Originally Posted by devilish_fetish
ALL of the hospitals (and the cnm i asked about my options during a hospital birth before deciding on a homebirth) stated that what they could do is put the catheter in, but not put any medicine in if you don't want it in. This way if an emergency c-section is necessary, they won't have to give you general anesthesia. If i was having a hospital birth, it's what i'd do. but that's just my .02
(Interestedly following this discussion, here!! I have twins due in July, and have recently changed doctors but am waiting to discuss protocol etc. and be sure that I want to stay with this practice....)
I don't know that having an epi line in place with no meds would
ensure that general anesthesia is unnecessary in the event of an emergency c-section. It's not even completely clear that having an active
epi during labor ensures that the extra boost of meds necessary for a c-section could take effect in time (via epidural) to accommodate a really serious emergency.
I think it might be worthwhile to clarify the degree of emergency we are talking about when we mention the possibility of "emergency c-section," or maybe distinguish whether the c-section is "necessary" (we can't get the baby out this way) versus "emergency" (the baby is in danger.) Would a doctor really
be comfortable assuring someone that under no circumstances would you need general anesthesia if you had an epidural going and ended up in an emergency c-section situation??? That there's no chance of even an active labor-dose epidural taking too long to bump up and take effect for a really serious emergency? And would the doctor say the same about the spinal line running saline (no meds) and starting "from zero"?
I guess it's worthwhile to ask whether the spinal line with no meds even would be viable for a truly urgent emergency? And if not, and
if the "necessary" (versus "emergency") c-section for position problems is the more likely scenario in 2nd twin births anyway, would there typically be a window there for a quick spinal prep (not an epidural) before the c-section?
If the answer to that is "probably yes," maybe it makes more sense to avoid the epidural and the spinal line entirely if the main reason for opting for them is "avoiding the need for general anesthesia in the event of a c-section." If a true urgent emergency
would likely result in general anesthesia IN SPITE OF having an epidural in place, why not labor without the epidural and plan on having a spinal if c-section becomes a reality and there's time for the spinal? (Realizing that general anesthesia may still result if the urgent type of emergency comes up, just as it could with an epidural in place and running.)
If position issues are statistically more likely than distress-plus-position issues in second twin c-sections, it seems like general anesthesia is an unlikely prospect whether you have an epidural in place or not. There typically would be time to prep for the procedure. (And spinals are supposed to be faster than epidurals, regardless.)
I guess the potential issues of internal version and extraction are the remaining ones to consider, whether it makes sense to have the epidural there for the mother's comfort during these procedures. But maybe the window of time applies here, too. After all, if you have the epidural line with no meds in place, is there going to be time to start up the meds and have them take effect before the procedures need to happen? And if there is, would it be just as possible to wait and opt for a spinal at the point that internal version comes up, as well? (Is there a 5 minute window, or not? And how long does it take the meds to take effect once they start running them through the epidural line, anyway?)
And I guess if one of the "potential issues" to consider is a previously vertex Twin B turning breech or transverse after the first twin is born, I'd want to know the OB's thoughts on what people have shared in recent threads about "holding the spot" externally and preventing the vertex baby from turning once the womb space is opened up. As in, what about these approaches to managing the situation?
Part of my reservations at this point (at the point of discussing options with my OB) is that I've read that there are similar risks to the mom from the saline version (no meds) of the epidural line placement. So apart from the issue of epidural meds, just by having the line in place, you run the risks for spinal headache, lingering epidural backache, and the possible need for a blood patch. Not that they wouldn't be a worthwhile trade for the option to have muscle control and remain vertical while laboring, so setting the spinal line with no meds might be worth it. But I would wonder if it really
were such a truly necessary step to avoid general anesthesia, so that's where I'd start.
("Can you guarantee that I wouldn't need general anesthesia anyway, in an urgent situation, even if I have an epidural?" "In a typical situation such as deciding on c-section for positional reasons with no associated distress, would there typically be time for a spinal ANYWAY?" "Even with some distress or emergency, is there likely a 5-15 minute window that might allow for a spinal ANYWAY?")
I'm still a couple of weeks away from my appointment with my OB, so majorly musing over these things right now!