Must you have an epidural?

kakleibo · August 2013

I'm 22 weeks. My doctor, who I love, has been saying all along she supports VBACs and I've been dreaming of my natural birth. Then at my last appointment she sprang on me that a VBAC requires not laboring at home, coming in as soon as labor starts, and an epidural. I was taken back and just assumed this must be what all VBACs require and just sort of agreed to everything she was saying. After reading some articles, this doesn't seem to be the case. I wonder if I can have a walking epidural under this senerio or if it has to be a classic epidural? I hate to intentionally ignore my doctor's advice--a woman I respect and admire, but I am feeling like I should if I want to have a successful VBAC. What are your thoughts/advice out there in bump land?

mysticl · August 2013

Some doctors/hospitals have these policies in place in case you rupture to better facilitate an emergency c-section. The question I would ask is are these policies medically driven or liability driven? Sometimes hospital policy is because their malpractice insurance says they have to something a certain way, not because it is good medicine.

As for "requires" I would ask what they mean by that. If you do labor at home or refuse the epidural will they try to transfer you to another facility? Will they attempt to pressure you into a c-section? Will they attempt to obtain a court order to do the surgery against your will?

lalamakita · August 2013

From what I've experienced and heard here from others - an epidural is not always or even often required. My doc certainly doesn't require one - though he does want me to have a heplock - so they can administer drugs quickly and my vein is open (stress or shock can shut down veins) - which I'm fine with (but nothing in the heplock)

At 38 weeks, my doc did an u/s that measured the thickness of my c/s scar, and it gave him an idea of how stretched it is and how likely it might be to tear - mine is good so he is less concerned that I'll tear than if he didn't know. I think this knowledge is good.

Getting there early is also not always required. My doc wants me there when ctx are between 2-5 minutes apart. And also I know the longer you're there, the more chance they have at wanting interventions.

Also, beware of the bait and switch some docs do, when they assure you they're totally vbac friendly at first and then change that when you get real close to delivering. You still have enough time to shop around for another doc, or other opinions.

I'd also really suggest a doula. Even though I'm having #3 and my 2nd VBAC, its amazing what she knows to suggest I do for positioning, etc and how to see what the docs and nurses are 'up to' and can head off interventions with lots of questions, suggestions discussions, etc.

The more preparation you can have the better. Good luck!

skio · August 2013

Go to the hospital when you feel like it. There's no need to even tell your OB you're in labor; that "requirement" is crap. Laboring at home for as long as you can is important to minimizing intervention.

I agree with pp that a lot of this stuff is to protect themselves, not you. Talk to your OB about the epi; tell her you'd rather not. My OB recommended an epi and I said no thanks. I was we'll aware that in case of an emergency, I'd be knocked out. I preferred that to having an epi 'just in case.'

Advocate for yourself. If you're not comfortable with these things, tell her you're not. Talk about alternatives. Tell her that you want your birth to go a certain way, and if she doesn't support it, find a new provider. I know it's hard; I'm very non-confrontational, but I was firm when it came to certain things about my VBAC. Labor at home, no epi, no unnecessary ultrasounds, no induction. And it all went perfectly because I stuck to my guns.

This is the birth of your child, not a medical event. Good luck! You can do it!

wilsontl19191 · August 2013

I asked for the epi but it was not "required". By the time I got it, I was fully dilated and it failed anyway! I felt everything including getting my tears stitched up. About 20 minutes after I was all sewn up, I was up and out of bed!
Once my water broke I went straight to the hospital. But, my DR let me labor naturally and as I wished.

kakleibo · August 2013

Thanks to everyone who has contributed to this string so far, you are giving me some great questions to ask my doctor and other advice. Much appreciated!

MeggM1 · August 2013

I had a pain-med free delivery and my doctor actually encouraged it. She said one of the indicators that a rupture occurred is pain level and that indicator is removed when there is an epidural. We were in a great hospital where I could get an epidural in no time if necessary. I'm sure she's supportive of her patients that do want epidurals though. It was really refreshing to have so much support for a natural birth ( she did require me to have a hep lock and wireless heart monitoring, which were no problem). My delivery was a successful, unmediated VBAC and I personally had a great experience. I always encourage women who want to try for a natural birth to advocate for themselves if it is what is best for them!

bnikiz · August 2013

I had my vbac consult last week. My hospital also requires an epidural. They said it is safer for the line to be in place and for you to be mostly numb in case you need an emergency c section. Other wise you end up with general anistetia which is a worse recovery and can cause more complications.

MamaP19 · September 2013

lalamakita said:

From what I've experienced and heard here from others - an epidural is not always or even often required. My doc certainly doesn't require one - though he does want me to have a heplock - so they can administer drugs quickly and my vein is open (stress or shock can shut down veins) - which I'm fine with (but nothing in the heplock)

At 38 weeks, my doc did an u/s that measured the thickness of my c/s scar, and it gave him an idea of how stretched it is and how likely it might be to tear - mine is good so he is less concerned that I'll tear than if he didn't know. I think this knowledge is good.

Getting there early is also not always required. My doc wants me there when ctx are between 2-5 minutes apart. And also I know the longer you're there, the more chance they have at wanting interventions.

Also, beware of the bait and switch some docs do, when they assure you they're totally vbac friendly at first and then change that when you get real close to delivering. You still have enough time to shop around for another doc, or other opinions.

I'd also really suggest a doula. Even though I'm having #3 and my 2nd VBAC, its amazing what she knows to suggest I do for positioning, etc and how to see what the docs and nurses are 'up to' and can head off interventions with lots of questions, suggestions discussions, etc.

The more preparation you can have the better. Good luck!

This.

cynnnabun · September 2013

I had 2 VBACs. They wanted me to come in as soon as possible, but I didn't. My first I labored at home for awhile, I did have an epi, by choice. My 2nd was 6 weeks early, so I went straight in to attempt to stop labor. I had a failed epi with her, and was walking around a lot. I would have another conversation and be firm in your wishes.

Must you have an epidural?

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