Epidural and VBAC

[azmomma]

I just met with my new doc (at 28 weeks prego)...and I was really into everything he was telling me. He really seems on the same page as me - from what I've found with all my researching. One thing that he did mention that surprised me was that he DOES recommend an epidural with a VBAC. I was asking him so many questions I want to go into further detail when I meet with him again.

My question to you: Has anyone on here had epidural with VBAC? Why would he encourage epi with VBAC - that way you are already somewhat ready for a c-section in the event of a uterine rupture perhaps??

I should note that he WILL NOT do pitocin or other means of induction. He's a very natural doctor.

Thanks!

[ollineeba]

Originally Posted by azmomma

that way you are already somewhat ready for a c-section in the event of a uterine rupture perhaps??

Yes. Or any other reason for a c/s.

I'm of the opinion that an epidural does decrease your chances for a successful vbac. Now, that's not always the case, of course, but it greatly hinders your mobility -- listening to your body's cues, movement to help baby descend, when/how to push, etc.

[limette]

The risk of an epidural leading to a c-section is the only thing keeping me trying for a home birth. Otherwise I would love to have a pain free labor (back labor is horrible for me).

My midwives recommend a heploc for vbac in case of an emergency but not an epidural.

[GOPLawyer]

JMO but I would absolutely recommend NOT having an epidural. As a general concept, epidurals increase the chances of a c/s. Further, if you were to have a UR, you wouldn't be able to feel/detect it. I think it's crazy to take that away.

[Bmorefarmgirl]

can't epidurals also slow labor? due to decreased mobility, etc. slow labor would lead to needing to speed things up, ie, use pitocin. i think agreeing to an epidural beforehand would be a big step down the "cascade of interventions" road.

[mediumcrunch]

Reasoning behind that is usually so they can get you to the OR faster. I call foul on that. If you are experiencing a catastrophic rupture and need to have a crash C-section they will not be concerned with anything but getting that baby out, including topping off an epidural to C-section strength. You are looking at a rapid acting IV anesthetic and gas.
I believe, the real reason, it is easier for them to monitor the baby. Mom is immobile and external monitors work better that way and convincing a numb, catheterized mom to accept an IUPC and scalp monitor usually isn't hard and that is often how a VBAC mom with an epidural will end up. With the whole intervention kit and kaboodle. Sometimes, like in the case of maternal exhaustion, it is necessary but I wouldn't buy into it 'just because'.

I've had epidurals with 2 of my 7 VBAC's. My first one and my last one. First time, because that was how you had a baby in the hospital as far as I knew. The last, after 4 unmedicated births, because I was emotionally and physically exhausted before labor even began and didn't have the support I needed for an unmedicated birth. Both ended in vaginal births but I'm hoping to be in a place and have the support I need this time to happily shoo the anesthesiologist away.

[azmomma]

Originally Posted by mediumcrunch

I've had epidurals with 2 of my 7 VBAC's. My first one and my last one. First time, because that was how you had a baby in the hospital as far as I knew. The last, after 4 unmedicated births, because I was emotionally and physically exhausted before labor even began and didn't have the support I needed for an unmedicated birth. Both ended in vaginal births but I'm hoping to be in a place and have the support I need this time to happily shoo the anesthesiologist away.

MediumCrunch... That is AMAZING 7 VBACs!!!!!! I have a question for you - How/What did you do during those "medicated" births (epidural) to help your labor along? I.E. Did you wait until you were a certain # of cm's dilated? Did you have a doula there to help you "keep mobile" such as turning over on side...maybe they help move legs for you in bed??? I'm just trying to think things out here.

Thanks!

[mediumcrunch]

My first one was a textbook induction on an unripe cervix for low fluid (insert eyeroll). Pit to the eyeballs, first epidural around 2cm, 2nd one (after the first catheter shifted) around 4cm. No doula-they didn't really exist in 1994 in KY . I was lucky. Really lucky. He was in a bad position and I pushed for almost 3 hours. He ended up with RDS and polycythemia and I had bladder damage and had to self cath until he was 10 days old.
This last one, well as a grand multip with a msuy cervix at 2-3/80% and 6 vaginal births under my belt (pardon the pun) progress with an epidural wasn't an issue. I was induced, this last time for worsening PIH at 36+6. It only took AROM and a little pit and the baby was out in a few hours. I've never had a birth like that first VBAC again.
I had 'real' doulas with babies #5 and #7 (mom or attentive midwife with #4 and #6). They were absolutely INVALUABLE with #7. I had pre-e (admitting BP of 180/110) and was on mag and pit and had a broken foot to add to the mix. If I didn't have April and Jackie there is no way I would have been able to forego pain meds/epidural. Having their constant support, help to change positions, just their presence was such a help.

If you can afford it and find a woman you connect with I can't recommend a doula (or two) enough for a hospital VBAC. Even if you have a great midwife at some point she will be busy with what is going on below your waist and won't be able to give you that 1-1 emotional support that is so important, especially if things aren't going as hoped for.

[mediumcrunch]

BTW, my nurse for my last VBAC was awesome. She had had a homebirth and 2 unmedicated hospital births herself. But even she became unaccessable to me for support when my BP took a dive (2 doses of epinephrine to keep me conscious) and baby started looking iffy. Last 90 minutes or so of my labor was spent with nurse, OB and anesthesiologist at bedside. They were joined by the NICU team at the end.

My Pre-e labor had me in tears with "this is not the way I have babies!!!" and I just gave up with this last one, like I said the pregnancy had been hellish and I was completely drained. I'm hoping to get my 'groove back' this time around, this pregnancy has already been so much better than the last.

[azmomma]

WOW mediumcrunch! If I were you I would have had an epidural too...you are amazing hearing all that you were going through broken foot and all! Thanks so much for sharing, and it has really made a difference. I'm interviewing a doula tomorrow. I'm SO hoping she is the right fit...I really don't feel up to lots of interviews. She was highly recommended by a very reputable source. My main concern is that since she has HBAC that she will support me with my wishes. I'm not the homebirthing type (nothing wrong with it AT ALL...just not for me), and so if she is so much more natural...and I am not. I hope she can be okay with that. Anyways, thanks!!

[AlexisT]

One thing I would like to add about PE: Because an epidural lowers blood pressure, it can sometimes be very helpful to women with PIH/PE. It's very much a case by case thing but it's something women with a history of hypertension should know about. I know of a few births where the epidural meant that vaginal birth was possible.

[DocsNemesis]

I wouldn't get an epidural as a VBAC for exactly what was mentioned. It might hurt like hell, but I want to FEEL it if I have a rupture, so I can say hey, this isn't right, get her out NOW. I'd also rather be knocked out for an emergency like that-it'd take time to get an epidural up to cesarean strength, time I wouldn't want to waste. I'd be sad missing the delivery, but I know my fiance would take care of her and all I care about is her well being That and I HATED my cesarean...I might opt for general even if it weren't an emergency, I dunno. But thats just me-the cesarean totally freaked me out, I can't stand the feeling of people touching me while numb. It really does something weird to my brain

[babz]

I had a epidural w/vbac

I got an epidural with my VBAC. My doc too was a proponent of epidural for VBACs - she told me that epidurals can relax the mom and allow her to open up.

I really did not want an epidural or pitocin. After many hours of flaky labor I got a low pitocin drip, which made my contractions come regularly. But my blood pressure started going up, probably due to the pain. My section was probably due to the fact that I had been on bedrest for elevated bp. I am terrified of elevated bp.

Knowing that one of the more pleasant ways to treat high bp in labor is epidural, I asked for one.

My doula asked me to have my doc check my cervix before the epidural - 5cm, 100% effaced. 30 min. after the epidural, doc checked again - 8cm! My bp also went down to normal and didn't go back up. The anaesthesiologist checked on me too to see if I needed more meds in the epidural. I actually could still feel some pain, but the edge was off, so I told him I was no thanks. A few hours later, they shut off the epidural and 45 min. after that I started pushing - two or three pushes and he was out. My doula said that he didn't act drugged probably b/c the epidural wasn't in very long. And I was up and peeing about an hour and a half later.

After the epidural, I paid very close attention to the monitors. Decels are normal during contractions because the baby's head is being compressed. But if they keep on, something is wrong. They can get you to the O/R pretty quick. I know a mom who ruptured on no pain meds and didn't feel it and didn't know anything was wrong except from the decels on the monitors.

Would I do it again? You bet. I think key for me was waiting as long as possible for both interventions. I hope for future births it's not necessary, but I was glad for both pit and epidural for that particular birth.

[MamaMelis]

I had an epidural for my VBAC! I got to the hospital at 5 cm, got it at 7-8 cm, and by the time I was ready to push 5 hours later I had great feeling and was able to get her out in 4 easy, controlled pushes.

The hospital where I delivered (and my OB) had mandated fetal monitoring with a VBAC. It was, quite honestly, annoying. Being trussed up in bed with fetal monitors made me feel like a trapped animal ~ Getting to 7 with movement was easy, but the moment that they told me that they needed me on the monitors for a straight hour (they didn't have telemetry units) I knew that it was time for an epidural. Laboring in bed stuck in one position is simply too much for me.

I was okay with it. My #1 goal was to get that baby out my vagina, with a minimum of interventions. I had no pit, no AROM, no nothing other than that epi, and for me, with the lingering fears and lack of faith from my CS (just 13 months prior) it was extremely helpful for me in relaxing, not fighting the pain and the fear that came with essentially being trussed up in a bed in one position.

Now that I have had a successful VBAC and reclaimed faith in my bodies ability to birth vaginally, I am really looking forward to our upcoming home birth (May).

I know that many feel that epi's are all bad, but to me, in my situation, it was helpful. I have no doubt in my bodies ability to birth drug free when given the space to move and stand and roam. When tied down to a bed, I simply could not handle the pain in a productive way and was tensing up too much to allow my body to open. The choice to birth in a hospital and adhere to their "rules" was right for me last time, and now that choice to labor and birth at home is right this time.

HTH and best of luck with your upcoming birth!!!

[thorn]

Originally Posted by MamaMelis

The hospital where I delivered (and my OB) had mandated fetal monitoring with a VBAC. It was, quite honestly, annoying. Being trussed up in bed with fetal monitors made me feel like a trapped animal ~ Getting to 7 with movement was easy, but the moment that they told me that they needed me on the monitors for a straight hour (they didn't have telemetry units) I knew that it was time for an epidural. Laboring in bed stuck in one position is simply too much for me.

the cords on the monitors at the hospital I had both of my vbacs at were long enough that you could stand, pace a little, sit on a birth ball, rocking chair, hands/knees etc. you had to stay within about 5 feet of the bed, but definitely not stuck in one position in bed.

I wouldn't agree to a mandatory epidural for a vbac, at all. Epidurals slow down labor and immobilize you, both of which are bad for birth in general. They also have other risks. I agree there are situations where they can be useful, but I wouldn't get one for no reason.

[MamaMelis]

Originally Posted by thorn

the cords on the monitors at the hospital I had both of my vbacs at were long enough that you could stand, pace a little, sit on a birth ball, rocking chair, hands/knees etc. you had to stay within about 5 feet of the bed, but definitely not stuck in one position in bed.

.

Thats super! Mine weren't.

[JayJay]

You know in terms of relaxation, I totally get it - but I had something different with my labor, and it helped me relax: an intrathecal. Basically they shoot a very small amount of morphine into the base of your spine in a slightly different location than the epi, and what is does is bake the pain "rounded" instead of so "sharp" if, like me, you are having a crazy transition in which baby doesn't tolerate you doing anything but standing up! In the end with no sleep for a couple of days, and the standing up thing, I had the intrathecal.

It was wonderful and did the trick - did NOT numb me at all or take any pain away, just made the pain more "round" instead of such a jagged pain. Also it only took effect from the top to the middle/bottom of my uterus, so I was able to really feel everything further down below, including everything about how Bella came out. I could walk about, use the bathroom and all of that with no problem at all. The only side effect I had was a bit of itching during the labor, and then after everything was done, I did have the nausea which they then treated with meds (which made me kinda super high!). But as I said, it didn't "numb" me at all, like an epi would have - I would have been very upset, had I been numb.

Once it was in and working, I was able to breathe through contractions properly again (since the sensation was still there) and dilated from 7 to 10 in about an hour, then had the "Ferguson Reflex" where your body pushes the baby out all by itself, which is amazing!

So there is an alternative!

[thorn]

that's interesting JayJay, never heard of that before. my doctor offers a paracervical block, which is a shot of anesthetic in a nerve near the cervix that sounds like it numbs in a similar way. I didn't get it but I know lots of people who have and loved it.

the problem is finding a provider who knows about using anything other than the epidural, because they are the norm in most births now.

[JayJay]

I didn't know about the intrathecal either until I knew I had to get something IN labor. My blood pressure was about 150 over 103 for the whole hour and a half (or so) that I was in transition standing up, and because of the standing and having to support myself, I wasn't dilating. On top of that her heart rate was dropping to the 80's (and at one point, EXTREMELY SCARILY, to 63bpm) whenever I did anything but stand. I knew I needed something to change, and knew I did NOT want an epi, or to be numb. I really didn't want the nubain or whatever either, so then they came up with the intrathecal and it really didn't numb anything at all actually, just as a side effect, dropped my blood pressure, which then meant Isobella was tolerating me taking a side-lying position again.

I was also extremely tired, having been in labor on and off since the previous Friday (it was now Tuesday), and having had no sleep at all Monday night. I think the mixture of circumstances led to what ended up happening in transition. I think the only other way would have been to use a birth swing - you know, those that hang off the ceiling and one can put one's arms through and support oneself? But, the hospital didn't have one.

But yes, anyway, the intrathecal was a good option for me Hopefully the anesthesiologist you have will know about it as an option - one would think that, even if they're not commonly used in the hospital in favor of the epi, they'd know about them?

[onyxravnos]

Originally Posted by GOPLawyer

JMO but I would absolutely recommend NOT having an epidural. As a general concept, epidurals increase the chances of a c/s. Further, if you were to have a UR, you wouldn't be able to feel/detect it. I think it's crazy to take that away.