Epidural question

DH and I met with a prospective new OB today. I explained that I'm hoping for as natural a birth as possible (if the babies and I are doing well). I'd rather not have an epidural because I know they can slow down labor and increase the odds of needing other interventions or a surgical delivery ... but if I do end up needing a breech extraction for Baby B, it would be nice to have that option. He said it would be possible to wait till I'm dilated to 8-9 cm before doing the epidural so labor wouldn't be slowed down prematurely--that I could get one as early as I want or as late as I want. That's a little different from what my current OBs had said (they make it sound like it's all or nothing). Just wondering what you all know about this, and what you experienced or were told by your OBs.

And what did/would you do for pain management if it looked like you were going to need a breech extraction for Baby B?

 

I haven't heard of the epi slowing down labor. With my son, I was induced. I was given pitocin, doctor broke my water at 7:30. Given the epi at 4 cm dilated and was only in labor for 5.5 hours and pushed 22 mins. My son was born at 1:26pm. I couldnt have done it without the epi and plan on getting it again. Doctor said he will induce at 36 wks if both are head down. If not I can go another week and have the csection. They were both head down at my last appt. Praying they still are.

 

Something to just keep in mind. When I had the boys, I had to push right as the anesthesiologist was cleaning my back off to put in the epi. (So apparently I must have been dilated to 10???). Anyway, he was only able to get the test dose of the epi in me. I didn't feel the contractions, but my toes were still tingly, so not everything was numb. I did start to feel burning in my back with Baby B's contractions though, so it must have been wearing off. I couldn't tell you how long my total labor was as it went so quickly, but I'm guessing about 1 1/2 hrs.

I honestly didn't know there was a test dose until the anesthesiologist said that's all he could get in me. If I were to get pregnant again (which it ain't gonna happen! ), but if it did, I would ask for just the test dosage and not the full dose.

 

Korey's Mommy: Good to hear.
But yeah, studies show that using an epidural (and pitocin) can slow down labor and make it more likely that you'll end up needing other interventions or a surgical birth. Though if you do have pitocin, an epidural is a good thing since pitocin can make the contractions really strong! (If I do end up needing an induction, I'd go ahead and get the epidural; otherwise I hope to go drug-free.)

 

My husband is an Anesthesiologist. He says that there were some old studies from the 80's and early 90's that indicated that epi's did slow labor, but in more recent time (past ten years) research has shown that epi's do not slow labor and it was other factors that were also combined with that like pitocin and inductions that slowed labor and resulted in surgical interventions. That being said, if you still want to go for the natural birth method, my suggestion (from my husband) is to ask to have the epidural placed and tested when labor is in early stages and then do not get any drugs pumped in unless you need it. The test dose wears off very quickly and then you would already have the epi placed if you end up needing it for whatever reason. Placing the epi is the hardest part and they do not like to do it if you are restlessly moving and close to pushing. That is what most anesthesiologist would probably recommend. I hope that helps.

 

I didn't have a breech extraction but I was very dilated when I received the epi - about 30 minutes after the epi I was at 10, so I know it is possible to wait until you are very close to get the epi!

I agree with what the previous poster said about receiving the epi BEFORE you are as far along as I was, I was SCREAMING for the epi and had an extremely hard time sitting still for them to get it in, I was having what felt like constant contractions. If you can have it put in but not the medicine then I'd try that, it is really hard to sit still during those contractions!

 

My OB recommended having it in place in case of an emergency c-section or breech extraction. She said they could always just put the catheter in without any meds...but at least it would be in place. That being said, I did get the epi which actually helped me progress faster because I could relax. After the epi, I went from 3cm to 10cm in just under 5 hours, whereas I was kind of stalled at 3cm for a couple hours before the epi.

 

QUOTE(JessieJean @ Nov 19 2008, 08:28 PM) [snapback]1078181[/snapback]
My OB recommended having it in place in case of an emergency c-section or breech extraction. She said they could always just put the catheter in without any meds...but at least it would be in place. That being said, I did get the epi which actually helped me progress faster because I could relax. After the epi, I went from 3cm to 10cm in just under 5 hours, whereas I was kind of stalled at 3cm for a couple hours before the epi.


I asked about this with my l and d nurse today and she said that if something were to happen, it might not numb me fast enough that i would need it to if i needed a section or any reason.

I do not want an epi. I am really mixed on it now.

 

QUOTE(no1kate @ Nov 19 2008, 02:16 PM) [snapback]1077785[/snapback]
My husband is an Anesthesiologist. He says that there were some old studies from the 80's and early 90's that indicated that epi's did slow labor, but in more recent time (past ten years) research has shown that epi's do not slow labor and it was other factors that were also combined with that like pitocin and inductions that slowed labor and resulted in surgical interventions. That being said, if you still want to go for the natural birth method, my suggestion (from my husband) is to ask to have the epidural placed and tested when labor is in early stages and then do not get any drugs pumped in unless you need it. The test dose wears off very quickly and then you would already have the epi placed if you end up needing it for whatever reason. Placing the epi is the hardest part and they do not like to do it if you are restlessly moving and close to pushing. That is what most anesthesiologist would probably recommend. I hope that helps.



Ive never heard that idea about getting the test and then just having it there if the need for it came up.
I kinda like it- Thank you for responding!

 

QUOTE(JessieJean @ Nov 20 2008, 02:28 AM) [snapback]1078181[/snapback]
My OB recommended having it in place in case of an emergency c-section or breech extraction. She said they could always just put the catheter in without any meds...but at least it would be in place.


Yep, this is what I was told yesterday too. My multiples midwife also explained that with singletons, the reason they won't give you an epi too late is because by then its almost all over, whereas with multiples, you still could have as much as a couple hours before twin 2 is out and everything is done. Made sense to me-maybe that's what your OB meant too. With my son, I was induced and stalled at 3 for hourrrrrrrrrrs, and once the gave me the epi and took me off the Pitocin, I zoomed right on along, so I was one of those as well. Here you have to have to progestin vag suppositories three times before they'll even start Pitocin, which I like. Gives me more of a chance to let my body kick start itself. Good luck! Let us know how it goes!

 

I'm not sure with twins but with my daughter I was in labor initially for about 1hr and 1/2 and got to the hospital and was already 5cm dialated. They got the epi in within abt an hour and I was already at 7cm. Didn't feel a thing and 2 1/2 hours later and 3 pushes my daughter was here - it was great. I am hoping that I can go vaginally with the twins with an epi bc it was so easy for me...

Good luck with your decision....

 

Thanks for all the feedback, everyone!

The idea of putting the catheter in place does make sense ... though I bet once I've gone through the trauma (for me anyway; I had a really bad spinal tap experience) of getting a needle in my spine that I'll be like "Well just go ahead and give me the drugs."

I am really hoping that B flips back to vertex, though, so I can try to go through the whole thing drug-free. That would be my ideal ... but we'll see what happens.

 

My OB and I both wanted to go drug-free. I was expecting to have to do a breech extraction, and what I basically gathered was:

1) Bad as it sounds, you HAVE just pushed one baby out of there, so you're pretty wide open already and
2) Yes it hurts like #$%^@#% for a minute or two, but then it's over.

My doula thought she could get me through it, so I went ahead with that plan. I'd rather have a couple of minutes of pain than deal with the meds before and after. (I had a spinal headache after my c-section. Ugh.)

And then Baby B kindly flipped vertex at 38 weeks. He stalled coming out, though, so I was glad to have every ounce of mobility I could to push him down.

 

QUOTE(SC_Amy @ Nov 19 2008, 11:40 PM) [snapback]1077719[/snapback]
DH and I met with a prospective new OB today. I explained that I'm hoping for as natural a birth as possible (if the babies and I are doing well). I'd rather not have an epidural because I know they can slow down labor and increase the odds of needing other interventions or a surgical delivery ... but if I do end up needing a breech extraction for Baby B, it would be nice to have that option. He said it would be possible to wait till I'm dilated to 8-9 cm before doing the epidural so labor wouldn't be slowed down prematurely--that I could get one as early as I want or as late as I want. That's a little different from what my current OBs had said (they make it sound like it's all or nothing). Just wondering what you all know about this, and what you experienced or were told by your OBs.

And what did/would you do for pain management if it looked like you were going to need a breech extraction for Baby B?


I decided to go for the epidural as Baby B (DD), although head down, was in a position that could have meant a c/s. My OB gave me the epi when I was at 6cm dilated and it didn´t slow down my labour at all. In fact I dilated the remaining 4 cm so fast that I didn´t have time to think as I was being told to push! I was induced and the whole thing lasted 4 hours from start to finish.

Baby A (DS) came out head first and DD came out feet first as she turned and escaped! I don´t regret my decision to have the epi and didnt even feel it when it was administered or removed.

One thing to take into consideration besides the fact that you have an anaesthetic in place incase you need an emergency c/s, is that giving birth to 2 babies vaginally is a very tiring experience (though a very rewarding one!) and having pain relief does enable you to give that one extra push. When DS was out all I could think was "OMG, I have to do this again!".

Looking back, I think that I could have done it without the epi, but that´s me saying that 6 months later! :winking:

GL with your decision and for the birth!

 

I've read recent stuff that an epi can actually help speed labor because without the intense pain of the contractions, Mommy rests and relaxes. With an epi, I went from 5 to 10 in under 2 hours.

 

I would find out if having the epi in place would restrict you to bed or not and then go from there. If not, then it's good to have in place but not flowing with drugs. If it does then put it off because you're going to want to be moving around into positions that make labor more comfortable.

Usually, docs want the epi in place with twins in case of a suddent c-section but your OB sounds open to waiting and I think that's great.