Author Topic: No time for an epidural last labour... mental/emotional prep for 2nd birth?  (Read 1021 times)

MBot

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We are pregnant with our second (hooray!) and the only part I am really unsure about is the second delivery. Slight details below, nothing graphic.

Although I like the idea of epidurals, I don't know if I'll have time for one. I do plan to make our wishes known with all care providers in advance, advocate strongly and have my husband also advocate strongly that I want one RIGHT AWAY given our past experience.

Our first came very quickly (I woke around midnight and figured it was Braxton-Hicks, got up at 3 and my water broke, went to the hospital and by the time they did checks I was dilated to 9.5 cm. Had our son before 7 am!) Without too much detail I had a lot of pelvic damage and surgery and physio to do after too... in all aspects,  the pain was awful through the short labour, delivery and recovery.

I had prepared as far as some pain relief options (tub, counter pressure; positions..)  and then my back labour meant I felt best flat on my back of all things, and couldn't go in the tub with a broken water.

This time, I want to mentally prepare better in case there is no time for an epidural; but I don't want to go with some system that finds unmedicated  birth the ONLY option. Any suggestions?

tthree

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Two quick, epidural-free deliveries here.  The first one was NOT pleasant, way too many stitches without an epidural=no fun.  Things I learned from the first one and did better the second time: 
  • Nitrous oxide, that stuff is pretty amazing.
  • Counter pressure did nothing for me from a pain relief perspective.  (It made me want to hit DH, but I don't think that is the intended outcome).  Instead I found calf raises during contractions to be a good distraction.
  • Sitting.  Worst. Idea. Ever.  Only amplified the pain.
  • Shower instead of bath.
I agree about the after pain.  I joke that I pushed so hard to get the baby out because I thought the pain was going to be over; however, the joke was on me, the pain after was probably worse.  The second time was so much better though.  I hope it is the same for you.

gooki

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FWIW, second birth is typically easier if the first was natural.
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1967mama

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Second birth was much less traumatic for me too ... shower, ice pak, heat pak and counterpressure helped with back labour.  Large episiotomy and forceps with first (with no pain relief - failed epidural). Completely natural birth with the second (except for they broke my waters when I was 10cm).

I was really nervous about the 2nd birth and did A LOT of reading about natural childbirth (Penny Simkin, Ina May Gaskin and midwifery books). It went soooo much better than the first where I was so scared and it was so medicalized.

Another great thing we did with the 2nd birth was hire a doula ... WHAT a difference! My husband could focus on me and she would just help him help me. So great! Didn't take away from his role at all, but made him a much more effective birth partner. She was also able to clearly tell us what was happening throughout labour, and how close we were, encouraging us along the way. Can't say enough about Doulas! Interview till you find one you click with.

Anatidae V

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I've only had one labour, and it started with my waters breaking at 11:30 pm (flooding just like in the movies 😳) and baby was out 4.5 hours later at 4AM. One stitch, which I had a local anaesthetic for, but no medication for pain relief besides that. I did have a bit of panadol over the next few days.  Penny Simkin's "the birth partner" was fantastic, really gave us some good ideas on relief but mine was so intense we had my partner rubbing my back and I was chanting myself "up the mountain" for the rise of each contraction. That was actually really helpful, the midwives told us beforehand that "you only have to get through half of each contraction, then relax as it goes away". We also did a 2 hour course with a physio who basically went through the positioning and other techniques in Penny Simkin's book, which helped us as well. They were clear that these techniques were completely able to work WITH other pain relief. Also, look into a TENS machine. It sends a weak electric current which disrupts the nerves sending pain information. You can hire them from physios or hospitals, they have ones specific for labour and you'll need to have it and know how to use it prior to labour, and it's fine to test it before you go into labour :D anything that helps you with period cramps should help (heat packs etc).

At my hospital, even my quick labour would have been plenty of time for an epidural as they have an anaesthetist there at all times. I plan on starting to look for a doula before my next pregnancy (as soon as we're sure we'd like a second child), because another person to rub my back and coach us would have been great.

ETA: I had some pre-labour/ Braxton Hicks that were relieved by rocking my hips while on a large fitball. I don't remember any of the placenta contractions because I was absorbed by my baby, but the breastfeeding cramps were painful.
« Last Edit: July 15, 2017, 05:14:14 AM by Anatidae V »

1967mama

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I have heard great things about TENS in labour -- I liked it during physio for a shoulder injury and can imagine it would be nice in labour too.

Also, I just remembered that with my last baby, one of those little battery operated vibrating massagers reallllly helped with back labour ... birth partner just holds it firmly on your sore spot on your lower back.

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jeninco

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I also had back labor with my two, but as a counterpoint to above, counter pressure helped enormously. Our Doula was also a massage therapist, so she knew what she was doing, and I'm pretty sure she was putting ALL her body weight on two points on my back. I think I had bruises afterwards, but it was awesome -- 70+% of the pain went away when she did it.

Seconding the doula, just so someone else can bustle around and take care of things (and you, in an informed way). Also seconding that the second birth is typically easier.

Meditation helped me too, of all things. I got through several hours just sitting and breathing. Also delivering in a squatting position. (The hospital had "squat bars" and the doula knew where they were :^)  )

marion10

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There was no time for an epidural with my first labor- by the time I asked for some pain relief it was too late. For a first birth- I had a pretty short labor- about 10 hours- six of it in hospital. For my second- no time for an epidural either- he was born 15 minutes after I got to the hospital! Total labor- 3 hours. Based on my damp,evsize of two- if you really want an epidural get to the hospital earlier. I chose to Labor at home as much as I could- we lived very near to the hospital. With my second I was at the movies with number 1 and finished the movie and drove home!

little_brown_dog

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Given your history, I would work closely with your OB/midwife to come up with a plan that minimizes you getting caught off guard again (if possible). They may recommend that you immediately come to the hospital right when you start to feel frequent contractions, rather than wait for the contractions to get closer together. Experienced moms tend to dilate faster anyway.

As for pain relief, I had a normal unmed active labor with my first (baby got stuck while pushing, but that was a whole different kettle of fish). Most of my labor was textbook – 12 hours from water breaking spontaneously to 10cm, with steady increases in pain over time. If you experience this normal/typical labor pattern, I found that the hot bath really helped for transition. Given that you might not get the chance to get in the bath, I’d be prepared with a hot water bottle to at least ease some of the pain as you ride to the hospital or if you end up in bed again. No one told me that once you are in labor, it is 100% fine to use really hot bath/shower water to ease the pain. I only realized it once the nurse drew me a really hot bath. If I had known, I would have absolutely filled a hot water bottle to help me through the contractions I had on the way to the hospital and before getting in the tub. I used a hot water bottle to get through 2 miscarriages which were quite painful, and the heat really helped. You can move it around to your back or the underside of your belly, whichever feels better! I definitely plan on using the water bottle with this next baby. Worst case, it doesn't help much. Best case, it helps alot.
I'm actually surprised this pain relief method isn't used more - like, why aren't women offered hot bean bags or something? If it's perfectly fine to immerse the woman in steaming hot water, a bean bag or water bottle or two should be a great option for those who can't use the tub. Oddly, hot water bottles and bean bags are often recommended for women suffering severe menstrual cramps or miscarriages...

« Last Edit: July 15, 2017, 11:40:10 AM by little_brown_dog »

MayDay

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2 unmedicated births here.

Both mine were super short (and the first included tv-style dramatic breaking of water).  First birth was 3 hours start to finish. Second birth was some early labor on a Ned off, then 3-4 hours of real labor.

Fast labor sounds good in theory but it hits you like a freight train.  A doula is definitely a must. A midwife who can put pressure on your cervix so you don't tear and coach you to slow down can also help. I tore less the second time and I attribute some of it to my midwife slowing me down (well, she tried lol, again with the freight train image) so the skin could stretch.

I don't have specific suggestions. I read a lot of natural birth stuff and my doula was hugely helpful. I've heard people rave about hypnobirthing but I've also heard it can be tough with fast births.
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MBot

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Wow, thank you for all the replies!

Several mentioned a doula... that's a good push to check out that option. I never thought about needing one last time,. Now I can 100% see the value there!

jeninco, how did you find a doula who was also a massage therapist? Did you find her on a list of doulas or was she primarily a massage therapist?
 That sounds freaking amazing. (I'm in a town of ~75k people and its the largest city for 3 hours each way... my options are a little limited).

little_brown_dog, the hot water bottle suggestion is genius! Very doable/scalable. I find heat really helps me and I was disappointed I couldn't go in the tub.

Anatidae V, the counter-pressure we did a little of, but I think we could have done better/more with it. I think it was out of The Birth Partner, but we more looked at that casually than really went through it. That course you did sounds like a good resource.. and if it can work WITH other things... everyone here seems so polarized between birth "must be all natural" (seemingly everrryoonnee) and "get you to the hospital" (the minority)

1967mama, The TENS machine is also a neat possibility!  I wonder if someone has one I can borrow. We already have one of those little back massagers too. Wow, good to know.

tthree that calf raises suggestion is so interesting! I never would have thought of that. and I'm glad to know that counter pressure didn't work for you that well, it's not like a magic bullet that is good for everyone.

Nitrous oxide helped a little for me but also took away the urge to push.. but also because I was so afraid of the pain to push or stop the nitrous. I wonder if with better mental preparation I could use the nitrous without being afraid.

If you don't mind a specific question, Has anyone done particular (online?) courses or books that were helpful? I think all I've seen here for in-person courses are Bradley Method and the super-basic health department prenatal courses.

I'm not sure if I'll just set myself up for failure with something like Hypnobirthing, and I don't think my pain relief goals are compatible with something like the Bradley Method. I have reserved a copy of Birthing From Within because I like working through my fears with exercises/I can handle things being a little artsy or out-there if it ends up being useful. And another completely medical book so I know exactly what's going on with the pelvic floor, areas of damage, healing and how the surgeries/physio work.

jeninco

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MBot,

I found my doula because she was co-teaching the class I took. (Which wasn't entirely just a "Birthing" class: they covered some other stuff as well, so I'm struggling to figure out what to call it.) Having someone who knew where to apply counter pressure and could do it hard enough for a long time was super-helpful.  Plus, she knew where everything was in the hospital room (they keep stuff like the squat pushing setup in a closet) and knew all the nurses.

I googled "find a doula" and immediately hit "findadoula.com", but I have no comment on who's listed, or even the reliability of the site. You should probably talk with a couple of people and see who makes you feel comfortable: the woo-woo can range from nonexistent to pretty intense.  If your preference is for no crystals (or for lots'o'crystals!) you should be able to find someone who feels right for you.

I last read Birthing from Within a while ago, and while I appreciate the general sentiment, their track record was so-so on outcomes. As a mathematician who sometimes works in statistics, my suggestion is to hold several grains of salt while you read books on birthing. Last time I looked there was a whole lot of what people believe masquerading as Important Medical Advice! (Then you get to read books on how to raise small children, and at least you're well prepared with the salt...)

Good luck! I'd actually suggest a doula, a class/some reading, and whatever techniques seem like they make sense to you -- and practice them! If nothing else, if gives you a focus while you're having contractions. And head in early, if you want to get there in time for the epidural.

Anatidae V

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I haven't watched it, but Penny Simkin has a couple of DVDs which looks like it covers aspects of her book:
https://www.pennysimkin.com/shop/
Worth seeing if you can find a copy.

BAM

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Usually 2nd labors are easier, even if it's only because your body now knows how to push. Most moms I've talked to said they pushed for 1+ hours the first time and less than 30 minutes the second time. Mine was 1 hour first time, 2 contractions of pushing the second. That helped a ton!
Also, it seems that most of the tearing, etc happens the first time too.
My first birth was much more painful, recovery was much harder, etc than any of the following ones even though I was all over the board on how long labor went, etc.

MrsWolfeRN

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Following, currently pregnant with my second, had C-section the first time because of breech presentation. Midwife is encouraging me to try a VBAC. I assume it will be like a first birth because I didn't have any labor the first time, but recovery should be easier than C-section.

Trifele

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Two natural deliveries here, and +6 on getting a doula.  I too had some massive tearing and recovery issues after delivery #1 and was very afraid for #2.  Another thing I did (in addition to hiring a doula) was to get an EpiNo.  It's a strengthening and stretching device, and it gave me confidence that I could get through the second delivery without a repeat of the physical damage. 

chaskavitch

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...
Anatidae V, the counter-pressure we did a little of, but I think we could have done better/more with it. I think it was out of The Birth Partner, but we more looked at that casually than really went through it. That course you did sounds like a good resource.. and if it can work WITH other things... everyone here seems so polarized between birth "must be all natural" (seemingly everrryoonnee) and "get you to the hospital" (the minority)

1967mama, The TENS machine is also a neat possibility!  I wonder if someone has one I can borrow. We already have one of those little back massagers too. Wow, good to know.

...

Nitrous oxide helped a little for me but also took away the urge to push.. but also because I was so afraid of the pain to push or stop the nitrous. I wonder if with better mental preparation I could use the nitrous without being afraid.

...

I didn't have a doula, but my sister was surprisingly amazing with counter-pressure.  Poor DH didn't understand my "MORE IN, LESS OUT!!!" instructions, but if you have someone who can readily interpret what you need, having them to press on your hips or push your legs in during contractions REALLY helps.

Some hospitals have a TENS device on hand.  Ours was supposed to, but by the time I needed it, I definitely had completely forgotten that I wanted to try it, so I have no idea how readily available it was. 

The hospital I was at for our son's birth last year just added nitrous as an option for pain control during labor - I'm so excited to at least try it for our (theoretical) next baby.  I'm looking forward to having an option between no pain meds at all and "yay, I can't move now" epidural.

mm1970

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We are pregnant with our second (hooray!) and the only part I am really unsure about is the second delivery. Slight details below, nothing graphic.

Although I like the idea of epidurals, I don't know if I'll have time for one. I do plan to make our wishes known with all care providers in advance, advocate strongly and have my husband also advocate strongly that I want one RIGHT AWAY given our past experience.

Our first came very quickly (I woke around midnight and figured it was Braxton-Hicks, got up at 3 and my water broke, went to the hospital and by the time they did checks I was dilated to 9.5 cm. Had our son before 7 am!) Without too much detail I had a lot of pelvic damage and surgery and physio to do after too... in all aspects,  the pain was awful through the short labour, delivery and recovery.

I had prepared as far as some pain relief options (tub, counter pressure; positions..)  and then my back labour meant I felt best flat on my back of all things, and couldn't go in the tub with a broken water.

This time, I want to mentally prepare better in case there is no time for an epidural; but I don't want to go with some system that finds unmedicated  birth the ONLY option. Any suggestions?
My 2nd labor was much like your first.

I'd had a epidural with the first and wanted one again.  I didn't get it.  Worse, my husband missed most of it, as he was dropping our son off at a friend's house.  I gave birth approx 1 hour after getting to the hospital, husband got back about 15 minutes before our baby was born, at least the doctor made it (but he was there only about 5-10 mins before).

Um, at least it was brief.  That's all I can say about it.

TrMama

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Given your history, I would work closely with your OB/midwife to come up with a plan that minimizes you getting caught off guard again (if possible). They may recommend that you immediately come to the hospital right when you start to feel frequent contractions, rather than wait for the contractions to get closer together. Experienced moms tend to dilate faster anyway.

I really think this is your best course of action. My first birth was a trainwreck, but the second was much better. My Ob used my past history to make sure things went more smoothly the second time.

Anatidae V

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Given your history, I would work closely with your OB/midwife to come up with a plan that minimizes you getting caught off guard again (if possible). They may recommend that you immediately come to the hospital right when you start to feel frequent contractions, rather than wait for the contractions to get closer together. Experienced moms tend to dilate faster anyway.

I really think this is your best course of action. My first birth was a trainwreck, but the second was much better. My Ob used my past history to make sure things went more smoothly the second time.
The on-call OB got there in time for mine because I was repeatedly babbling to the midwife that my mum had short labours, and got her to check my dilation as soon as we got in - she was busy telling me that I might be disappointed with progress, to set good expectations, but verrrry quickly walked out of the room to find someone to call him once she saw how far I was (I heard her arguing with someone just outside the door).

To use a TENS machine here, you have to hire it from hospital or physio before you go into labour, they aren't available on the day-of and you need to be shown how to use it. It's standard to have gas (nitrous oxide) available here as well, several mums I've talked to said it was really handy.

Aelias

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Two births here--both with Pitocin, but no pain meds by my choice. 

It's great that you're already preparing yourself for the next birth.  That should give you some time to communicate with your caregivers and get in the right place.

I feel like just working through any fear you have around birthing, pain, and recovery from your first birth would be helpful.  A good doula can help with that.  Being afraid or panicked is counterproductive to the birth process.

You have good reason to believe that an epidural might not be an option for you. So, with that in mind, you can prepare yourself for what might come.  But you can't know for sure. I feel like just accepting that uncertainty is so important. I certainly had ideas about what I did and didn't want in a birth (hint--a Pitocin IV was NOT at the top of the list!) Of course, you make plans and preparations, but when the moment comes, you just accept it, and move forward.

All the best!

TVRodriguez

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I read and recommend the Hypnobirthing book and took a prenatal yoga class that was quite informative.  I never took the Hypnobirthing class although I listened to the CD during my pregnancies.  I had one medicated birth and two unmedicated. 

I had a doula at my first 2 deliveries (she was the prenatal yoga teacher)--didn't need her by the third birth, which was way more relaxed.  By the third birth, I really "got" the idea of relaxing during labor, allowing my breath to come naturally, riding the contractions and allowing them to wash over me instead of fighting them.  My husband held up a sign I made that said, "Ride it, don't fight it" with a crayon drawing of a wave (I used my kids' art supplies).

I was committed to a hospital birth b/c, well, you never know what can happen during a delivery, but I also wanted to avoid interventions if possible.  I didn't feel like the Hypnobirthing book/approach set me up for failure, even though I wound up having pitocin/epidural for my first birth (baby's arm was squashed up on his head, we learned, as he came out, adding that to the head to squeeze through the canal). 

My main goal was to walk out of the hospital with a living child--all else was icing.

StarBright

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I read and recommend the Hypnobirthing book and took a prenatal yoga class that was quite informative.  I never took the Hypnobirthing class although I listened to the CD during my pregnancies. 

I second hypno. I did the Hypnobabies course with both births and I found it really reduced my anxiety around labor.

It was particularly amazing for my second birth. Because I had already experienced labor, I was able to really roll with the relaxation exercises while bouncing on my exercise ball.

I did a class, but I know hypnobabies also offers self study: https://www.hypnobabies.com/






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OP, I thought of you at my recent OB appt. My OB told me that since I had a fast labor for my first, and need several hours of antibiotics prior to delivering (due to positive GBS), that I have the option of being induced in the morning (they would break my water and have me walk around) and would likely deliver by the afternoon. He noted that this would only be an option at 39 weeks or later, and only if I was dilating/effacing (I don't recall the specifics). I asked about risk for c-section with this approach, and he said that based on my history and under these circumstances there would not really be an increased risk.

While I did not think of my self as someone who would induce early, I have to admit that it is appealing given the ability to (somewhat) control the timing (this would allow me to avoid having to find someone to watch our first child in the middle of the night) and to make sure I get my antibiotics and an epidural.

So, as others have suggested, talk to your OB about possibilities such as this. (And just because induction overall has some greater risk of c-section, doesn't mean that it necessarily would be in your case).