Epidural vs. Pain Meds. Want best chance for VBAC

[capsgirl08]

I gave birth to DS after 30 hours of med free labor and pushing before being taking in for the c/s.  He was 10lbs and I pushed for 4 hours.  DH said several people had to come in and get leverage to push DS1 back out of my pelvis.  I remember rocking side to side on the table as they were trying to get him out.

I am 34 weeks pg with DD.  Fro several reasons, I want a vaginal birth.  I tolerated pain well with DS, but the pushing was excruciating.  I have past trauma and did not even like the nursing checking my dilation.  I am wondering what the most wise decision would be, and if that would include pain medication.

Does anyone have information on what might be "better" safety-wise as far as pain management is concerned? Specifically, something that compares epidurals vs. IV drugs, and what the differences are between the IV drugs?

As much as I want a med-free birth, I want even more that she be born vaginally, and I am coming to terms with and accepting that epidurals or IV meds might make that possible.

Any thoughts or information?  Thank you very much in advance!

[Jayray]

Several birth books I have compare the IV drugs and epidurals.  Off the top of my head...The Birth Partner does (even between the different types of IV drugs!) and I think the Our Bodies, Ourselves pregnancy book does.

From what I understand, IV drugs are for earlier in labor.   You can't use them during pushing because they effect the baby, too.  They want them to be pretty much worn off by the time the babe is born.  And from what I've read, it SEEMS that IV drugs have more of an effect on the baby than epidural drugs.  You should definitely read for yourself, though. 

[MegBoz]

Yes, I think I too have read that IV drugs affect baby more. 

Some good books to start with might be "Thinking Woman's Guide to a Better Birth" and "Gentle Birth, Gentle Mothering" by Dr. Sarah Buckley (published in 2009, so very current.)

From what I've read on MDC, it seems IV narcotics sorta make you not care that you are in pain rather than really eliminating it. People talk about feeling loopy, nauseous, out-of-it. Sounds very unpleasant to me. I also personally HATE feeling nauseous. I took oxycodone once for a tooth abscess & thought I'd vomit any second for hours - it was awful. So if you also get nauseous with narcotics & hate that feeling, might be something else to bear in mind.

[zuzunel09]

I had an epidural; it doesn't paralyze you, it just eases the pain of strong contractions and pushing.  I had one for about an hour at the end of labor then they turned it off so I could push, so you might want to ask your doctor about whether they'll keep it on for pushing.  My son was healthy and alert with apgars of 8 and 9, although as everyone says no drug is risk-free.  I believe epidurals are made from novocaine-like drugs, but there are also some that blend the 'caines with narcotics for efficacy.  Mine completely relieved the excruciating pain of contractions, but I did have mild back pain at the injection site for several months.

[texmati]

Epidural. I had iv pain meds for my first birth-- no one told me that they would essentially put me to sleep. I wasn't even awake enough to tell them to stop giving them to me.

[SGVaughn]

I had IV drugs with my first...it was horrific..I never even asked for them...and between them and exhaustion it was like a never ending twilight existence..you could have handed me any baby afterward and I wouldn't of known the difference..I absolutely don't recommend that route

my second I had an epidural..it was a very strong epidural and I couldnt even lift my own legs..it wasnt an unpleasant birth and my daughter did really excellent after even though she was 5-6 weeks early(room air/alert etc)...the ob was very hands off so though I had to sort out pushing I was given plenty of time to do so and gentle guidance on when to push based on peak of contractions (by sight not monitor)

my third was a walking epidural...out of the three the best experience..I could feel her body move through my pelvis..I could still feel contractions even though they didn't hurt, just pressure and actually felt pushy when the time came..she was makin chirping noises before her body was even out..but she got passive oxygen..I really don't know if its because she swallowed and inhaled so much fluid and snot on her way out or what

[Smokering]

Of the two, I think I'd go for the epidural - ensuring I was given a "walking" epidural (one that allows you to be fairly mobile. I'd definitely avoid pethadine - my midwife's words were "I avoid it like the plague". MIL had it with DH, and was so out of it she can't remember him being born (which upset her a lot!); and a lot of people find it makes them nauseated. I HATE nausea - I'd rather have the pain!

Have you considered any wackier options? :p How do you feel about Hypnobabies? What about water birth? Or a TENS machine? The good thing about those is that they aren't "medical" solutions, so they wouldn't interfere with you getting an epi or pain meds if you decided partway through labour that you needed them. (I mean, obviously you'd have to get out of the birth pool to get an epi, but it's not like taking one drug which would contraindict another drug, KWIM?)

[SGVaughn]

I agree with what smokering said as well about exhausting all non medication options first because frankly the epidural will still be there waiting if they don't work out for you and they may very well be all that you need

ETA: I wanted to add that my third had an excellent latch right off the bat too...she'd go for anything that even resembled a nipple...lol

[Sudonk]

I agree with Smokering, too.  Give yourself plenty of options, because the epi will be there if that turns out to be the best choice for you.  And whether you choose to learn the full Hypnobabies program or not, their VBAC CD is a great resource.  It can be used as a stand-alone piece of preparation, or along with the Hypnobabies class or Home Study. 

[AlexisT]

Smokering: Pethidine (Demerol to the Americans) is a waste of time. From what I've read it doesn't even work very well for labor. American hospitals tend to use Stadol, Nubain, or fentanyl from the descriptions I've read.

Personally? If those were the two choices on offer, take it or leave it, and I needed pain relief, I'd choose the epi. With IV narcotics you run the risk of being loopy and still feeling the contractions. I've heard descriptions of Stadol labors where the woman would simply fall asleep between contractions. An epi might fail, and you'll be stuck in bed with an IV and catheter (American hospitals rarely let you walk--liability, plus, the epi tends to turn your legs to jelly even if it's supposed to be low dose) but its success rate is higher. I'd rather be numb as a plank from the chest down (the surgical epidural) than high as a kite on narcotics. YMMV. My idea of hell on earth is conscious sedation, so I have strong opinions on this one.

Other downside of narcotics: Can't be given after a certain point because they depress baby's breathing.

[justKate]

Quote:

Originally Posted by texmati 

Epidural. I had iv pain meds for my first birth-- no one told me that they would essentially put me to sleep. I wasn't even awake enough to tell them to stop giving them to me.

 

It's hard to talk about.  I don't remember a lot about DD's birth.  I wish I had gotten a lighter epi and foregone the IV drugs.

[noahs.mom06]

I agree about choosing an epi vs IV meds, but like Smokering, I strongly recommend exhausting all of your other non-medical options first. TENS can be amazing, as can water (your hospital will probably want you continuously monitored, from my experience, but you can ask if they have telemetry monitors, you can use those in the shower at least). I also strongly recommend having a doula. Most importantly, hold off as long as you possibly can on getting pain meds, whatever kind you choose... As a doula, I've seen quite a few VBACs turn into CBACs because moms decided they couldn't do it and got epidurals between 4-6 cm...