non natural vbac?

[texmati]

Is it wise to plan to get an epi if you are going for a vbac? There wasn't time for my epi to take before my section, so I was knocked out. I don't ever want that to happen again.

Are there concerns outside of the customary concerns regarding the epi?

[Monkey Keeper]

The biggest concern that differs is that you will not *feel* a rupture should it occur. Because of this, practitioners are pretty adamant about fetal monitoring once you get an epi since FHT are the only early indicator of a rupture when mom can't feel it.

Another issue could be the epi slowing down labor. Lots of caregivers out there try to hold VBAC moms to the "curve" more strictly because they're concerned about wear and tear on the incision of labor lasts too long.

An option for you might be to have the epi catheter placed but not dosed or running.

[texmati]

Thank you. Those are both issues I hadn't considered.

[AlexisT]

Keep in mind that not all ruptures result in severe pain. I see that promoted on MDC--"don't get the epi because you won't feel yourself rupture." It's not foolproof by any means. Many practitioners want you on EFM anyway, epidural or not, because it can detect signs of rupture before you would feel pain. (The issue with EFM in a VBAC is not whether it does this--it's whether this benefit outweighs the increased chance of a caesarean.)

If you're afraid of a crash section under GA, unfortunately an epidural may not be the answer. It would save the time of having the epidural placed, but you might not be numb enough for surgery and they'd have to top you up and wait. If time is so critical that they're doing GA, they may not have that long. I don't think having an epidural placed but not in use would be particularly helpful--in an emergent (not crash) section, they can do a spinal, which is quicker.

I don't think there's a reason to avoid epidural if you're truly in pain, but I don't think there's any reason you should have one if you don't really feel you need it. I do know of quite a few medicated VBACs, and tbh, I'd rather have the VBAC with an epidural than a CS.

[kltroy]

This is true... however, I'm not convinced that VBAC moms who choose an epidural do any worse, in general. Continuous fetal monitoring seems to be the most reliable indicator of UR (pain often accompanies UR, but usually changes to fetal heartrate patterns can be seen earlier), and that will be covered if you've got an epidural. If you wait until labor is well established (say, 6 cm) then more often than not it won't slow things down too much.

IMHO, it's simply a preference issue. Lots of VBACers got burned the first time they had an epi b/c it initiated the cascade of interventions (or, more often, was a part of that cascade, which started with induction of labor). So it's a case of once bitten/twice shy.

I actually know several moms who had epidurals and successful VBACs. Although it wasn't necessarily the plan for them, it's what ended up working best for them at the time.

My opinion: plan a natural birth, but go with the flow when it comes down to it -- if things aren't progressing fast and an epidural will let you get some much needed rest and let your body do its thing, this can be very helpful. With a supportive care provider, there's no reason an epi should change your chances of having a successful VBAC.

[GoBecGo]

I know several women who got an epi and then, once stuck in the bed, things stalled a little, the ob got twitchy, and a repeat c was done. Being able to move is a valuable and worthwhile tool for almost ALL labouring women, and not something to be traded lightly. I agree with PP, IF you have been labouring so long you are exhausted and have been awake for way longer than you normally would be then an epi might be helpful, but otherwise i'd be very cautious of them. Unfortunately every intervention increases the risk of the need for further intervention, so the less you can have the better.

[texmati]

thank you all, you've given me a lot to think about. Looking deep inside myself, what I really want is some control and peace in the birth process, which is not really possible. Birth is unpredictable-- natural or otherwise.

I was so afraid during my last labor... I don't want to have that fear and panic again. I have confidence in my body-- just not in myself.

[texmati]

Originally Posted by kltroy

My opinion: plan a natural birth, but go with the flow when it comes down to it -- if things aren't progressing fast and an epidural will let you get some much needed rest and let your body do its thing, this can be very helpful. With a supportive care provider, there's no reason an epi should change your chances of having a successful VBAC.

Thank you so much for this... I think I will go this route this time.

[lotus.blossom]

Hypotheticly (if I were to have a 3rd baby) I would consider an epidural for my VBA2C. Heres why..... I have had 2 failed natural births. First one at an attached birth center, second a homebirth transfer. BOTH times I had a malpositioned baby (despite every best effort to fix it). I have recently read a few birth stories from mamas who had hospital births, who were able to birth vaginally because of having the epidural and the doctor repositioning the baby. I don't know how common that is but for me if either faced with a repeat c/s or the possibility of a vbac with epidural I'm taking the latter!!!

[Monkey Keeper]

Originally Posted by kltroy

I actually know several moms who had epidurals and successful VBACs. Although it wasn't necessarily the plan for them, it's what ended up working best for them at the time.

My opinion: plan a natural birth, but go with the flow when it comes down to it -- if things aren't progressing fast and an epidural will let you get some much needed rest and let your body do its thing, this can be very helpful. With a supportive care provider, there's no reason an epi should change your chances of having a successful VBAC.

I have to clarify--I am one of those moms!

I was just providing some of the reasons that surfaced when weighing this decision myself. In the end, things were pretty much like kltroy spelled out above. I had atypical pain with my contractions and had been awake and in labor for nearly 24 hours when I got my epidural. It was a godsend if only for the 3 hours of intermittent sleep it gave me since I ended up not delivering for ~8 hours after the epidural was placed. I did end up with an fetal scalp monitor after the EFM was not tracing at. all. but it didn't hamper my progress in any way.