Worried I'll be refused an epidural in labour....

[koalakate999]

Hi, I'm currently 24 weeks pregnant, ( have 25 week midwife appointment on Tuesday).

I'm starting to get nervous about the pain of childbirth, and really nervous that there's no guarantee of an epidural, ( if they are short staffed, anaesthetist unavailable etc). I've also heard MW's try to put you off etc.

To add a further complication, I have a consultant appointment at the end of June, as when I was 15 I had corrective surgery for idiopathic scoliosis. Will I even be able to have an epidural in this situation ?

The midwife doesn't really seem to know much about epidurals and scoliosis surgery when I've asked her before, and has just said, well you'll need to wait to see the consultant, and that doesn't exactly inspire confidence. She' also said " well you might not need one, plenty of people manage without..."

I can't comment on the last part of your post regarding the medical issue but as for being afraid you might not get one because of staffing etc I can say from personal experience it's 100% a possibility!

With my first baby I was in agony and minutes away from being too far along to be able to have it, it was by sheer luck an anaesthetist happened to be on the ward just leaving someone else that my midwife could grab him. Two other ladies in the ward didn't get to have one.

The only sure fire way I can think of to "avoid" (ish!) labour pain is to plan a c section, which is exactly what I did with my second! It's a huge thing to think about, absolutely not for everyone and I understand lots of women want to labour naturally, but if the thought of unmedicated labour is as scary for you as it was for me then I would totally recommend looking into it as an option.

Are you seeing an obstetric consultant or an anaesthetic consultant? An anaesthetic consultant would be much more likely to be able to answer whether it was technically possible for you to have an epidural.

You can ask for an appointment to discuss your situation with a consultant anaesthetist (the specialist doctors who do epidurals on other pain management). I would have offered this if you were my client because that gives the opportunity for you to discuss your concerns and, in particular, whether your previous surgery might affect siting an epidural. Could this be what the appointment at the end of June is? Ask your midwife at your appointment on Tuesday.
The anaesthetist will want to meet you, because it is so much better if an assessment and discussion can be done before you are in labour.
Even if you don’t end up wanting an epidural doing the preparation is very sensible so that you can have confidence that the medical team can and will support you effectively if you ask.

It's an obstretic consulant, apparently all women who have had scoliosis surgery are referred for a routine appointment during pregnancy with them, ( I was discharged from the original scoliosis team when ten years ago, approx. three years after the surgery took place).

I've had no issues since then so never spoken to a HCP r.e. scoliosis between my discharge and now...

Obviously you need to follow medical advice but I had decided very early on when I was pg with my 2nd baby that I wanted an epidural. I made it very clear to my Consultant and when I went into hospital to be induced I told my MW.
when I was (eventually) in labour I asked when I was getting my epidural and a mw tried to brush me off with a “oh I don’t think that will be necessary “ I said I wanted it noted on my medical records that I had asked for an epidural at x time and been refused by (name of mw) and I wanted to medical reason for the refusal noted on my record.
I got my epidural quite soon afterwards

Hope this helps… (am an anaesthetist)… you really need to see an Obs anaesthetist in clinic. The OB’s consultant will probably get this sorted when you see them, but in case they don’t mention it then ask. How feasible an epidural is will depend on exactly what surgery you’ve had. If it isn’t possible then there are some alternatives for pain relief (it may be worth asking if your chosen unit does remifentanil PCAs). The anaesthetist in clinic would also be able to discuss what mode of anaesthesia would be safest if you needed to go to theatre for anything. Hope it all goes well.

Thanks so much. So do you think the best thing to do is tomorrow, ( at the 25 week appointment), to ask specifically for a consultant anaesthetist referral .

I would really recommend the book 'practical ways to make your birth better'. I read it twice while I was pregnant and highlighted bits I wanted my partner to read. It made me feel much more knowledge and confident about what was going to happen.

There are many forms of pain relief so while I totally understand that you want an epidural, you won't be left with no pain relief if that's not possible so don't worry about that.

But do read up on the different pain relief options available so that you can put in your birth preferences document what you would like to try and what you don't want to use.

For me, I wanted to avoid an epidural of possible as I wanted to remain mobile and reduce my chances of needing a c-section. I hired a TENS machine and used that from the very earliest stages of labour, right through to 8cm dilated when I got in the pool. I also found gas and air surprisingly very effective - and used that in combination with hypnobreathing/visualisations.

But everyone is different - that's why it's important you know what's available and their advantages and disadvantages. It's a cliche, but knowledge is power!

Of course, see what is said at your appointment, but if I were you I'd be planning for 'worst case' as in if an epidural for whatever reason isn't possible, what other pain relief/techniques do you know about/are ok with trying? Hypnobirthing, TENS machine, gas and air, birthing pool etc etc. There are lots of options that aren't epidurals. Maybe focusing on them will make you feel less nervous about the availability/possibility of an epidural. (Personally I never felt the need for an epidural any time I've given birth, so you never know, you might end up not even wanting one! (but of course everyone is different.)) Yeah, my advice is focus on your other options for now. 💐