidural even if it's lower dose does 'bed down' so to speak and you get number (?)over time. So at the end, the midwives and consultant didn't want to top me up because they felt that my pushing wasn't as effective. HOWEVER, I felt I was exhausted and that if I could get some relief I'd do it. And I was right.

The continuous monitoring wasn't a problem for me. Basically I was on the bed leaning over the back of it, rocking continuously. This worked for me. I was also able to stand by the side of the bed and do various things. If you really want to be up and about all over the place, which is possible, then it won't work for you obviously.

If you feel when labour starts that you can cope with the pain then you may not feel you need the epidural. But I think you may find the hospital can cope with the risks involved of epidural and VBAC, so don't panic if you need it.

I had an epidural when I had my vbac attempt, it was one of the many factors that contributed to the failure, the main one was the lack of compassionate care

I did not have or need an epidural for my two subsequent vba2cs, I used tens and gas and air.

If you have an epidural you are more likely to end up with another cs, or so i am told, and in my experience

I had an epidural and a vbac, albeit with forceps (about two pushes worth of forceps). I couldn't have done it without the epidural, I was worried about pain from the scar and it rupturing. Once the epidural was topped up I could concentrate and push properly.

jamila169, you had 2 VBACs at home? That's really interesting, I thought that was really discouraged (i'm realising i'm very ignorant about the whole VBAC thing!). I live just 5 minutes from a fab midwife-led unit but am i right thinking they wouldn't take me there for a VBAC? It's the continous monitoring thing that worries me, my local (consultant-led) unit is so busy I'm not at all confident that i would be monitored well (I was in for 2 weeks before dd was born and i heard several ladies actually give birth on the ward because they weren't taken to the labour suite quickly enough). It's good to know that an epidural IS an option but not potentially without it's problems.

Thankyou for your replies, all very helpful

Pollyblue - I'm having a homebirth after caesarian in July. One of the reasons I've refused to go to hospital is because epidurals are given so freely and it does decrease your awareness of scar dishinience (much more common for your scar to give than go IYSWIM). The majority of scar ruptures are, in any case silent and not noticed until the midwife checks you out afterwards.

It is wise to try and leave an epidural as late as possible though - for obvious reasons - you want to get through the majority of labour if you are on the clock at the hospital. Unless you are a biligerent little wotsit like me who just laughs at the idea of having a timed labour trial (do I get a badge if I do it in six hours? ).

I had a hospital VBAC, and managed great with mobility, gas and air and a bit of pethidine.

unless you can have a mobile epi, and even then, it is not like being able to get up, stay up and move at will, i would seriously rethink

an epdirual, by its very nature takes your birth down a whole different path, you will have to have more monitoring and you will have to have a drip, possibly a catheter too.

an epidural can mask pain in between ctx that could indicate a problem

they also increase the risk of an instrumental delivery by relaxing the pelvic floor and not allowing good rotation of the baby's head, and by possibly interfering with you feeling hte urge to push

if going for a VBAC, my top tips would be

stay at home for as long as possible, if not birth at home

use the minimum pain relief, to allow you to work with your body

avoid epidural if you can for the reasons outlined

it is up to you of course, but as with all things birthy, make an informed decision and look at aa doula to support you before , during and after the birth

and also, make sure you know why your previous birth ended with a c.section and that can help you prepare for your VBAC

whomovedmychocolate, I'm glad to hear you're aiming for a home birth, that's really encouraging. I really thought that was a no-no following a section.

lulumama, I had a section with dd because of placenta previa - i had several bleeds and ended up having a section at 37 weeks without going into labour. I'm now hoping to have another lo and initially thought oh well, i'll plump for anther section, because i know what to expect. But it took me 6 weeks to recover and the three days i was in hospital afterwards were pretty grim.....I'm just anxious about how i would manage labour, especially if having a VBAC meant i had to go to the consultant-led unit. The midwife-led unit is about 20 mins away from the consultant-led unit (and operating theatre!) - would this be considered an acceptable distance to travel if my scar did go bang and i needed surgery?

Sorry, my quick query has turned into questions, questions........ But it's really good to be able to ask people who have experience of all this.

Polly - your previous problem - placenta previa is not indicative of how this pregnancy will go.

I will warn you, you will probably be told you are not 'allowed' to use the midwife unit - but if you stomp your feet and say you are having a homebirth in that case - you'll be surprised how quickly people can backtrack on their 'no way' assertions!

Scars do not just go 'pop' btw. Because of the way the skin and muscle behave, there is a drawing out process (sorry if this is graphic). The scar can 'unzip' at several levels but still not totally disintegrate and true ruptures and exceptionally rare with horizontal scars (I've been reading up on this as you can tell). If your CS was within the last three years it's likely they did the three layer stitching technique which has a 0.04 failure rate (and that includes partial scar breakdown).

If you do opt to go for a VBAC in the consultant unit or elsewhere be very clear about what you will and won't accept - continual monitoring is not proven to improve outcomes in any way. Induction is known to increase the risks of scar rupture - so avoid that. Being upright and mobile and not going to the hospital to the last possible minute, will all help you succeed. 70% of people who go for VBAC succeed - there is a higher figure of 85% of people who home VBAC who succeed but I guess that's partly about feeling more relaxed at home and also not calling the midwives for the first bit.

i will just waft in and agree with WMMC! and tell you to add this address to your list of useful people www.aims.org.ukk for when you are told no you are not allowed to do X Y Z

you can labour where you want when you are making an informed decision to do so

the odds of a full rupture are very low and equivalent to a cord prolpase which is a risk for every single pregnant mother, to put it in perspective

no reason to have a section this time, if your placenta previa has not recurred.

i had a csection with dd and i am now expecting another lo in october. when i saw my consultant she said that although im having vbac this time they advise i have an epidural straight away and i will only be able to go for a couple of hours and if not enough improvement will have to have another csection

if you do not want an epidural and your labour is progressing well you do not have to consent to an either an epidural or anotehr c.section, without at compelling reason to do so

bieng immobile and stuck on a bed is a classic way for labour to fail to progress

your labour, your terms

again, look at www.aims.org.uk

This is all really, really helpful, thankyou!
I've just remembered that there is a midwife-led ward alongside the consultant-led ward at the hospital where i had dd (although it's often closed due to lack of midwives!). Have asked dh his views and he said he would rather i was in the main hospital rather than our local midwife-led maternity unit, but otherwise entirely up to me. So that might be a good compromise (happy to stamp feet if necessary!).
I didn't really understand what was involved if a scar did rupture - my dd was only born 16 months ago so hopefully i got the 'modern' stitching! I feel less anxious about it now - thanks for all your thoughts and information.

Hansnava - talk about danger UXB -they'd have crapped their pants with me then!
DS2 1st stage 9 hrs turned from brow presentation in transition 2nd stage 20 minutes
DD1 1st stage 13 hours, rotated ROA-OP-LOA 2nd stage 10 minutes
DD2 1st stage 40 hours , transferred for APH after 17 hours nother APH at 39.5 hours, waters broken , 2nd stage 10 minutes
midwives in each case were aware that slow, gentle labours that progress, however slowly make for successful VBAC's , bearing in mind that many of us had our first C/S for failure to progress - time limits didn't work before did they?

Hmm, thats's something i've heard before and bothers me a bit - what's the definition of 'failure to progress'? How long have you got before you get whisked off for another section?! I've a friend who had a dd, from first contraction to birth, during an episode of "Midsomer Murders". Another took 36 hours. So how long is too long?

i take ages to get to 3cm, historically.. one the first occasion, i was given a c.s , the second time, i was encouraged to be mobile and move and work with my body. i delivered vaginally 3 hours later

so i think it is wiser to take a good long look at that labour, and how happy baby is and recognise slow progress is not the same as no progress and a change in mothers position or something to eat and get some energy cna make a lot of differece

i have no idea how long too long is. my consultant says i should have epidural straight away but midwife says she dont know y consultants say stuff like that because they wont give me one till im at least 4cm dilated.
i really want a natural birth this time as ive never been away from dd any longer then a night and dont really want to start now.

anyone whos interested i found a good site about writing ur birth plan for vbac if u want to have a look its
www.storknet.com/cubbies/vbac/vbacplan1.htm

Sorry I just need to plough in here because I am soooo on your behalf hansnava. That consultant is really setting you up for failure by prescribing hefty pain relief like it's obligatory and imposing frankly daft time limits. My first vbac 4 years ago was a "textbook" 13 hours from first twinges. I arrived at hospital about 5cm dilated and went on to labour for a further 5 hours or so. On my birth plan I stated quite clearly that I wanted no time limits imposed. I did have an epidural that time, but when I requested it. Had my second vbac 3 weeks ago - around 6 hours from a show at 6pm to pushing baby out at 11.45pm - no time for drugs or daft doctors this time Agree you should hang around at home as long as poss to avoid unwanted interventions.

see, if no4 had remained at home,it'd have been reasonably quick, because after being exanimed and found to be 3-4 cm on the saturday, but with irregular contractions and not bothering me much, I stayed like that until about 40 minutes from delivery, so when midwife checked with me on the sunday morning I'd have reported irregular niggling ,then I'd probably been on the phone about 1am monday morning,and delvered sometime monday morning. As it was,I reckon the second aph was me going to 5cm, then within the hour I'd had her, the hospital did know though that I'd only go to section as an absolute last resort

thanks franke

i have to see the consultant next when im 32 weeks so i think im going to have to do some research and discuss it all with midwife as she seems to be a bit more open to me having a normal vbac before i go see consultant again.
its strange because when i found out i was pg again i just assumed that i would have to have another csection and i was more then happy with that as my labour with dd was horrendous, but now i know i could have lo naturally i realllly want it this way. plus i think my dp would go mad if he was alone with dd for upto a week lol

I read an article recently which goes into detail about what happens to your body (and your baby) when you have an epidural. It's massive so I won't copy it on to here! But if you have a look at this it's an eye opener.

With regard to time limits on VBAC labour - for my VBA3C I had my first contraction at 6am. Eventually went into hospital at 5.30pm and was 4cms. At 2.30am the next morning I was still 4cms. My DD3 was born 2 hours later. If all is well there is absolutely no need to have time limits put onto your labour. Hospitals run as a business and they want patient turnaround to be as fast as possible - it took me a long time to get my head around the fact that my birth experience wasn't the primary concern in how a hospital would treat me. But then I educated myself and by the time I had my VBAC, my birth experience most definitely WAS their primary concern, because I didn't give them a choice

it took me a long time to get my head around the fact that my birth experience wasn't the primary concern in how a hospital would treat me.
That's just it VBQ isn't it, in a nutshell - women still expect that everone has their best interests at heart, and they want what's best -not with the finance director breathing down their neck on one side and the legal department on the other they bloody don't!
anyway VBQ -what about this ican thing, do you want me to suggest links or what? I can access a lot of paid for articles through OU as well you know, but they'd have to be condensed and put into english i reckon to work as articles

that would be brilliant, thanks!

I had my first midwife app yesterday (i'm 6 weeks, very early days!) and said i wanted a home vbac, her response was "But we don't know if you can dilate!" "do you not agree with common sense?" "you'll probably be recommended a c section anyway" .....This does not fill me with hope about a successful vbac at all.
Anyone give me some tips in being assertive and at least getting a birth without continous monitoring if i am "allowed" to have a "trial of labour" in hospital?

you stick with what you want! and know why you had a c.s last time. get as much info and research as you can, and go for the birth you want to go for

www.aims.org.uk very useful when you are told you are 'not allowed' or 'have to ' do something in labour