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Epidural or Not?? What to do...

post #1 of 41
Thread Starter 
Hi Ladies - Can anyone who has had a hospital birth of twins share with me if they chose an epidural or not? Of course my OBs recommend it, but they say it is my choice. According to my OBs, they highly recommend the epidural in case there is a problem with baby b.

But here is the thing...I cannot even begin to imagine how I will give birth being stuck on a table with no or little feeling. How will I push? And my experience (an an OB nurse) is that an epidural usually leads to all sorts of other interventions. The epidural can cause my BP to drop, can cause labor to stall, then OBs will recommend the typical....pit...and on it goes from there. I just dread that level of intervention. I had such a great natural birth with my son, it is hard to imagine how this is going to go.

That said, I have decided on a hospital birth so maybe this all part of the deal. I don't know. Any recommendations on if I should consent or not?

I would love to hear from any mamas who had a similar experience and find out what you decided and why. Thanks in advance
post #2 of 41
I'm not a mother of multiples, so take my advice for what it's worth with that in mind.

Epidural is *not* part of the deal with hospital birth. What your doctors are telling you is that it would be convenient for them, in the event of emergency, if you had an epidural. And what your experience is telling you is that an epidural makes that emergency much more likely.

I think you should trust your experience.
post #3 of 41
I had a hospital birth with my twins and I did not choose to have an epidural.

The reservations you mentioned echo many of my reasons for opting out. And I am very glad that I was free to push in whatever position felt right (and that I could feel to push, and was in touch with what DID feel right as far as position), which for me was upright. I also was leery of the potential for the cascade of interventions that you describe.

I don't think that having an epidural is the "wrong" choice, but I think you need to examine your reasons for considering it. If you feel swayed toward having a "just in case" epidural, on advice from an OB, examine the reason behind that, too. Is it "just in case" an internal version is needed for baby B? Or in case of a breech extraction? Or in case of an emergency c-section?

I do believe, and perhaps moms of multiples here can tell you from experience, that having an epidural in place "just in case a c-section becomes necessary" (so you won't have to have general anesthesia) won't always prevent you from ending up with general anesthesia for a crash section, anyway.

If that's your biggest reason for considering it, why not find out about the feasibility of an anesthesiologist on hand prepared for a quick spinal prep in case a c-section is needed, and having a spinal if needed rather than depending on an epidural that would need to be "turned up" for a c-section, anyway.

When I started to have this conversation with my doctor, I was trying to get a sense of the time available (for the spinal prep) in an urgent situation, and when it just wouldn't be possible and general anesthesia would be required because of the urgency & lack of time. (How much time would be too little?) She pretty much brushed aside the possibility of general anesthesia, saying that they almost never needed to go that route, that there almost always was time for a spinal at the time the decision for surgery was made.

I guess there are emergency situations that wouldn't allow for that larger window of time, but the OB wasn't trying to leverage me in any direction out of fear that I'd be stuck with being knocked out if I didn't have some kind of "just in case" pain relief in place.

I think if the epidural is desirable to you for other reasons, ability to cope or whatever (I know it sounds like it's not, but I'm just saying), then that is what you need to weigh. But if you are considering it "just in case," then weigh very carefully how likely it seems that it would serve in that way, and how you might feel about having had it if in the end it didn't prevent the main thing that had prompted you to get it. (i.e., having general anesthesia for an emergency c-section) And also how you might feel if having the epidural may even have led to the circumstances that made the c-section necessary (that of course is harder to know for sure, but you might have thoughts/feelings/suspicions about it after the fact.)

I know general anesthesia isn't the only "just in case" reason.

For what it's worth, I had a breech twin B and I was prepared for a breech extraction if necessary (I was hoping baby B would turn after his brother was born, and I'd been visualizing it and was calmly giving him mental/verbal instructions and really concentrating on the visualization as I moved from upright into a position to allow the OB to check the remaining baby.) I do not know exactly what happened next....it was almost like he was a team player and had turned or was turning, but the doctor got a look and definitely may have done something. I don't remember feeling anything, but just hearing him shout that we had a cephalic presentation and that I could labor in any position I wanted (I got back upright.)

I later asked him (he wasn't my doctor, he was the on-call OB and I'd never met him before) and he said he'd seen a foot and turned the baby -- but I have wondered how much he really had to do.

At any rate, there was not anything in that experience for which I needed an epidural. (I did do the HypnoBabies home course, though!)

Good luck to you in your decision. There have been some posts on this issue before; you might search for some of the past threads if you want to take a look at those.
post #4 of 41
Another thing, re: versions.......I've heard moms of twins say they experienced an internal version without epidural anesthesia in place and it was "no big deal" or they don't remember feeling anything (like me, except I guess I'm not totally certain I experienced an internal version, or a "full" one!), and I've heard them say it was REALLY uncomfortable or painful or "NOT fun!" An external version can be the same way...."my doctor did an external version to turn the baby and it didn't hurt at all" to just the opposite.
post #5 of 41
Ok, hope it's ok for me to post, though I did not birth in a hospital. I did see a perinatologist, though, during pregnancy, and I felt pretty sure that I would get an epi "placed" if I birthed in the hospital. Part of it was that I don't do well going against the grain, and the other part was that I did have a drug-free hospital birth with my first while connected to a FHM as I had pitocin to induce me. Amy's post is so thoughtful, and ultimately what I wish I could have said for myself, but I felt I was going to have to pick my battles in the hospital, and that was one that I thought I might not pick. That being said, while I labored at home, I thought that I would definitely be challenged being that close to an epi, as labor is labor, and if you are that close to not feeling it, it might be enticing..... Then again, I'm all about feeling it and think it's important. But in a few of those moments...... oy!
post #6 of 41
nak .....

hospital birth, with twins, baby B was breech extraction ..


I was STRONGLY encouraged to have an epidural, and totally balked, since I knew I wouldn't be able to walk around, etc.

When I got to the hospital (crowning baby A), I was whooshed off to the OR, and anesthesia was called. The OB walked in the room, asked my sweet nurse, "where are we with anesthesia?". My nurse chirps, "Oh, she doesn't want an epidural!" I am not kidding, the OB rolled her eyes! SHe gave me the song and dance about the possibility of emergency C section, etc. I told her I'd risk it, and I was ready to push. The anesthesiologist just patted me,and said, "I'm here if you need me".


My reasons for opting out ....

I didn't feel like I needed one. I went to the hospital with DD#2 fully expecting to ask for an epidural when I walked in the door. Big surprise to me ..... I was crowning, and told there was no time for an epidural. I thought, hey, I can do this again!

I saw The Business of Being Born,and wanted NO part of any interventions .... breaking water, inductions, epidural, etc.

I wanted to labor the way I wanted ... really the only way to do that for me is to stay at home until the last minute.

I was scared .... no doubt. Not about being able to handle labor, but the nagging 'what if something goes wrong' kind of fear. I finally told myself that I was going to labor the way that I wanted, and not make any decisions that would harm either of the babies. In the OR, when I told the OB I did not want an epidural, I was totally at peace.

Breech extraction hurt like HELL, but I feel wonderful about my decisions.

Go, girl!
post #7 of 41
I shouldn't post in the middle of the night.

I meant to make clearer that it's not that "you're likely to get general anesthesia even if you have an epidural in place," but that in an emergency of true urgency (placental abruption, loss of fetal heart tone on the monitor, etc.), there may not be time to adjust epidural meds for a c-section. And in the cases where there is enough time, when the c-section is for position or whatever (necessary but not a crash situation), there could be time for the spinal to be administered right then. (Which is basically what my OB was telling me....that it would be very unlikely that general anesthesia would be needed or used. Rather than implying that if I didn't have X in place in advance, I was likely to face being knocked out if the c-section became necessary.)
post #8 of 41
Not a twin mama, but I once read a birth story (on here, I'm sure) where the mom had an epidural placed, but no meds infused, that way it was there if needed, but she was still able to feel everything and participate fully, and had none of the typical epidural side effects. Would that be an option?
post #9 of 41
i didn't want any needles/wires/ANYTHING until it was necessary as it gives them a free ticket to escalate their interventions. i'd rather be on top of the hill at peak of attack (labour/birth is a time of vulnerability)

if an epi had been important to me in case of emergency, to feel more in control or whatever, i'd have gone with that, but GA was fine with me in case of emergency.

i'm so glad i held out (just kept smiling and saying 'no, thank you' when they kept trying to prep me for surgery.lol) because i was confident it wasn't the right time. i had a canula put in my hand as baby a was born (two breech preemies, vaginal birth in the end : thank you God)

it was fine.
well, my babies had 4 weeks of hospital care ahead of them and my hand was badly bruised and all, but you know, i'm known to be picky about these things
post #10 of 41
I would also advise you to go w/ your gut. I had half a dozen interventions, knowing full well that w/ each one I was that much closer to a c/s. I was so wacked out w/ nervousness/excitement from month 8 - birth that I had a hard time speaking for myself. I would also encourage you, if you have a partner/husband, to educate them on what you want and why. That way you can focus on what you need to be focusing on and won't feel pressured to do one thing or another. Let them argue w/ the staff. A tough as nails doula would be nice too.
post #11 of 41
Quote:
Originally Posted by mamaeliz View Post
Then again, I'm all about feeling it and think it's important. But in a few of those moments...... oy!


Quote:
Originally Posted by DiannaK View Post
My nurse chirps, "Oh, she doesn't want an epidural!" I am not kidding, the OB rolled her eyes! SHe gave me the song and dance about the possibility of emergency C section, etc. I told her I'd risk it, and I was ready to push. The anesthesiologist just patted me,and said, "I'm here if you need me".
:

and AmyC - your conversations with docs and preparation for *everything* always amazes me
post #12 of 41
I am going for the epidural- but that's because I'm having a c-section LOL
post #13 of 41
I got one w/ my twins, and if I had it to do over again I would get it again. My twin B was breech-rear end first durring birht of baby A, then he flipped sideways and stuck his arm out. I had a manual version and yes it was just as you can imagine. My mom was in the room and she backed up agains the wall, DH kept telling me I was going great, my stomach was moving like something from the excercist and frankly I was totally freaked out. IT was surreal and I cannot imagine doing it without the epidural in place. I am sure it would have been possible for the Dr. to manually manouver the baby around w/o it, but I don't think it would have felt good. I don't know if he would have tried either if I were tensing up, KWIM? Babies cannot be born arm first, my OB was fine w/ feet first or rear first, but obviously that's not what happened. THis was my third birth and I don't think the epidural slowed labor at all for me, I am pretty sure I was pushing within an hour ro so of the epidural. I think I was 6 or 7 before it, and a 9 the next time they checked. I really think I went to a 9 durring the epidural b/c they have you curl your back out and I had 3 or 4 HARD cx like that, I didn't like it at all! Baby A was out in no time, B took a while, a manual version, a bit of a vaccuum to get him down farther, and then I was finally able to push him out. I did have decreased sensation, but I could absolutely tell when/how to push and I did feel the CX, the just didn't hurt as bad. IT felt like a belt tightening.
post #14 of 41
I had planned to try a NCB with my twins, and my OB & I agreed to place the epidural line in case it was needed (like an emergency c/s for baby B) but to not administer the epidural otherwise without my decision.

Quote:
Originally Posted by August09baby View Post
But here is the thing...I cannot even begin to imagine how I will give birth being stuck on a table with no or little feeling. How will I push?
I had a very difficult labor with my 1st and ended up needing anepidural. Despite what you hear, epidurals don't always mean no feeling. They also are gravity sensitive, so if you have to be in a certain position for a while you can actually feel the full strength of the contractions in some areas. (Like when I was stuck on my right side for a long time could feel everything in my left half.)

Also, I had enough sensation to be able to call in the MW to tell her it was time to start pushing, and yes I was indeed fully dilated. I also could feel DD moving through the birth canal, and I could feel her going back in a little after each contraction. The point of the epidural is more about pain management than completely numbing you.
post #15 of 41
When I was talking about this with my OB, he said that while he preferred women had them (um, well, at least he was honest! LOL) that having one "just in case of emergency" was kind of baloney... if it was a true emergency, they wouldn't wait for an epidural to "take" (numb appropriately) and would do general anesthesia. So I planned to not have one, and I knew the risk was that I would be under general if there was a true emergency.

That said -- I reached a place in labor that was frighteningly similar to a place with my 9 pound, 97th-percentile head, posterior son and started to have mental problems with the labor... and asked for an epidural (although with many qualms). By an amazing stroke of luck, the anesthesiogist (sp) was a guy from my yoga class! I told him about my worries, how I wanted to be able to feel and push, everything that was holding me back, the works. He placed the lightest epidural known to human kind, I think... I was able to walk around, move whereever, and I went from 4-10 in an hour and was able to tell the nurse when it was time to push, and feel every bit of the delivery. So it *is* possible to have an epidural in place that doesn't stop things. And being slightly numb did help when my Twin B appeared with two feet and a fist (the OB pushed the arm back up inside me and slowly guided her out by her feet when I pushed).

Just my 2 cents worth! Congratulations on your pregnancy and good luck preparing for your twins' birth.
post #16 of 41
I chose not to have an epidural with my twins but ended up getting one after 50 hours of induced labor... I only had it for 4 hours, I could still feel everything but it was not painful. Everyone is different and you never know what will happen. If I learned one thing through my pregnancy was to be open, to always have a plan B, and not to be attached to any one way.

If I where to do it again, I would have signed the paper work before hand, but still waited until it was absolutely necessary. In the end I was glad I had it because my second baby went into shock when his brother left and his heart rate dropped to the point where they almost did an emergency c-section. Instead the doc, went up with a vacuum while I wasn't contracting... my baby was fine but I was ripped really bad in the process... I can't imagine what that would have been like with nothing. Not to scare you! Trust your gut and all will be well! Happy birthing!
post #17 of 41
Quote:
Originally Posted by twinalicious View Post
I Everyone is different and you never know what will happen. If I learned one thing through my pregnancy was to be open, to always have a plan B, and not to be attached to any one way.
Great advice!
post #18 of 41
Quote:
Originally Posted by MeepyCat View Post
I'm not a mother of multiples, so take my advice for what it's worth with that in mind.

Epidural is *not* part of the deal with hospital birth. What your doctors are telling you is that it would be convenient for them, in the event of emergency, if you had an epidural. And what your experience is telling you is that an epidural makes that emergency much more likely.

I think you should trust your experience.
No I don't believe this to be automatically the case with multiples. There is a concern for an emergency c-section needed with twin B. I have a very naturally oriented doc who I have birthed with before (naturally which he encourages and the hospital not caring for) and we have discussed this. He has, of course, left it up to me.

I have not given birth yet but if I do vaginally I am really considering an epidural simply because after a previous birth trauma I don't think I could handle the delay in a section or having a vacuum/forceps without one (as happened to a friend who birthed twins naturally when there was stress on baby B and no not just doctor being a jerk- a real emergency). I don't think they are necessary but I also don't feel the same arguments against apply to multiples.Yes if there is an emergency they'll take care of it whether or not you have an epi but if you already have one you've already got that covered and save time.

Quote:
I had a very difficult labor with my 1st and ended up needing anepidural. Despite what you hear, epidurals don't always mean no feeling. They also are gravity sensitive, so if you have to be in a certain position for a while you can actually feel the full strength of the contractions in some areas. (Like when I was stuck on my right side for a long time could feel everything in my left half.)

Also, I had enough sensation to be able to call in the MW to tell her it was time to start pushing, and yes I was indeed fully dilated. I also could feel DD moving through the birth canal, and I could feel her going back in a little after each contraction. The point of the epidural is more about pain management than completely numbing you.
Yup! I had an epi with my first and I did hate it because I couldn't walk afterwards and all that but I was still able to push, feel pressure, her corwning, the need to push (her moving down), etc.
post #19 of 41
When my girls were born, it was a case of emergency-section-for-the-second-twin, with general anesthesia. We started off with both babies vertex. After her sister was born, she slipped down transverse. After an external version, her cord prolapsed. I've never had an epidural of any kind. Even if I had one, I almost certainly would have ended up with the general anyway, simply because of the time involved. As it was, her 1-minute APGAR score was a 1. Thankfully, her 5-min score was a 6, and she only spent about three hours in NICU.
post #20 of 41
I initially did not want an epidural but ended up getting one because it was recommended. I realize that it was my choice but I did not feel really strongly one way or the other and decided to go along with the obstetrician on this one. I was able to get many things in terms of care during my pregnancy that I wanted and knew my ob was pro-vaginal birth and the hospital very pro-breastfeeding and those were big issues for me so I let the epidural slide.

Both babies were vertex at the start of labour. After ds was born vaginally dd turned transverse and despite the ob's attempts to turn her he could only ever grab her hand. Ds's placenta abrupted and I started hemmoraging so a c-section was needed. Unfortunately due to the emergency nature of the labour at this point and the fact that the epidural had only been placed about 20 minutes before ds was born it was not strong enough and I had general anesthesia.

I have wondered if somehow the epidural affected the labour and maybe things might have turned out differently but really the epidural was only in for about 30 minutes. If I had chosen no epidural I think my labour and my babies birth would have been the same in the end.

The epidural itself was OK although I did feel like it affected my ability to push. With my two singleton births I remember not really caring about anything at the end except to get the baby out! This time the epidural made me comfortable enough that I was aware of all the people around me, the conversations they were having and I felt extremely self-conscious. Hospital policy was delivery in an operating room and there were probably about 10-15 people kind of lingering around. Ds ended up needing forceps to help get his head out - after that I was fine. But considering I didn't need any kind of help with my previous 8lb babies I was surprised to need help with little ol' 5lb 8oz ds.
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