Does VBAC = no pain meds?

[HappyMommy2]

I know that you don't want the epi too early and slow the labor ... but could I get it at like 5 or 6 cm?

I had to get it very early (1cm) due to pitocin before my first baby (c/s). Since I will never have pitocin again, I am thinking I could get further into labor without needing paid meds. But I think I might want them towards the end. It's a little scary to try for no pain meds.

What are your experiences?

[JanB]

Without suggesting for a moment that this is what should be done, or the ideal, I will share my experience with my VBAC baby:

I got an epidural at around 6-7cm of dilation, partially because I was exhausted from lengthy prodromal labor and partially because the hospital policy was to "strongly suggest" epidurals for all VBAC patients and I just kind of caved in. It didn't slow my labor; if anything the pace picked up a bit after the epidural went in. And my daughter was born vaginally with minimal tearing, about 4-5 hours later. They turned the epidural down or off (I am not sure which) right before the pushing stage, so I was able to feel pushing contractions, which I think helped immensely.

This time around I plan to go meds-free, but getting an epidural does not necessarily mean you will not have a successful VBAC.

[alegna]

I would avoid it. It *greatly* increases the chance of section.

But you're talking to a mom who homebirths, I never considered an epi an option short of a dire emergency. They have risk factors for both mom and baby.

-Angela

[ndakkitten]

I had an epidural for my VBAC in December because I was getting overwhelmed by the contractions. Yes I had pitocin, but it was an extremely low dose and didn't cause what I consider "Pit" contractions (believe me, I never want to feel those again!)

I got the epidural when I was at 5 cm and my husband knew I was nearing transition (he didn't tell me this though, he just said he figured things were going to start going faster). Now, my spinal dropped my BP which gave us a scare, but they brought it back up pretty quickly and I progressed rapidly after the epidural was placed....I had my baby less than an hour and a half afterwards.

If I had known I would progress that quickly, I may have opted to skip the epidural. However, I made my choice based on knowing I was ready for some pain relief and that the Nubain had been totally ineffective. Also, our doula was unable to make our birth, so it was just me and my DH (which wasn't bad, he was extremely prepared and is a paramedic). I did discuss it at length with my DH before making the decision.

In my opinion, an epidural can be useful. In my first labor, it allowed me to get pain relief so I could take a quick nap as well as relax, which actually allowed my labor to progress (I was stuck at a 7). After the nap, I woke up saying I had to push, and sure enough, I was complete!!

I would consider other options of pain relief before going straight for an epidural. I would have a doula and also research what pain meds you want ahead of time (such as Nubain, Stadol, etc).

I am also curious...why do you say you will never have pitocin again? Just because you are trying for a VBAC doesn't mean you won't ever use pitocin again. For my VBAC, my OB used a very low dose of Pit to augment my contractions to bring my baby down (she refused to drop even after my water broke).

[alegna]

Originally Posted by ndakkitten

I am also curious...why do you say you will never have pitocin again? Just because you are trying for a VBAC doesn't mean you won't ever use pitocin again. For my VBAC, my OB used a very low dose of Pit to augment my contractions to bring my baby down (she refused to drop even after my water broke).

It is well documented that pit GREATLY increases the chance of rupture. It should never be used in VBAC situations.

-Angela

[JanB]

Originally Posted by alegna

It is well documented that pit GREATLY increases the chance of rupture. It should never be used in VBAC situations.

-Angela

Agree with this. My OB/GYN also agrees. He says that in certain situations, he might consider using a very low dosage, but that as a general rule, Pitocin is to be avoided for all VBAC patients.

[Knittin' in the Shade]

Originally Posted by alegna

It is well documented that pit GREATLY increases the chance of rupture. It should never be used in VBAC situations.

-Angela

do you have any links to the documentation regarding this? When I was in hosptial waiting for labor to start, I searched high and low online for info, and found research about cytotec greatly increasing rupture, but not pit. FWIW, I did have a very, very low dose of pit for my VBAC, and it was perfectly fine and I had no pain medication at all. In fact, the hospital staff were glad that I didn't want an epi, as they said they usually discourage VBACs from the epi because they want mom to be able to have full sensation in the uterus so that any rupture would be felt.

[alegna]

Sorry- I haven't kept links on it...

-Angela

[JanB]

HEre's one for you, although it primarily discusses the use of prostaglandins in combination with Pitocin:
http://www.medscape.com/medline/abstract/16260206
From the American Journal of Obstetrics and Gynecology:

OBJECTIVE: This study was undertaken to determine incidence and risk factors for uterine rupture in women attempting vaginal birth after cesarean delivery (VBAC) in a wide range of hospital settings. STUDY DESIGN: We performed a case-control study nested within a cohort of women who have had a prior cesarean to determine the incidence and risk factors for uterine rupture in women attempting VBAC. RESULTS: The incidence rate of uterine rupture in those who attempt VBAC was 9.8 per 1000. A prior vaginal delivery was associated with a lower risk of uterine rupture (adjusted odds ratio [OR] = 0.40, 95% CI 0.20-0.81). Although prostaglandins alone were not associated with uterine rupture, sequential use of prostaglandin and pitocin was associated with uterine rupture (adjusted OR = 3.07, 95% CI 0.98-9.88). CONCLUSION: Women with a prior cesarean should be offered VBAC, and women with a prior cesarean and prior vaginal delivery should be encouraged to VBAC. Although other studies have suggested that prostaglandins should be avoided, we suggest that inductions requiring sequential agents be avoided.

[sweetfeet]

I went drug free. It was a planned hb so I didn't have access to drugs but I transferred after 33 hours of intense back labor and a cervical lip that my mw couldn't move out of the way. I think he jostled into proper position on the bumpy and crazy ride to the hospital and was born 25 minutes later. The pain is intense but wasn't unbearable. I'm glad that I didn't have any drugs. He was so alert when compared to my first.

[Robinna]

I'm a homebirther so I'm kinda anti-epi by nature - I think labour is cool and wouldn't want to miss any of it. I also believe strongly that it can start a whole cascade of interventions and not a single one of them are desirable so far as i'm concerned. Yes, it's possible to have an epi and that be it. But there's no way to be sure that pain relief is all that's going to happen. So you just need to do your homework and make an educated decision, it may well be that it's worth it for you, and that's totally valid.

That being said, I'm also a hypnobrther. I didn't actively use it for pain management altho I'm sure some of the posthypnotic suggestions in the course of the training were at play. (for me it was about conquering fear and cultural programming - I wanted my labour to be whatever it was supposed to be, for me, but free of cultural garbage) But if you don't trust the epi but are concerned about approaching labour without any "help" check out hypnobabies. 70% of mamas who use it are totally pain free.

xo Robin

[Sagesgirl]

I had Pitocin to augment my labor in my VBA2C. I also had Fentanyl (at least, I believe it was that; I honestly don't remember beyond it started with an F) injected into my IV line, which allowed me to get my first rest in about 36 hours. I would not have an epi, but there is so much more to pain relief in labor than just that.

[MCatLvrMom2A&X]

Good luck to you on whatever you decide.

[2Sweeties1Angel]

My VBA2C was a failed homebirth because I wasn't progressing. I labored for about 10 hours at home, more than half of it in my birth pool, and I just wasn't dilating so I went to the hospital to see what was up. I ended up getting an epidural several hours later because I was exhausted and oddly enough, it made me dilate. I had PIH and I read somewhere that high BP can hinder dilation and I know the epi lowers BP by a lot so I wonder if that had anything to do with it? Anyway, I had them turn it down really low, just low enough to take the edge off but not kill all sensation, for pushing.

The pain itself wasn't *too* horrible. It was bad, but nothing I couldn't deal with if I had to. It was the exhaustion that got me.

[richella]

I only took the epi because I could see the writing on the wall and I knew the c/s was coming so I might as well get some relief. The nurses told me it "usually" speeds up labor but it did nothing of the sort for me.

I intend to go med-free this time, but if I do take anything my first choice would be to start with Nubain or Stadol (MW told me they are similar). I found that to be of great benefit when I was too tired to ride out the contractions. You still feel it, but somehow it's more bearable mentally.

But, I'm also doing HypnoBirthing. Can't recommend it from experience yet, but I find it's already helping me eg when people tell me negative things about vag birth/labor. I just know whatever they're saying has nothing to do with me, and it doesn't really bother me.

[ckhagen]

I had an early (2cm) epi during my first birth because of Pitocin. The epi in and of itself led me into a c-section because it gave me a low grade temp (100.1) and had me sitting on my tailbone which kept the baby from rotating.

My VBAC was drug free and it was SO much more tolerable than the Pit contractions. Of course it was painful, if I would have had the option of an epi (I delivered in a FSBC), in my fit of pain-induced "I can't do this!!" rampages, I probably would have taken it. But, I'm REALLY glad I didn't. The experience was so much more than the pain... I learned things because of it.

[witchbaby]

Originally Posted by 2Sweeties1Angel

My VBA2C was a failed homebirth because I wasn't progressing. I labored for about 10 hours at home, more than half of it in my birth pool, and I just wasn't dilating so I went to the hospital to see what was up. I ended up getting an epidural several hours later because I was exhausted and oddly enough, it made me dilate. I had PIH and I read somewhere that high BP can hinder dilation and I know the epi lowers BP by a lot so I wonder if that had anything to do with it? Anyway, I had them turn it down really low, just low enough to take the edge off but not kill all sensation, for pushing.

The pain itself wasn't *too* horrible. It was bad, but nothing I couldn't deal with if I had to. It was the exhaustion that got me.

my vbac was similar. we planned an hbac and i labored at home for more than 24 hours but didn't progress past 2cm. i got an epi about 38 hours in and got my first sleep in more than 2 days. i gave birth after 48 hours of labor.

[wombatclay]

Knittin' In The Shade:

I was in hosptial waiting for labor to start, I searched high and low online for info, and found research about cytotec greatly increasing rupture, but not pit.

Check out the studies linked from (and summarized on):
http://www.homebirth.org.uk/vbacinduction.htm

They're all major studies published in reputable/peer reviewed (national and international) medical journals. Some care providers feel that the use of pit and other medications to augment an already active labor can be safe, and some studies do show that the use of pitocin and other oxytocins to augment labor can be safe (though other studies do show in increased risk of UR). However the use of pitocin to INDUCE labor in a VBAC mama carries serious risks. Cytotec is an insane risk for any mama (it's not even approved by the FDA for induction...it's an "off lable" use and the package insert on the drug even says not to use it for labor induction!), but other chemical induction agents aren't necessarily safe either.

To the OP- a VBAC doesn't mean you can't have pain meds (though you may or may not want them). Some doctors try to "scare" mamas by telling them that a VBAC means no pain meds, and that you might as well go with a repeat c/s and save yourself the pain. This isn't true, and it's just another way for non-VBAC spportive care providers to intimidate mamas. That said, if you have strong labor support (find a doula!) and a care provider who believes in natural birth and in you...you may find that you don't really need pain meds after all!

Good luck!

[CountryMom2e]

With my first, I labored for awhile, and then when my contrax switched from 1 every 7 min to one every 90 sec, I had stadol and then an epi. I hated stadol - it really drugged me out. The epi was glorious. Good thing I had it, as I wound up needing an emergency c due to my becoming preeclamptic and DS's heart and pulse ox dropping. As it turns out, DS had a short cord.

With my second DS, I was scheduled for a c-section the next day because of my worsening repeat pre-e, when I unexpectably went into labor. I had wanted a VBAC but did not want an induced VBAC, hence my reluctant agreement for the repeat c. This time I knew I would labor fast (my first I went from 3cm to 10 in 3 hrs), so I knew there was little risk of an epi *stalling* my labor. I tried stadol again, which was ok this time, but the back labor was brutal, so I went ahead with the epi. I had to stay on my side because of my pre-e, so my epi affected one side more than the other - otherwise, no side effects and I got to sleep for about 2 hrs while Jack descended. My MWs called it passive descent - I was fully dialated but we waited and rested while he came down until I felt the urge to push. After just 40 min of pushing, he came into the world with a great big woosh : Jack also had a short cord! But i think because I didn't push, he came down with less stress. Then again my condition the second time around was more stable too, with my BP fairly reasonable and steady. Who knows.

My advice? You never know what will happen. Be open to different possibilities. Try other pain relief first if you need something. But have your labs done early so if you find you want/need an epi, you can have one quickly. It sucks to be in transition, contractions every minute, and be trying to get an epidural done. But it sucks even more to have back labor and be confined to bed without pain relief!!!

GL!

[OnTheBrink]

My VBAC was supposed to be a HBAC, so I didn't have any plans for any medical stuff. But after 54 hours of intense labor, I was exhausted and still at 1cm (despite the tell tale transition signs), so we transferred. I actually transferred wanting and planning for a cesarean. But the hospital MW refused to recommend that since baby and I were both fine.

So, I was manually dilated from 1-4cm (ouch). Then, I was given pitocin to augment my labor and stadol to give me some rest.

While the stadol did allow me to rest, there was something very bad about it. I fell asleep between contractions and woke as they peaked. So, to my aware self, it seemed that I was in one constant terrible contraction. It was horrible! I felt totally out of control and, frankly, in terrible pain.

I don't know what it would have been like to have the pitocin without the stadol. (OnlyBoys was there. I'll ask her in what order the pitocin and stadol were administered.) I HATED the stadol, though.

That said, I think an epidural would be scary. I would hate to not be able to feel what was going on. At least with the stadol, I was woken by contractions and certainly would have been aware of a rupture or something else bad.

It's certainly a great idea to avoid pitocin and pain killers. But sometimes things don't go as planned!