Epidural, Or Not?

I’ve touched on my fears surrounding having a epidural before. To cut it down though, I’m afraid to have an epidural for two reasons. The first is simply fear that it won’t work because they won’t be able to site it in the right place. The second is that, working or not, I’ll have a repeat of the nerve damage that I suffered before – or worse – and have to start motherhood with that hanging over me.

I’ve known all along, however, that it’s something I have to face up to and plan around. The ideal is still for me to have a natural vaginal delivery without an epidural. But I have to accept the possibility that I may end up having a caesarean section, and the even bigger possibility that I will be induced with syntocinon, which everyone says is ridiculously hard going without an epidural.

I think I’ve sort of got my head around the c-section problem. Now that we know Flangelina is not breech there is no reason why I would need a planned caesarean delivery. That means if it comes down to a c-section, it will be in an emergency situation in which there will be a significant risk to either the baby, or me, or both of us. At that point I’m willing to bet everything that I won’t care how the baby arrives as long as they do so safely and if that means a general anaesthetic and surgical arrival, then I’ll just be grateful that it’s possible.

The induction, or even simply prolonged spontaneous labour, is a bigger dilemma. I honestly think that my fear of an epidural is great enough that I’d rather go through childbirth without it almost no matter what. And my attitude to labour is perhaps slightly unusual – in that I’m excited and really want to do it. I’m fortunate to have a naturally positive attitude, believing that I can do it, and having met plenty of women who actually have . But of course, I haven’t been in labour yet.

So I need to get some proper perspective on this issue. I need to know whether it’s sensible for me to plan that I will definitely have a GA if I need a c-section. I need to know what the options are if I can’t cope with other forms of pain relief. Is an epidural likely to be possible? What are the actual chances of repeated nerve damage or other complications? The best person to answer these questions, and hopefully reassure me, is a consultant anaesthetist. After all, these are the people who are actually responsible for getting epidurals and spinal blocks on board.

I was referred to an obstetric anaesthetist fairly early on in my pregnancy, but was beginning to despair of actually getting to see them before I went in to labour. However today, I finally attended that appointment, with Ian in tow for support. And now…. Well, I’m still not totally sure.

I certainly don’t have all the answers, and much of what I think and feel is still the same. The anaesthetist reassured me that the risks of nerve damage remain low despite my previous experience but was sensitive to my anxieties and agreed that she couldn’t guarantee it would be OK, and the risk was definitely higher than average given my past history. She did say that although my spine did not feel to be the easiest shape, it certainly didn’t feel impossible either, but again could not guarantee that placing an epidural or spinal would necessarily be successful. She reassured me that a spinal block carries less risk than and epidural and seemed to feel that it may be worth an attempt at a spinal block if it should come down to a caesarean and time allowed.

Ultimately though, I still have to make the decision of what I will consent to. I still have the dilemma that I don’t want to miss our baby’s moment of arrival in to the world by being under a general anaesthetic. But I don’t want to lose out in the first weeks and months because I’m trying to recover from functional neurological loss. Considering having an epidural still puts me in to a panic and I suppose only time will tell how I’ll feel when actually faced with the decision for real, in labour. It may well be that I simply cannot make a final choice until that point.

The anaesthetist said that she would summarise our discussions to enter in to my record on delivery suite, and would also stipulate that I should be seen by a consultant anaesthetist on arrival, for cannulation (I have truly awful veins – something else with which she agreed) and should any form of spinal or epidural be attempted. I think I get the feeling that she was steering me towards considering at least an attempt at a spinal. I think she was possibly humouring me a bit in that I don’t know what labour is like – I got the impressions that she may have thought I was being a bit naive and will change my mind. She could be right. Having spent most of the rest of the day thinking it through though, I’m pretty set that my decision for now is not to consent to any form of spinal anaesthesia. I just don’t feel that I can take the risk.

I sort of feel better for having made that decision though. It means I can work on psychological pain management techniques, but also try to get truly mentally prepared for the possibility of delivery under GA. I’m not at all “happy” with the idea of possibly ending up with a GA, but I’m not happy about having an epidural or spinal either. If I block in to my mind now that it won’t be happening, I can at least stop panicking about it.

I’m just really, really hoping for a straightforward vaginal delivery. But the only thing that I know for sure about labour is that it very rarely goes to plan.

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