Epidural - how late it too late?

[heartmoonshadow]

Hi,

I have quite a way to go until I give birth - 12 weeks or so but I was wondering about epidurals.

I have heard some people say that they were not allowed an epidural as they were too late - how late is too late as I really want to have one?

Thanks

HMS

I really think everyone has totally different experiences in childbirth and of course it is agonisingly painful, but some people can cope better than others, some have big babies, some small, some are back to back, some are right way round, some have cord round the neck more than once and round the tummy acting like a noose (like my friend and I both experienced), some labours are fast and some are slow but you won't know until you are in labour. To be honest I was happier with that - the fact that I didn't know what was going to happen next or how long it would last. If someone had told me I'd be on labour for over 30 hours I would have given up there and then, but looking back, it wasn't THAT bad. I'd advise doing a lot of research, doing a rough birth plan and then just relaxing as much as possible....if you can!!!

Also the worst thing for me is that I had had barely any sleep for two nights prior to giving birth which meant by the end of my mammoth labour I did not have any energy to push, which prolonged things a bit. (Although talk of forceps miraculously hurried things up a bit!)I tell anyone I know who is pregnant to sleep sleep sleep when they get close to due date - although easier said than done!

Being a first timer myself and having spoken to the consultant anaesthetist as part of an anaesthetic class I just wanted to say - An epidural is a perfectly acceptable choice!! dont let anyone guilt you out of it. The anaesthetist says the earlier you request it the better for several reasons -

1. you are more able to stay still.
2. It can take a while for an anaesthetist to become available.
3. It takes a little while to set up and to kick in.

Most importantly Do be aware of the risks (AS with any kind of pain relief), Do be well informed and remember as with all things in life - Your body - your choice what to do with it or NOT as the case may be. My friend managed a long labour, a baby who came out elbow up, an episiotomy all with NO pain relief until they went to stich her up. She is now pregnant again so some people can be AMAZING. I am NOT one of those people and shall be requesting an epi as soon as poss despite everyone I know looking at me with pity and asking - oh WHY?? when tell them.

heartmoonshadow, I'm in a similar position to you in that this is my first baby and I already KNOW that I want an epidural.

I won't be able to move anyway because I have Gestational Diabetes so will HAVE to be induced AND have to be hooked up to an Insulin drip the whole time aswell as a heart monitor. So since it will be virtually impossible to move into a more comfortable position for labour, I have opted for the epidural.

Although I was surprised that my MW actually encouraged it, saying that they can give it really early, as soon as they break your waters, when you're induced and that the pain will most likely become intense very quickly as soon as they give the Oxytocin so an epidural is often recommended. They also said that because I'm being induced early, it's likely to be a long labour so I've decided to make it as easy on myself as possible... The advice I've been given, is to make sure you really LISTEN to the MW and stop pushing when they tell you to prevent the tearing.

So, good luck with whatever decision you make. I'm due in less than 6 weeks so maybe I'll come on and tell you something completely different after I've experienced it!!

No I am NHS. My mum had an eclamptic fit wih my sister and I have a raised BMI (Although anaesthetist said I looked ok to her- loving the anaesthetist) so I am technically high risk.

I had a 1 to 1 appointment but then they said I didnt need to go and I should go to a class instead. There were 3 of us there. 1 wanted a VBAC and the other had a history of bad reactions to GA. It was very useful and I am VERY glad I want as they went through ALL of the options and even went so far as to showing us what would happen if we needed a c-section. Even if I didn't want an epidural I am glad I went as I feel much better informed and aware of all the options and risks associated with each 1 - Including TENS, WATER, PETHADINE, ENTANOX etc

I would recommend asking your midwife to see if your hospital runs anything similar as if the classes run anyway and you are particularly worried about it I see no reason why they would say you couldnt go.

DawnAS: You do still have options of moving about even when being induced, on a drip, and on a fetal monitor. You can use a birth ball by the bed, stand and lean over the back of the bed, sit in a chair near the monitor, stand and lean against the back of a chair, use a birth ball on the bed and lean over it, there are a good number of positions that can still be used. If they have telemetry, you can walk around with your pole while being monitored.

Some women do feel the contractions come on fairly quickly, but they should be upping the meds very slowly...this can sometimes give you a closer to natural labour pattern.

Some will suggest the epidural if you are being induced since it allows them to increase the meds at a faster rate...however, this runs the risk of causing a hyperstimulation of your uterus and can put more stress on baby. You may also run the risk of baby not coming down in an optimum position with an early epidural because it may effect baby's descent and rotation into your pelvis. Be sure baby is well into your pelvis before having membranes ruptured as well to lessen the chances of other interventions becoming necessary.

An epidural can be a good choice if you have a long labour and other comfort measures are not found to be helpful to you, but you do still have options prior to it with an induction.

You might want to consider doing some more research and bring any questions you might have to your midwife.

Out of curiosity why does there seem to be such a backlash against women wanting to choose an epidural?

Looking at all the options I would have thought woman planning on using Pethadine would be seen as worse if anything (Not that I think Pethadine isnt a valid choice - just more risky and with more side effects than an epi from what I read). But all I have come accross are women who pity me for not wanting a "Natural" drug free birth.

I dont pity me! or anyone else making that choice esp if they are very scared!

I am sorry I dont mean to sound harsh on anyone I am just genuinely interested. Maybe there is something I am missing?

I know the risks - Intervention much more likely, headaches, lack of mobility (Although my hospital use doses akin to mobile epis so you can change position but are not encouraged to walk around for safety reasons), slower progress, bigger chance of tearing (Although I have to say if I am gonna tear anyway - which I suspect - I would much rather do it under anaesthetic!!!!!).

However I also know I will need SOMETHING as I do not have a high pain threshold and I think the risks of opiates are much higher and much more likely to affect the baby - where as the effects of an epi are pretty much limited to me(there is some evidence that suggests some is passed on to baby but no where near to the extent of opiate based drugs).

If it's any help, hever, I was shouting for an epidural pretty much from the off!!! My pain threshold is practically non-existant, I wince when plucking my eyebrows, so tbh, I just thought sod pain, why suffer if I don't have to!!!
Yes I was hooked up for ages, but i've got a fab dh and the midwives were amazing (in a busy nhs hospital, by the way!), I kept topping it up and my labour was as great as these things can be. I had ds at 4.31am and I had no tears, no stress and was up and walking about holding ds and showing him off to anyone who stood still long enough
I realise I was very lucky, although for the 13 hours i was in labour I didn't think so, but I really don't see the point in being in a lot of pain if pain relief is available just to be able to say you did it naturally!

heverhoney1.....I don't think there is necessarily a backlash against women choosing an epidural....it certainly has a place in obstetrics, I think some people become concerned when it is chosen without full knowledge of the potential risks or that there are a good number of alternatives that could be tried first in many cases.

Yes, it increases the possibility of other interventions...those inturn increase the possibility of more and thus they all increase risk to baby and mother. The risks to mother or the labour can result in concern for baby. For example, drop in blood pressure, which is why you have an IV going with an epidural, can effect baby's heartrate. Epidural increases the risk of c-section which of course increases risk just from it being major surgery. Most practioners won't see serious or long term effects from an epidural, or they may see only a handful during their career, but they are possible....personally, I've known three. In 18 years of practicing that is a very small percentage, but that doesn't matter to those women and their families.

While it is true some other pain relief choices may have a greater risk to baby, epidurals have long been touted as not having any direct risk to baby, but some paeds don't agree and studies have been or are being done.

If a woman goes in knowing that if I chose "A" that "B" and "C" might become necessary and they are ok with that, then fine. If they have had other pain relief options explained and suggested to them, but they feel they aren't providing the relief they are looking for, then fine. As long as they are aware of what options they have, and the potential risks as well as benefits with an epidural they are making an informed choice.

The choice can be determined by the woman's pain threshold, the level of support she is receiving from those around her, what is happening in her labour, her own views on how she would like her birth to go, past experiences or hearing the experiences of others...good or bad, her level of preparation for labour and birth, etc..

Some women are fine with the possible risks....other women don't want to take any chances, however small most might be.

Mine was too late . When I knelt up to allow the anaethetist to get at my back he stepped back in shock saying he could see DD's head. She was born about 10 mins later.

IIRC, it takes about an hour to work so worth saying you want it at an early stage.

Every labour is different. I am not going critise anyone for having an epidural as I had one with my first baby, although I had nothing but TENS with my second. With my second labour I didn't even have gas and air, there was not time.

A lot depends on your set of circumstances. If I had an idential labour to my first labour I would have the epidural again. I am not a wuss, but after 28 hours in labour I needed something and I found I hated gas and air.

Epidurals are not evil and they do have advantages. For example if you need a c-section then all they have to do is top up the epidural. Unlike gas and air an epidural will not make you drunk. With a mobile epidural you can have some degree of movement.

I find it daft that people somehow think that having gas and air is a natural birth. Personally I like being in the 21st century where I could use a TENS machine.

The main thing that puts me off both G&A and Pethidine, is that I want at least my brain to be still there - even if I have no feeling from the waist down. I want to be "with it" and I've heard that both G&A and Pethidine can make you feel a bit out of it.

That's a nice feeling at the start of a Saturday night out with the girls (not that I remember what that is...), but I don't fancy it during labour.

Also, I was told that as long as you LISTEN very carefully to the MW when they tell you to push, to stop pushing etc. it limits the possibilities of tearing during an epidural. In addition (again all hearsay as I haven't been through it yet), I've heard that the urge to push is incredible during that stage, so surely since you can't feel the urge to push during an epidural, wouldn't it be easier to stop pushing than with any other pain relief and therefore reduce the risks of tearing?

All these questions I am noting to myself aswell as I have my pre-birth meeting with my MW after my 36 week scan in two weeks, after I've been given my induction date... I will be sure then, to get as much info as I can.

My problem is also intensified due to me being an Emetophobe (Phobia of Vomiting). My MW ensured me that they could give me an anti-sickness drug with the epidural which although may not stop me feeling sick, would most likely stop me being sick.

So really, I am a wuss and proud of it!!

I'm not sure about anyone else DawnAS, but I had gas and air and did not feel out of it - just made me talk funny and took the edge of the pain. It wears off so quickly anyway that if you didn't like it you could not have it again. Also, you say that listening to the midwife telling you not to push prevents tearing - well I had this firmly stamped on my brain by my antenatal teacher and was all i could think of when baby was crowning........but I still had a second degree tear! But that was probably because I never did my perineal massage! Does everyone else do that by the way - was it just me that wimped out?

I have had an epidural after 24h of labour and 4 hours of pushing so I had been fully dilated for a Loooooooonnnnggggg time !
Camille was stuck and I had to be transferred in an ambulance. At last, a competent person examined me (a lady obstretician) and said that baby will not come out we need forceps so I had the epidural then even though the contractions were coming all the time. My partner was holding me and the anesthetist said "you will NOT move" in a convincing enough way to me..
the most wonderful feeling of my life to have felt all this pain going away after all that...

remember : You do not have to do it in pain, it does not make your baby any better !