Having an early and continuous epidural during labour

[EmPeEf]

Hello. Sorry, it’s a long one 😅

I’m currently 12 weeks with baby #3, and since my last delivery my disabilities have become a lot worse. So my midwife has arranged for me to meet with a consultant and with the anaesthetist team to talk about my birth plan.

So, my disabilities prevent me from standing for very long, bending forwards, sitting comfortably etc etc. Basically how you want to be moving around during early stages of labour. I could alleviate a lot of this if I were able to be in water, except at a point the pain becomes blinding and then I lose the feeling in my legs. So I was concerned I wouldn’t be able to have a normal delivery. As my understanding of epidurals was they have to be timed well as they will eventually wear off.

My midwife seems confident we can get me through a vaginal delivery though, as the plan will be I’ll have a safe word or action, (I’m also autistic with non verbal tendencies during times of stress), when I’m at my limit, and from that point I will be given an epidural that will be continued until delivery. This was new information for me, as I thought you got this window you needed to aim for; not so late you can’t have one, but not so early that it runs out.

Has anyone experienced an epidural managed this way before? To clarify; it will be to numb my back pain more than anything else. I didn’t even feel transition with my second delivery as the pain was so intense in my back. Didn’t feel a single contraction during my second stage either because the other pain overwhelmed everything else, and I just continuously pushed for 8 minutes solid. This resulted in my son’s lungs not being expelled of liquid as he didn’t spend long enough in the birth canal, and was almost taken to NICU. I also lost 1200ml of blood, and this is what we’re trying trying to avoid this time.

Would love to hear some experiences with epidurals, especially if they were given early or lasted many hours.

it's probably worth taking a look at a website called labourpains (labourpains.org) - it's run by the Obstetric Anaesthetists Association and has lots of accurate information about epidurals and the other analgesic options.

in very general terms.... not sure why you think epidurals run out - they're almost always run as continuous infusions in Uk practice (historically they did used to wear off at the end because the MWs turned them off... we use lower concentration anaesthetic these days so there's no need to turn it off usually). Most of the time they work really nicely (7/8 work well...1/8 isn't so great). A very early epidural can increase the risk of needing interventions to help with delivery. A late epidural, particularly for women who've had straightforward vaginal deliveries before, may not have time to work (takes about 40mins from starting to getting good pain relief) but still exposes the woman to the potential risks/side effects. To site an epidural you also need to be able to sit up (and still) and curl your back forward (the website I've mentioned shows the position pretty well somewhere on one of their pages). There does need to be a consent process before siting an epidural and that does usually need at least some communication from the patient (a reasonable chunk of that process could be done in the clinic appointment if verbal communication may be a problem during labour). An epidural in labour is primarily to manage the labour pain - there is no guarantee that it'll help with musculoskeletal pain, particularly if that is from higher up in the back (and in fact being immobile and relaxed for a long time can make MSK pain/stiffness a bit worse for a while). Occasionally for people with neurological problems an epidural isn't such a good idea (and if that is the case it's worth asking about other options for pain relief like having a remifentanil PCA if that's available). An epidural won't make any difference to the chance of having a PPH. The anaesthetist in clinic will be able to factor in any specific medical info that applies to you/speak to any a neurologist if necessary and hopefully make a sensible plan.

@Greybeardy thsnk you so much for this detailed response. I’m sorry it’s taken me so long to respond. Been in survival mode lately 😅

But really great information, really reassuring. I really appreciate you doing that as it was also useful for my partner. And it’s helped us narrow down our questions for when we meet the team and have our consultant appointment for sure 👍🏻

Hello ! On my fourth I had my epidural first and was then induced . This was as a result of an horrendous birth experience on my third . My consultant agreed to do this . We are in Dublin and I had a private guy for all 5 kids .
Anyway, the whole thing was textbook . Entirely pain free - in fact I didn’t even realise he was born !
Happy days as I hate pain !
So yes, this worked very well for me . Be creative in what you ask for / suggest . Many times they will give a stock answer of ‘no’ but challenge it ! Best of luck with the birth .