April Childbirth Hot Topic: Timing of Epidural

[Maribeth]

For those of you who had an epidural during labor . . .

"Women who receive epidural anesthesia early in labor are no more likely to undergo a caesarean-section delivery than women who receive systemic narcotics for initial pain and do not receive an epidural until later in labor, according to a study published in the Feb. 17 issue of the New England Journal of Medicine." Click here (http://www.storknet.com/cubbies/childbirth/news-earlyepidural.htm) to read Kaisernetwork.org Daily Reproductive Health Report on the study.

At what point did you receive the epidural? Did you feel you had it soon enough, too soon, or at the perfect time? Did you end up delivering vaginally or via c-section?

Share your experiences with us! We'll archive for the childbirth cubby - http://www.storknet.com/cubbies/childbirth (http://www.storknet.com/cubbies/childbirth)

Thanks!

[lilpea]

At what point did you receive the epidural? I received an epidural around 10:00 p.m. after 14 hours of progressively painful back labor. I was only dilated to 4 cm at the time, but really suffering. I begged for it. I spent the next 8 hours in an out of it - coupled with shaking, the chills, throwing up, and eventually a fever of 104.3. I had several epi refreshers and did manage to get to 9 cm dilated before the fever (I was also given pitocin sometime in the wee hours). DD just couldn't get into position - she was face up and stuck. My regular OB came in just before 8:00 a.m. and ordered me into the surgery (I was originally scheduled to be induced that morning which is why she was there).
Did you feel you had it soon enough, too soon, or at the perfect time? It is really hard to say. If I had been encouraged to move around more DD may have turned into proper position - maybe not. I had been laboring for 14 hours before the epi and she didn't move, but then again, I didn't know she wasn't in position (although the back labor should have clued someone in). All I know is that after the epi was done I couldn't move so we were limited in what could be done to turn her. Plus, the overnight OB was a hack. (He even apologized to me the next day for screwing everything up.)

Did you end up delivering vaginally or via c-section? Emergency c-section after 24 hours of labor.

[hedra]

At what point did you receive the epidural? With Gabe (the only time I had an epidural), I had it at 1 cm, but that was after 66 hours of labor with no progress.

Did you feel you had it soon enough, too soon, or at the perfect time? It was about right, for me - I was exhausted, and was desperate for sleep. I didn't need it for pain, thank heavens! (Labor was tiring, but deep relaxation was enough to get me through it easily.) However, it did appear to cause heart instability in my son (possibly due to circulatory changes, since his heart stabilized as long as someone was doing vigorous massage on my legs), so I was glad we didn't use it earlier. We'd used up the other options, and while both Gabe and I were doing okay, I really needed the rest.

Did you end up delivering vaginally or via c-section? vaginally - 14 hours later! I had the epidural for 12 hours, then pushed for two (only 30 minutes effective pushing, as I was so numb from the multiple boluses of meds, it took a while to wear off). I don't think it speeded things up much at all - being able to sleep on my side appears to have caused my son to turn - it turned out he was slightly malpositioned, and turning onto my side pushed him into position - from then on, it was a clinically-perfect 1 cm per hour progress (after the first two hours on the epdural, anyway).

[Juju]

At what point did you receive the epidural?
Cameron: I had been in labor for 16 hours and was dilated to 7. I had him vaginally 1 hour later.
Gabrielle: I had been in labor for a little over 8 hours, and had just had the catheter inserted into my back when I started feeling the need to push. They stopped the epidural process and I had her within 20 minutes, so I did not actually receive an epidural with her.

Did you feel you had it soon enough, too soon, or at the perfect time?
Obviously we were too late when I had Gabby, and I think I got it too late with Cameron as well: I had actually requested it about an hour previously, and had to wait while they had a problem with another woman's epidural. When I was ready to push I was still so numb that I had a really hard time feeling what I was doing, and ended up with a significant tear.

Did you end up delivering vaginally or via c-section? vaginally

[Beesmom]

At what point did you receive the epidural? I requested the epidural after 12 hours of labor when my water broke naturally. It took them at least two hours to get to me though, so I may have progressed further than 4 cm.

when I wDid you feel you had it soon enough, too soon, or at the perfect time? I wish they had been able to give it to me as soon as I asked for it. My contractions got MUCH more productive immediately after my water broke. I did get nauseous right after I got the epidural.

Did you end up delivering vaginally or via c-section? Vaginal delivery. NOTE my epidural favored my right side. Once or twice after I got the epidural I had to call for the anesthesiologist to see if he couldn't help to even out the pain relief. He upped my dosage the first time and the second time I was about fully dialated so there was nothing he could do for me. He suggested that I lay on on my left side to let gravity help the medication work.

[JulieD]

At what point did you receive the epidural?
With my firstborn, he was unable to get into a good birth-position because of his cerebral palsy (which occured prior to birth) and so I stalled at 7 cm for over 12 hours - after a very long, difficult labor we transfered from our homebirth to the hospital for pain medicine and I was still 7 cm.

Did you feel you had it soon enough, too soon, or at the perfect time?
It was at a good time. I was dehydrated and exhausted at that point so it gave me a chance to rest and we avoided a c-section.

Did you end up delivering vaginally or via c-section?
Vaginally (thank goodness)... when my muscles relaxed with the epidural my son could maneuver into a good position and I continued to dialate. We did have lasting effects from the epidural (about 3 months) so in the future (if possible), I would employ a doula vs. opting for the epidural.

Interestingly enough, the Citizens for Midwifery replied to that study with some poignant facts and information: http://www.maternitywise.org/nejm_epidural_response.html

[Jelly-Anne]

I didn't have an epidural with Payton. Labour progressed too quickly and by teh time the anesthetist came, it was too late.

I was induced with Brooklyn. I had the epidural after only 3 hours or labor. I was about 3 cm.

It was the perfect time FOR ME. Although I know some of the nurses were annoyed that I had it that soon. It did slow my labor down. But my thought was that as long as the baby was fine, I didn't mind that labor took longer as long as it wasn't as excruciating as my first one.

I had Brooklyn vaginally about 8 hours after the epidural. She may very well have been born sooner if I hadn't gotten it, but no regrets. I actually go to enjoy giving birth to her since I wasn't concentrating so much on the pain.

[Paula]

At what point did you receive the epidural? I was 7cm dilated, having transitional contractions and needing to push when the doctor was starting the epidural.

Did you feel you had it soon enough, too soon, or at the perfect time? I could have gotten it sooner when I initially asked for it. However, I did not have a birth plan and the doctor hadn't arrived yet so there were no orders in the chart. I wasn't thinking rationally and everyone (including me) expected labor to last much longer. Regular labor had been relatively easy, but transitional was very painfully and I could not imagine 8 more hours of that pain. Dh and I had guess-timated that dd would be born around 8am. I was in a lot of pain at 12:30am. I just wasn't expecting it to happen so fast.

Did you end up delivering vaginally or via c-section?Vaginally. It slowed my labor up, but was light enough where I could tell when I needed to push. My L&D was approximately 5 hours from my water breaking.

[Aimee]

With my first child I received my epidural at 4 cm. I ended up delivering vaginally about 5 hours later (though I was fully dialated within 2 hours of receiving the epidural). With my second child I received my epidural at about 5 - 6 cm and was fully dialated an hour later. Both times my labor seemed to speed up after receiving the epidural. In both situations I felt that I received the epidural at just the right time.

[Tami C]

I got the epidural after about 10 hours of hard labor. I only minimally recall agreeing to it, because the pain I was in was so exhausting. I know I was losing all focus on the world around me, and none of the breathing exercises were enough. My dh and mother both knew I needed the help. I think it was a good time to get it, because I know that nothing we could have done would have changed the outcome- an almost 9 pound boy, born via c-section. I know in my heart that we tried everything we could to avoid surgery. But after 9 more hours of almost non-stop, every 90 seconds contractions, I was still only at 7cm and could not deliver vaginally. There came a point when the baby started showing signs of distress, and it was time to make the decision.

[Susue]

I was induced and got it not too long after they broke my waters and started Pitocin and delivered vaginally after about 15 hours of labor. I was happy with my decision about when to get it. Although it stopped woking after a few hours for some reason and I had to get it again.

[patticakes]

I had both babies vaginally
With Ben, I had an epidural in the morning after being in labor all night. I was 4cm, the epidural really slowed down my labor. I started pushing at about 4pm and pushed for 3 hours. By then the epidural had completely worn off and I was exhausted and in a LOT of pain.

With Abbie, I had the epidural, they broke my water and the baby was born 2 hours later. I felt no pain and pushed only 5 times, no tearing , nothing. It was great!!!

[bugsmom]

With my first DD I had an epidural at about 4-5cm. Shortly after that, I started spiking a fever and delivered her 5 hours after the epidural. I had 2 hours to push her out and a vaccum extractor was needed. SHe was not tolerating my fever and her heart rate was in the 190s. I had horrid back labor with her. I was also started on pitocin. She was 8lb2oz and spent 2 days in Nicu due to changes in her white blood cells.

With DS, I opted for no epidural and used the bradley method. My labor slowed over night but my OB opted to keep me. We lived 1 hour away and I have a history of rapid progression from 4-10cm. I was also due to be induced 4 days later. At 7 AM on the 18th, the started me on low dose pitocin and at 8AM the ob came in a ruptured my membranes. At 8:30 contractions started to get a little intense, so I received one shot of nubain. At about 9:10 AM they came in to get me up to go to the bathroom, I said okay I felt the need to have a BM, anyway. They checked me and I was complete about 5 mins later, I felt the need to push. DS was born 15mins later with about 4.5 pushes. He was 9lb 13oz. Much easier delivery.

If I had DD's to do over again, I would have not gotten the epidural.

Both kids were vaginals.

[NancyS]

Had my first epidural at 5-6 centimeters after begging for it for a couple of hours and delivered about an hour later...definitely what I needed to relax.

Second epidural...I was induced and got it right away. I was only two centimeters. I had a very enjoyable labor and delivery (8-9 hours). Pushing was a non-issue, I'll I really had to do was sit up.

Third epidural...again, induced and I got it as soon as the anesthesiologist was available (I think I was just at 3). I had a few issues this time with it staying on one side but I got plenty of relief. I again had no problem pushing being totally numb but it took a little more effort this time since he had a tank head. Still, probably an eight hour labor and pushing for five minutes or so.

I like the routine. Going in the morning to be induced, IV, break water, epidural, catheter...baby : ) I hope and pray it again goes as smoothly but truly, anything can happen.

I have a tendency to drop my blood pressure so now (after my first delivery) I know to ask them to push lots of fluids. L&D is just so very individual. For me the epidurals have been wonderful but I know they're not for everyone and they can have very different effects on the process for different women.