Welcome to another 'Who you might meet'! As part of this series we aim to introduce you to some of the people you might meet during the course of your pregnancy, during your birth or in the postnatal period. If you have been fit and well before your pregnancy, it could be the first time you meet health professionals and access healthcare services. Or if you are from another country, it could be that maternity services in the UK run a little differently from your home country. So in this post I have interviewed my lovely friend, Thea Morgan. Dr Morgan is an anaesthetic doctor and mum to two lovely little people. Welcome Thea!
Hello Thea! Can you tell us a little about yourself. Who are you and what do you do?
I am a mum to two small monsters and I am also an NHS doctor. I have been in your shoes. Twice. My job at work is as an Anaesthetist, whereas at home I am tamer of mischief.
Ok so what does an anaesthetist do? Will I meet you during my pregnancy?
So an Anaesthetist is a doctor that works in one of the largest hospital specialities. We look after patients in maternity, intensive care, and in theatres. We also have training in pain management. You may see/speak to an Anaesthetist in pre operative assessment if you are scheduled to have an elective caesarean section. Or you may meet an anaesthetic doctor in your pregnancy if your BMI is slightly higher or you have had issues with anaesthetic medication in the past.
Right. So what about when you go into labour?
Depending on the hospital, there is usually an anaesthetist assigned to the maternity / labour ward during each shift. They would be involved with inserting epidurals, checking epidurals are working and providing the anaesthetic for caesarean sections, both planned and unplanned. We also have an interest in pain management. During the week in "daytime hours" (0800-1800) there may be more than one anaesthetist assigned to maternity. Out of hours there are fewer people around so sometimes there can be a short delay before an anaesthetist can come and see you to do an epidural.
So if you decided you want an epidrual then we need an anaesthetist to come and do it? Can you tell us a little more about epidurals. How long do they take to put in? What about monitoring and movement in labour?
Yes. An epidural can only be inserted by one of the anaesthetic doctors so that's why there can sometimes be a delay between requesting one and the doctor coming. We might be busy in theatre before we can get to you. Epidurals are used to assist with pain in labour. This labour pain infographic is really useful, it is authored by The Royal College of Anaesthetists and covers spinal and epidural anaesthesia. I would strongly suggest reading it prior to labour. As for how long they take to go in, it depends on a variety of factors. Sometimes it is a couple of minutes for the small plastic tube to be inserted, other times it can take a little longer. The Anaesthetist will work with you to do the procedure around contractions and to get you in the best position. It's worth noting that epidurals don't work straight away and can take 20-40 minutes to take affect after it has been put in.
Those that have an epidural will need to have a cannula inserted before the procedure and most maternity units run intravenous fluid through the cannula slowly whilst the epidural is in. This is because the epidural can lower your blood pressure. Movement in labour can be restricted depending on how much the epidural is blocking the motor function (the ability to move). The type of block depends on the type of maternity unit you are giving birth in so it is worth asking about this.
What are the pros and cons of an epidural?
I think this is a very personal list and I think it would be worth writing yours down with your birthing partner. There are the risks of the epidural which are on the information sheet so have a good think about the numbers associated with these risks. For some people it could be too much of a risk and would mean avoiding an epidural, for others an epidural is definitely a part of their birth preferences. This website is fab too.
Did being an anaesthetist make it hard when you were pregnant or in labour? How did it affect your birth choices?
Birth choices and experiences vary between different people. My first labour was very different to my second labour for a variety of reasons. My second pregnancy was medically challenging so my labour options were different to my first delivery. I was induced in my second delivery and so I gave birth on the delivery suite in a hospital. It was a highly medicalised birth but I also knew that it probably would be due to the type of pregnancy I had had. Everyone has a different birth experience and people often talk about the horror stories. Despite being heavily medicalised, my second delivery was beautiful and calm and much more pleasant than the first delivery.
Any top tips for couples who are undecided about whether or not to have an epidural? What would you suggest for women keen to avoid an epidural and/or women keen to have one?
I personally don't feel that you need to decide whether you would like an epidural until you are in labour. However I do feel that you should read information available about the different types of pain medications even if you don't plan on using any. It is very hard to consent when in pain or tired and having an idea about the options beforehand is very useful. If you are keen for an epidural then let your midwife know. It means that this can be in your maternity notes and it also means that the anaesthetist can be informed when you arrive at delivery suite. You won't be able to have an epidural if you are giving birth in a birthing centre or aiming for a home delivery.
Any final thoughts?
The next bit is not necessarily related to my profession but more my personal experience of women talking about their birth experiences and how they felt that they had "failed" in some respects. Failed because of forceps, failed because they chose an epidural, failed because their birth ended in a caesarean section. If any of this happens, you have not failed. I think it is important to have an idea of what you would like the birth to be like but also keep a very open mind that it may not happen as you expect it. This can be for a variety of reasons and none of this is because you have failed. Most maternity units offer a "debrief" service if you feel that after the birth you would like to talk about the experience and understand what happened and why.
Thank you so much Thea. We couldn't agree more with your thoughts about failure. Sometimes we can be so hard on ourselves. Birth is unpredictable and whilst we encourage people to think about birth preferences, sometimes plans change. We talk about all forms of pain relief in our Gather antenatal classes and spend time thinking about comfort measures like movement and breathing, in our active birth class. You may be certain you want an epidural but you may not be able to have one until your in established labour so why not come along to our classes to find out how you can manage early labour before you get to hospital. As ever, there is never any judgement just open, honest and evidence based information from two midwives with heaps of experience.
@growandgatheredinburgh