Timeframe to make epidural decision during labor

[Anonymous]

Good Morning --

I am 35 weeks and just had my first labor and delivery class last night. It had been my plan to just play it by ear about whether or not to have an epidural...if the pain became too intense, then I would ask for it. But, in class last night, the teacher explained that you usually have to decide when you're about 5 centimeters dilated and that this occurs in the "active labor" stage..not the crazy, contraction all the time "transition" phase or the "pushing" phase. So, it seems that you would have to make a decision about the epidural before labor phases begin where the real pain sets in...in other words, you have to get one before you know whether you will really need it. How have other people made this decision who were planning on playing it somewhat by ear?

[Anonymous]

I delivered at Sibley in May. I waited until the pain was overwhelming before I asked for the epidural. My main issue was that the epidural did not take the first time, so my husband had to act as my advocate to have the epidural checked and fixed. There didn't seem to be any issue with missing a window of opportunity. My labor lasted 13 hours and I started the epidural process about 7 hours into it. It did take about 3 hours for the epidural to be fixed, but I don't think my experience was the norm.

[Anonymous]

Most first labors are long, so you will probably not find yourself in the position of wanting an epidural at a stage that is too late. When your contractions start and intensify, you will probably know whether you can cope with it continuing or whether you will want an epidural. I had one first time (at Sibley) but not second (wanted it, but wasn't given it as doctor not available - not in DC). There are pros and cons of both. If I had a 3rd, I am sure I'd ask for one again.

[Anonymous]

OP here...thank you for these responses. Did you find that the epidurals made your labor last longer? Was having the catheter a big deal (for some reason, I am most scared of that!). Did you find that the epidural really made the progress that much less painful?

[Anonymous]

12:05 here. Catheter was no big deal (I was also obsessed by that!). Yes, epidural took a lot of pain away for all but the last part of giving birth. I mentioned pros and cons because with the epidural I had a longer recovery 'down there' than without. But I don't know how much of that was because it was my first baby. Also, without the epidural I felt the urge to push which I never felt the first time. With the epidural, the doctor told me when to push and I couldn't tell myself how long that would go on for. When I felt the urge to push, I could tell it wasn't going to be long. I said that I would choose an epidural if I did it again because I know I am a coward for pain and that I would end up asking for it! When I was told I couldn't have one the 2nd time, I resigned myself and kind of withdrew into myself and realized I just had to do it. I think going with the flow (i.e. deciding when you get there) is a good idea because you just don't know how things will pan out. Good luck & it will all be worth it in the end. You will feel so proud of yourself either way.

[Anonymous]

I didn't feel anything even while pushing. In fact, my OB thought that the reason I wasn't making progress was because I couldn't feel the urge to push, so she ordered the epi off - then of course I felt everything! The baby was stuck so I ended up with a c-section, but just from that hour that I pushed without the epi there was no way I would've been able to endure that kind of pain for many hours during labor (and my hat is off to those who can). I also didn't think that the catheter was a big deal. In fact I don't remember them inserting it at all - is it possible that it was after the epi was already in?

[Anonymous]

I just wanted to pipe up about the epidural. I had an epidural for a c-section (different situation), but I just wanted to say that i couldn't even feel the epidural.....it was no big deal. I was worried because I'd heard about how there was a huge needle, etc. But they don't even let you see the needle...so you don't see anything and it doesn't hurt. After a C-section they keep the epidural in for over 24 hours for pain relief etc, and I couldn't feel the cathedar or anything. FWIW

[Anonymous]

I got mine pretty early, when i was only a couple centimeters dilated. I knew I'd get one anyway, and they offered it to me early, so i took it. i'm glad i did it early because it wore off for two hours at one point and i was drugless at 5 cm dilated, which was not fun. would have been even less fun later on. so i got another spinal shot which hurt, but it was preferable to a drugless labor. i'm not a wuss, but i don't see the point of pain when the option of "discomfort but no pain" is offered.

With the epidural, I still felt every contraction, but they didn't hurt. The pushing wasn't painful, exactly, but very uncomfortable and the pressure on my girl parts was very uncomfortable between pushes. So the epidural took away the pain, but I definitely felt that I was having a baby.

From what my friends have said, the epidural sometimes allows you to push harder and get the baby out faster. My pushing was only 26 minutes. I had grade-2 tearing, but I didn't notice due to the drugs, and recovery wasn't horrible.

Good luck!

[Anonymous]

I gave birth at Sibley and will again soon. I waited a long time to ask for an epi--I think I had been in hard labor (pitocin) for 12 hours--not sure what my dilation was since my water had broken they were doing minimal exams. I asked for it and the anesthesiologist was there in 5 minutes--10 minutes later I was out of pain and wanted to kiss the anesthesiologist !

Everyone's labor is different so you really do have to play it by ear and be flexible. As for the epi, I had a very easy recovery, so I am not sure what all the fuss about making it hard to recover (obviously c-sections are totally different). I was up and about shortly after delivery. As for more damage to your "nether regions"--hate to tell you but it ain't the epi that does the damage... There is typically more "damage" to that area with your first, at least according to my OB.

There are pros and cons to an epi of course, as reading many threads or internet sources will tell you. If you have a long labor, or are induced with pitocin (makes contractions harder/faster) you will probably do better with one, so you can get enough rest for the pushing phase. If you have a fast labor, you might be able to go without (fast: under 5 hours). It does make it harder to feel when to push, but the key is to let the epi wear off as you near the 9 or 10 cm. I remember having a little button to push to increase the drug. My L& D nurse told me to stop at around 8 cm/9cm. While it makes the pushing more painful, it is easier in some respects because you can feel when to push.

As for the needle--I was so psychotic from the pain, I would have jammed a 4 foot needle into myself to get out of it. They don't show you the needle and if you let yourself get into hard labor, you won't care anyway. Couldn't feel a thing with them putting it in.

Good luck to you. The whole uncertainty of the first time is hard--just try to go with the flow--educate yourself but be flexible.

[Anonymous]

When I got to the hospital I was 4 cm dilated. I went from triage to a labor room and they called for the anesthesiologist who showed up within an hour. Didn't feel the needle, catheter was no big deal. My mom sat with me and said she almost passed out when she saw the anesthesia needle, but honestly, the contractions were so close at that point, that I was just concentrating on getting through those. I felt great after the epidural, but my labor almost completely stopped. They had to give me pitocin to start things back up.

In retrospect, I should've just done it without the epidural. Not because I'm a natural birth advocate or anything, but because I was in labor for another 14 hours after the epidural. I deferred to the triage nurses who told me I would be I would be dealing with contractions for at least 2-3 more hours. I couldn't imagine enduring that pain for that long, so I went for the epidural. Now that I think back on it, I really think that the baby would've come in less than 2-3 hours without an epidural. But, with your first, you have no reference, so you trust the nurses and doctors who seen this before. For my second, I'll probably do things differently.

[Anonymous]

Anonymous wrote:

In retrospect, I should've just done it without the epidural. Not because I'm a natural birth advocate or anything, but because I was in labor for another 14 hours after the epidural. I deferred to the triage nurses who told me I would be I would be dealing with contractions for at least 2-3 more hours. I couldn't imagine enduring that pain for that long, so I went for the epidural. Now that I think back on it, I really think that the baby would've come in less than 2-3 hours without an epidural. But, with your first, you have no reference, so you trust the nurses and doctors who seen this before. For my second, I'll probably do things differently.

I'm the PP who had one birth with an epidural and then one without. Just wanted to chime in that the second labor without an epidural was actually longer than the first one (19 hours compared to 17). So I'm not sure you can assume that no epidural means a faster delivery.

[Anonymous]

My first labor was in total 7 hours with only 20 minutes of pushing. I had an epidural, even after arriving at the hospital 6 cm dilated. So I think you'll be fine. I can't imagine if my labor had been quicker than that!! I also did not find the catheter to be a big deall....you don't even feel it going in. And I still knew when to push, etc...but I will tell you I went from screaming in pain to calmly lying in bed chatting with my family. It made a HUGE difference for me.


Good luck!

[Anonymous]

The night I delivered my second baby, the L&D floor was packed. My OB had already delivered 5 babies before I showed up. In any case, it took awhile for me to get into a L&D room and then I labored for quite some time naturally. When I finally asked for an epidural, it took the anesthesiologist 20 minutes to get to my room. It then took five attempts to get the needle in my back because I couldn't sit still. As soon as it was placed, I swung my legs around to lie down and exclaimed, "I have to push!" Three pushes later, DD was born. The epidural took effect in time for my OB to stitch me up.

Long story short...I was never told I had to have the epidural during a certain timeframe. I actually wish I'd been checked before since apparently I didn't need it.

[Anonymous]

I was PETRIFIED of an epidural. Even though I knew I wanted one. Of course, your experience will depend on you as the individual and your tolerance for discomfort and the staff. I had a great nurse that helped me through it and felt just pressure. Catheter is no big deal at all.

The epi got rid of all the pain but once I got close to being full dilated, I felt pressure in my pelvic floor (had a C in the end due to a VERY large baby).

I was given the advice to not wait until you're in agony to request the epi. You may not be next up for the anesthesiologist. That was my situation. By the time I requested it and he got there, I was having VERY strong contractions.

I'd have another epi in a second. Greatly improved my enjoyment of the time in the L&D and with my husband. We talked, laughed, etc., instead of me writhing in pain, sweating and screaming. That is my preference though. I'm not a natural birth girl.

[Anonymous]

OP poster here...thank you for these responses. I'm encouraged my the diversity of experiences. Did anyone find that the presence/absence of a doula affected the epidural decision making process?