Epidural

Disclaimer:I am not saying that getting an epidural is bad, or makes you less of a woman or any of that. I believe that every woman should be the one to make the choice that is right for her about what type of birth she will have, insofar as it does not endanger the health of her babies or herself.

So.
At my various appointments yesterday (I spent from 9:45am to 4:15 pm at the hospital), I talked with both the anesthesiologist, a fellow, and my perinatalogist about epidurals. I have also discussed it with my midwife, and so far I'm getting a kind of list of pros and cons.

I had an entirely natural vaginal birth with my son. I would like to do the same with my twins. All my doctors/midwife agree that I am an excellent candidate for vaginal delivery, and Baby B (who is presenting) has been head down since at least 20 weeks.

Here's what I've got so far:

Pros:

• If I am one of the 7% of women who give birth vaginally to the first baby and then need an emergency c-section for the second baby, having an epidural in place means that I won't need to be put to sleep.
• If the second baby needs to be manipualted into position externally or internally after the first baby is born, the epidural will make me more comfortable
• Labour will be (supposedly) painless

Cons:

• An epidural can have numerous complications, ranging from mildly annoying to very serious
• The epidural may not work at all, and need to be re-done
• The epidural may slow labour and increase liklihood of a c-section
• There can be negative effects on the babies during labour (irregular heartbeat, etc.) and after birth(difficulty latching, slower response)
• An epidural means I can't move around during or after labour
• The hospital staff won't allow my husband to be there for the insertion of the epidural
• I feel as though I will be losing control of the birth

I guess really I feel as though I'm being pushed into getting an epidural because it makes things easier for my doctors. I am not afraid of being in labour, I know it is painful, but I also know that my body is made for this. I understand that birth (especially with twins) is unpredictable, and I may need a c-section anyway. Of course, I would do whatever is necessary to ensure my babies are born safely. BUT I don't believe in unnecessary medical interventions for things that may or may not happen.

Anyone else who feels this way? What is your take on getting an epidural? Did you/will you have one? Why or why not?

 

i felt exactly the same way as you although at the time wasn't able to state it so succinctly - i just had a very strong gut feeling that i didn't want or need an epidural. in the end, i agreed to have an epidural at my last appointment the day before the girls were born, partly to shut my doctor up about an elective c-birth & partly because she had really scared me & i didn't know then what i know now to defend my position. when i went into labor that night & headed into the hospital, a different doctor was on call who felt differently than my OB which was reassuring. and then, my labour progressed so quickly that there wasn't time to do an epidural anyway, so i birthed both girls vaginally without meds. it was awesome.

i started pushing in triage & had to be run down the hall to an L&D room, when we got there, baby A was already well down in the birth canal & i remember very clearly the resident asking the on call OB if i was going to get an epidural & the OB turned to her & said "nope, she's pushing". the resident's face just blanched. it made me laugh & cringe a little on the inside. but the resident did a great job & i hope that that positive experience will be remembered by her. :good:

 

I got an epidural with my DD and let me tell I was TERRIFIED but it was a good experience and I am definitely getting one again with this birth. The first needle to freeze the area hurt the most - it was like a bee sting - but then after that I never even felt the epidural going in.

Also, to answer your question, I know they say that an epidural "can" stall labor. Well, when you are in so much pain, you don't care - you want that epidural. And once you are pain free, who cares if you labor is a bit longer -- you're pain free, remember?? he he... So to me, I would have gotten it sooner. And it did not slow my labor down one bit. In fact, I got the epidural and half hour later baby's head was half out on its own!!!!

I am in Canada, and they let 1 person stay in the room with you. My DH did not want to see the epidural, so my MIL was with me. But really, I know it feels like it's a huge deal that they can't be in the room with you -- but it's also the same when you go to the OR for a section. They prep and sterilize the area, THEN bring your DH in. So it's really a small part in the grand scheme of things

I would definitely get an epidural again. I went in with an open mind and am glad I got it done. The relief you feel is amazing. And to me, you don't get a medal for going "natural" and if someone can take away your pain and it's relatively harmless to you and baby - why not?!

If you let it affect you (the decision), then you can be depressed over it. But I suggest going in with an open mind and if you decide to get one, you are NOT a failure!


To me, being put out completely is way worse than getting an epidural.

 

I had an epi with my oldest. I had HORRIBLE back labour, to the point where I was sick to my stomach. I decided to get it, and felt like a new person afterward. It didnt slow my labour down at all, in fact it sped it up. I also had one with the twins, which was a scheduled section. If I were to ever have another baby, I would get another epi.

I agree with the PP about getting an epi is way better then being put out. This way if they do have to do an emergency section, you'll be able to see your babies pretty much right away.

 

My DD and DS were born vaginal with no meds at all. My 3rd, DD, I was in terrible back labor and on pitocin. I did get the epidural and since I was able to relax I went from a 3 to delivery in like 30 min. My 4th, DD, I had been in "labor" with my water broke but no contractions for over 4 hours so the Dr started Pitocin at midnight. Again, I went into back labor. At 1:45 am I was sitting on the edge of the bed, still at 3cm, for the epidural and at 2:05 am my DD was born. The anesthesiologist was still hooking me up when I said the baby was coming and he went to get help while the nurse stayed with me since my DD was crowning. So the epidural for me relaxed my body to the point that it could dilate and it sped things up. I was up walking within the hour.

As far as this time with the twins, the Dr really isn't giving me a choice and to be honest I think I agree. Although I wanted a natural birth, it may not happen. Baby A is vertex but baby B is transverse. I am planning a vagnal birth. The thought of having to be put under in the case of an Emergency frightens me far more than the epidural. The thought of having my OB reach in and turn the baby and pull him breech frighterns me too. My OB said that the pain would just be way to much and I believe him. If they were both head down maybe it would be different but this time I am not willing to take any chances... every second counts when getting the babies out.

BTW... I am terrified of needles so for me to ask for an epidural was even a shock to me!! Good luck!

 

I'm glad I'm not the only one! It seems like no one understands why I don't want one, they act like I'm some kind of masochist just because I happen to think my body will be able to take it. I'm kind of secretly hoping that my labour will go quickly and they won't have time to do an epidural. My labour with my son was pretty fast and they say second labours are usually quicker, so...

 

I do have an older son so I have been in labour before and while I agree that it is painful, it was not so painful to make me want to get an epidural.

I'm in Canada too, and my peri was the one who said that hubby would have to leave. What part of Canada are you in?

And I just want to clarify - it's not that I would feel like a failure for getting one, although I do think that there is a great "high" and an amazing feeling of accomplishment that comes with a drug-free birth - I personally don't want one if it's not necessary and nothing has made me feel so far that it would be necessary.

 

Thanks for your input. It's interesting to hear from someone who's given birth both ways. I agree that the thought of having to be put under in the case of an emergency frightens me far more than the epidural, but the chance is so low. Many women with singletons have had their babies successfully born breech or manipulated without drugs, so while it would be less painful with an epidural, I just don't think it's necessary. And mine are both head down, which helps.

 

I should have mentioned that I was induced - so my labor was extremely painful, piggy back contractions - no break in between. I delivered my first child in 2 hrs, 5 mins! So it was a very "rushed" process and a painful one pre-epidural.

I am in Ontario. I live about 2 hrs away from Toronto.

 

It may not be necessary for you and that would be great! The fact that they are both head down is a bonus!! I think like a pp said being induced with pitocin or other drugs does make labor a ton worse. You get no break from contractions at all. Having given birth with out induction and with, I can attest to the extreme pain of the pitocin.... however, maybe I am a bit wimpy!! I wish you the best... I kinda hope my labor goes too fast for the epidural too. It may considering I am 90% and almost 4cm as of Wed!!

 

:bow2: I think you are amazing. I also think you have really considered what you want and you do have experience with birth. I say go for no epidural. Yes, it's unusual, but being unconventional doesn't mean wrong. I had an epidural and wasn't bad at all, but then, I had a breech A and a transverse B, so I've never pushed 1 out :lol:.

 

Wow, I know nothing about induction, I hadn't heard that it was more painful. What a fast labour!

I live in Ontario too! Just outside Ottawa

 

I don't think anyone who goes through a pregnancy (especially a twin pregnancy) and gives birth can be considered "wimpy"! Don't sell yourself short Good luck with your labour and birth! It sounds like you are very close!

Thanks I really appreciate that.

 

this was the key for me - i didn't want a routine epidural. if i felt i needed one, for whatever reason, once i was in labor than i would have had no qualms about getting one. but all the reasons my OB gave me for getting one were for things that might go wrong, not for anything that was currently going wrong. maybe if epis were 100% safe, with no adverse effects or possible complications, than i would have been okay with that. i guess i just felt that if something went wrong during labor, we would deal with it at that point, and otherwise i preferred to have as few interventions as possible so as not to create complications, KWIM?

 

YES! Exactly this. Finally someone who understands!

 

Sounds like you've made your decision and you're comfortable with it which is what's most important! So long as you're well informed of all of the pros and cons which you now are, I think the decision is yours to make.

Fingers crossed for an uncomplicated labour and delivery, and I look forward to reading your birth story!

FWIW I had an epidural as I had a scheduled c-section and it was the easiest breeziest procedure I've ever had! I was so nervous going in but I would do it again (if I wanted to of course) in a heartbeat!

 

I am in Ottawa...are you delivering here?

I had a non-medicated vaginal delivery with my son. I was induced (they broke my water at 41w6d) and he was out in 4 hours...it was very intense but I did it without an epidural. I figured I would be able to handle it again with my girls as I knew my body had done it before and felt very confident I could do it again! I had to fight hard for my natural birth plan but I was lucky to have an OB who supported my decision. I had almost the same pros/cons list as you and like you I was not opposed to an epidural I just wanted the decision to be mine. One thing that helped me make my decision was that I was told a spinal could be put in in about 3-5 minutes if needed for a c-section, breech extraction, etc. If an emergency arose I also knew there was a chance I would have to be put out. I weighed my options and decided to proceed un-medicated...I am soooo glad I did!!

I went into labour on my own this time (no induction) so it was longer (10 hours) but actually very easy, nothing like how it was with my son. Baby A was head down and she "fell out" on the floor in the bathroom (a nurse caught her, thank goodness). Baby B was transverse when labout started. The OB manipulated her externally to get her head down and she was out in 3 pushes. It was funny because they actually took me to the OR for Baby B and after the delivery the orderlies were trying to figure out how to move me back to my bed from the OR table while I was holding both babies (they brought A in to the OR after she had been checked over) and I said I could just do it myself if someone took the babies for a second...the look on all their faces when they realized I had just had my twins without an epidural was priceless!!! I think all 20 people in the OR stopped and stared

Good luck with your decision and your birth. I hope you have positive people around you to support you no matter what you decide!

 

Wow, that is an awesome birth story! I am in Ottawa, I'll be delivering at the General. Which hospital were you at?

My peri and the hospital staff are definitely on board with a vaginal birth (as long as the first baby is vertex) but they are really pushing the epidural. Did anyone give you a hard time about not wanting an epidural? How did you deal with it?

My husband is very supportive and my midwife will also be attending the birth, though in a supportive role, she does not have privileges at the General. I'm just frustrated that no one seems to understand why I wouldn't want an epidural. And while they admit that they can't force me to get one, they are not very supportive of my view.

 

this is, unfortunately, par for the course. my OB gave me a very hard time about having an elective c-birth, and when i wouldn't budge on that, she pushed even harder for the epidural. i actually caved, but in the end had things my way because the labor went so quickly. knowing what i know now, i would have just started repeating "thank you. i understand the risks & the benefits and have chosen not to get an epidural. if anything changes, i am happy to discuss it again at that point" and leave it at that. remember, you don't have to convince them to agree with you - you just need to be clear on what you want. it really has to do with perception of risk, and you aren't going to change how they perceive the risk, only know that you perceive it differently. does that make sense?

 

I did have to fight not to have the epidural as well...the only people who were supportive for me were my husband and midwife. It was a fight until the very end with everyone else. I delivered at the Montfort which was where I had my son as well. I also had a midwife and while she does have privileges at the Montfort twins are considered an automatic transfer of care so she was not the primary at my birth and had to hand most of the control over to the OBs and hospital staff. I had an OB who was co-managing my case and while he didn't really understand why I wouldn't get the epidural he was very relaxed and let me make the decision myself. He did remind me at every appointment how uncomfortable I would be if he had to reach in and pull Baby B out and I reminded him that if it was not an emergency I could have a spinal put in very quickly (as he had told me) if needed. I just held firm…like you said even if he didn’t understand he couldn’t make me do it against my will.

When I went into labour the OB on-call was NOT on board with my birth plan. She came into the room spewing stats about c-sections and all the 'dangers' of an un-medicated twin delivery. I was very thankful I had done my homework and had a very supportive team surrounding me, otherwise she probably would have scared me into it. Thankfully I had my midwife to advocate for me as well as my doula, my husband and myself. Something else that worked in my favour was that my OB was coming on-call at 8am that morning. We kept my labour slow and easy and then called him at 6:30 to come in early so he could deliver me. In the end everything just lined up very well for me.

If you say you have the support of your midwife and the hospital staff for a vaginal birth then I’d say you’re well on your way. Once your labour is progressing they will have to respect your decision not to have the epidural. I did give in on some of the other “must have’s” such as an IV, constant monitoring of Baby A and intermittent for Baby B, incredibly annoying but as long as they knew this was happening they mostly left me alone. I’d say that as long as you believe in your decision and trust your body then this will come across whenever you have to advocate for yourself. Stay firm and once they see you will not be easily convinced the other way then all they can do is respect your decision. Everyone wants the same outcome…healthy Mommy and healthy babies and hopefully as a team you will find the best way to reach this goal!

 

Just thought I would let you all know that I had the babies this morning. I had my first contraction at 12:30 am got to the Hospital around 1:30am and was complete at 1:45 when they checked and had Lidea at 2am and Levi at 2:09 am. No time for epidural or other pain relief. Lidea was born head down and although very painful she came fast but Levi was transverse so the Dr reached in and pulled him by the feet... EXTREMELY painful. The worst pain of my life. It is all over now, and I did it with out drugs, just lots of screaming and begging for relief which only came after they were out. I can't say now if I would have had the epidural (although I did beg for it) and the pain was severe but it is all over now and I have 2 healthy babies! Good luck with your decisions.

 

[quote name='E's 3' date='27 November 2010 - 07:50 PM' timestamp='1290905422' post='1728057']
If you say you have the support of your midwife and the hospital staff for a vaginal birth then I’d say you’re well on your way. Once your labour is progressing they will have to respect your decision not to have the epidural. I did give in on some of the other “must have’s” such as an IV, constant monitoring of Baby A and intermittent for Baby B, incredibly annoying but as long as they knew this was happening they mostly left me alone. I’d say that as long as you believe in your decision and trust your body then this will come across whenever you have to advocate for yourself. Stay firm and once they see you will not be easily convinced the other way then all they can do is respect your decision. Everyone wants the same outcome…healthy Mommy and healthy babies and hopefully as a team you will find the best way to reach this goal!
[/quote]

I was supposed to deliver at the Montfort, but was transferred to the high risk unit at the General because of a shortening cervix and a growth discordance with the babies. Maybe with the increased medical attention, there seems to also be a push for more medical interventions. I think I'd also be willing to compromise on some of the other things like the IV and such. I know that I'll be discussing this again with my care providers so it helps to know that other people have been there and had a positive outcome.

 

Congratulations! That is one quick labour! The breech extraction does sound painful but you're right, it's all over and you have 2 healthy babes

 

These stories make me realize how awesome my OB was. She never even considered a c-section and didn't give me the option of one because both babies were vertex. Even with a transverse or breech baby B, vaginal delivery was always her goal. She let me make the decision on the epidural, but that if I decided against it, asked that I have the line placed (without medication) so that it could be turned on at a moment's notice.

I went into labor naturally, but ended up getting pitocin when they realized that baby A's bag had been leaking for up to 12 hours. Since there was the concern over infection, the OB wanted the babies out as soon as possible - but still she never mentioned a c-section. I did fine for several hours, to the point that I considered going forward without the epi. Then I got pitocin contractions, one on top of the other for as long as 10 minutes at a time. I got the epi, fell asleep, woke when I was 10cm. Pushed for about 15 minutes. Both born vaginally 21 minutes apart. My total labor was 6 hours.

It was so textbook perfect that I wouldn't change a thing. The epi made the pitocin tolerable, which saved me from a c-section. I'm convinced that the epi sped up my labor because I relaxed.

Do what is best for you and the babies. Good luck.

 

i knew you can get that done for IVs (hep lock) - i didn't realize you could do it for epis too. i wish my doctor had suggested that! oh well.

 

Interesting conversation. This is also the position of my OB (having the line placed without medication so that it can be turned on right away if needed) and I'm quite happy with this approach. I have no idea if I'll need it (probably, I have no illusions about my own toughness ), but I like that it's there if needed, but not necessarily a given.

 

Kinda silly, but I think I was more scared of getting an epi than I was of anything else surrounding birth. I could have dealt with it if I knew I needed it - if c/s became necessary, or if for whatever other reason I needed it. But I knew I had a healthy body and a high pain tolerance. I just wanted the chance to try for a natural birth.

In the end, I chose to stay home, in main part so that I would have control over these decisions and not be bullied. I had a great, very experienced midwife, and neither of us would have hesitated to transfer if the need arose.

But fortunately things went generally smoothly. Didn't need an epi for a minute, and having one would have been a huge problem for me. I spent most of labor walking and moving around, and gave birth upright on a birthing stool.

I would have considered placing and epi catheter, so the port was there if necessary, although I wouldn't have liked it. That is something worth considering.

But do try to go unmedicated! You know your body, and have done this before. If unmedicated is your preference, and you've clearly put a lot of thought into it, ask that your caregivers respect that.

:youcandoit:

Good luck in your last few weeks!

 

I had to get an epidural with twins, hospital policy. Actually, I checked with several hospitals and they all said they very strongly recommended or required it for a twin birth. The reasoning in all cases was that they wanted all options in case things went "wrong" without having to wait for an epidural or spinal to be put in, without having to hurt me unnecessarily and without having to put me to sleep. The line was placed and I received a low dosis to check everything was working and give me a bit of rest (which I really needed) and did not receive more medication until I asked for it. The midwives and doctors were very supportive of my wish to labout as naturally as possible after an induction.

For me that approach worked well, safety but no unnecessary/routine medication. In the end I did have to have a c-section and I was really glad that everything was in place, no delays and I got to be there when the babies were born.