|Pain Relief in Maastricht|
Jen gave birth to a son in January 2007, four years after a previous caesarian section. She delivered at Academisch Ziekenhuis Maastricht (AZM) and received the new form of pain relief which was introduced in The Netherlands last year.
When did you first find out about the new form of pain relief ?A couple of months after I'd had it! When I got it I told the hospital staff present that I had no idea epidural medication could be self-administered, and even then no one told me it was a new technique. It took reading about it at this site for me to realise it was and I have since read more about it.
Did you ask for it in advance or was it given to you at the last minute ?I didn't ask for it at all, the OB on duty was encouraging me to get it within three hours of my arrival at hospital. He wanted to start a pitocin drip, which makes contractions much more difficult, and therefore was recommending the epidural as well. I was particularly surprised by this because both pitocin and epidurals are generally not recommended for mothers attempting a vaginal birth after a previous caesarian, which was my situation and the reason I refused both.
I didn't change my mind until many hours later. I got the uncontrollable urge to push too early (5cm). I needed to stop pushing before my cervix swelled in reaction, as that would dash all hopes for a vaginal delivery. After fighting the urge, with my husband and doula's support, for many long hours, I was too exhausted to continue and got the epidural.
Was there any reluctance to give it to you ?I was reluctant (and never so terrified in all my life) to get it, but no, they clearly wanted me to have it. I did end up waiting a couple of hours after I decided to take it, because there had been an accident and the anaesthesiologists were busy.
Were you offered any alternatives ?The shower, which was lovely, but that was much earlier. I had constant electronic fetal monitoring for most of hard labour, and one can't shower with that. I did request pethidine during the wait for the anaesthesiologist, but it only made me doze between contractions, and didn't lessen the pain or the urge to push one bit.
I assume this type of epidural is the only kind they give to labouring women at AZM, since they never mentioned or offered a traditional epidural.
How far into labour were you before the epidural was set up ?It had been 24 hours since my water broke, which was how my labour began. I was at 8cm, which is usually considered 'too late' for an epidural, but I had been 'stuck' there for some time.
What did it feel like after you administered the pain relief for the first time ?Nothing! The effect came on very gradually and it was at least fifteen minutes before I stopped feeling like I needed to push, and about fifteen to twenty more before I stopped feeling pain. I was really disheartened then, because I hadn't really wanted it in the first place, and then it didn't appear to work! But eventually it felt very much like my lower body was asleep, like when one's foot gets 'pins and needles', and I had no more pain.
How often could you administer the pain relief ?The infusion machine would administer a dose every nine minutes at most, no matter how often the button was pressed. So that I could sleep (I was very exhausted by then), a nurse was coming in to push the button for me. I don't think I ever gave myself a dose, to be honest.
How far into the labour were you allowed to administer the pain relief? Did you have to do without for the final stages of delivery ?We stopped the doses when I reached 10cm, about three hours after receiving the epidural. The baby was still quite high then, so they left me for maybe forty-five minutes to an hour more to let him descend, and to let the morphine wear off (and it did very quickly, which is, I think, partly the point of this system).
If you had to do without, was the pain really intense after having had the pain relief ?No. The pain returned soon after I stopped getting morphine doses, but the urge to push was, ironically, gone until the OB had me 'try' a few pushes. The pain alone, without having to fight the pushing urge,was manageable, and then once I did start pushing it was a complete relief. The pushing stage was far less painful than the dilating phase!
On the other hand, if they'd given me that button during the stitching up part later, I'd have pressed it some more! I don't know why they didn't as the epidural tube was in place for some time after the birth.
Did the pain relief affect your baby ?I don't know. He was very awake and alert for a few hours after he was born, his Apgar scores were great, and he nursed very early on. However, he was jaundiced (and therefore sleepy, which made feeding difficult) in his first week of life, and both epidurals and pitocin have been found to contribute to this. I don't know whether they caused it in his case.
Were there any side effects of the pain relief ?My upper body got extremely itchy because of the morphine. I also suffered from a headache, though I don't know if that was a side effect or if it had been there already, unnoticed until the epidural took away the contraction pains.
If you have another baby would you choose the same form of pain relief ?No. I hope that if I have another baby I won't get the urge to push before I'm fully dilated, and that labour won't take so long. I know from this experience that I can handle it! In this case I know it was the right choice and it actually enabled me to avoid a second caesarian, but the thought of it still makes me cringe. Needles just don't belong anywhere near my spinal cord!
What advice would you give for someone reading this who would like to ask for this form of pain relief? ie. how would she go about arranging it ?Ask for it. It seems to depend on the hospital. I think academic hospitals are more likely to be trying it and to have it available 24 hours a day. But mums-to-be should educate themselves on the pitfalls of all types of pain relief long before labour starts. The risks tend to get glossed over by many OBs. It is also important to realise that this is still an epidural (ie: it is administered through a catheter that is inserted into the epidural space around the spinal cord) with most, if not all, of the same risks as the traditional epidural. What makes this different from a traditional epidural is that the medication is self-administered and contains only morphine.