epidural for labor/delivery and MS

[geekgirl]

Hi Everyone--
I'm having what seems like a weird problem with my health care provider, and I wanted to check with folks here and get some anecdotal advice/experience.

I was DX with early stage MS in 2007 after a bout of optic neuritis and an MRI showed numerous brain lesions. Was on Copaxone for a couple of years; currently off it because I am now pregnant with my first child and am due in November. I have had no symptoms or flare ups in the past four years and have never had motor skills issues. I was trying to use an OB at my local hospital--this week, she sent me in for a routine consult with Anesthesiology to prep for delivery.

I should also mention that I would prefer an epidural if it's safe and possible at the time of delivery, and I discussed this with my neuro who said there are no contraindications for epidurals and MS. This is also what the National MS Society says. My OB also knew this and was fine with it.

So I went in for the consult and right off the bat, before asking me anything about my MS symptoms, the anesthesiologist told me that two of his eleven people would absolutely refuse to give me an epidural b/c I have the MS dx. He said that their reason was that there's not enough evidence to support whether it's safe for people with MS. I pointed out that the National MS society and my neuro both said that there are no contraindications and he said that didn't matter, their decision was based upon the fact that there wasn't enough supporting evidence and he couldn't compel them to do it. Offered to have him talk to my neuro to learn more about my case--he still said that the two wouldn't be interested in doing that, it had nothing to do with my case. But that given that it was only 2 out of 11, the odds were pretty good that I would get someone who would be willing to do it. (!!)

Smells like a "I don't want to get sued" deal to me. It seems like there are LOTS of things we don't have data for--if I ask for a Tylenol, will these two say "we don't have enough data about giving women with MS in labor Tylenol?"

So, end result--I decided to find a new OB and hospital, at 28 weeks I decided to go to the hospital where my neuro is because I figure 1) it's a much bigger hospital in a city near me, and so they probably have more experience with MS and 2) my neuro is there and I would think that they would be more willing to talk to him and at least consider my particular situation.

So my questions for the group--anyone ever been denied an epidural for labor/delivery just based upon the DX? Any issues that came up when discussing it with OB/anesthesia?

I'm really torn because I like my OB and it would be a lot easier for me and my family if I can deliver locally--but not if there are people there that won't treat me based upon a Dx. I'm trying to figure out if this sort of thing is common--I don't want to go through all the trouble of switching to a different hospital/doc and then having the same thing happen.

Many thanks for any advice.

Geekgirl

[cosake]

I've not been in this situation, as I had both my boys well before diagnosis.

However, I would ask to speak with someone else above their heads at the hospital if you really want to use this OB. Find a patient advocate or someone else who can help you try to get this resolved. It seems really unfair that you need to switch OBs to get the care that you deserve.

I hope that you can find a good resolution on this. Keep us posted.

[scusrey]

I've had epidurals with both my births and I can't be 100% positive but, I don't think the MS ever factored into it when it came to the anesthesiologist or OB. Now I'm like, hmmmm, were they really confident in their knowledge and abilities or ignorant on the situation?!!

[aitch10]

Hi Everyone--
I'm having what seems like a weird problem with my health care provider, and I wanted to check with folks here and get some anecdotal advice/experience.

I was DX with early stage MS in 2007 after a bout of optic neuritis and an MRI showed numerous brain lesions. Was on Copaxone for a couple of years; currently off it because I am now pregnant with my first child and am due in November. I have had no symptoms or flare ups in the past four years and have never had motor skills issues. I was trying to use an OB at my local hospital--this week, she sent me in for a routine consult with Anesthesiology to prep for delivery.

I should also mention that I would prefer an epidural if it's safe and possible at the time of delivery, and I discussed this with my neuro who said there are no contraindications for epidurals and MS. This is also what the National MS Society says. My OB also knew this and was fine with it.

So I went in for the consult and right off the bat, before asking me anything about my MS symptoms, the anesthesiologist told me that two of his eleven people would absolutely refuse to give me an epidural b/c I have the MS dx. He said that their reason was that there's not enough evidence to support whether it's safe for people with MS. I pointed out that the National MS society and my neuro both said that there are no contraindications and he said that didn't matter, their decision was based upon the fact that there wasn't enough supporting evidence and he couldn't compel them to do it. Offered to have him talk to my neuro to learn more about my case--he still said that the two wouldn't be interested in doing that, it had nothing to do with my case. But that given that it was only 2 out of 11, the odds were pretty good that I would get someone who would be willing to do it. (!!)

Smells like a "I don't want to get sued" deal to me. It seems like there are LOTS of things we don't have data for--if I ask for a Tylenol, will these two say "we don't have enough data about giving women with MS in labor Tylenol?"

So, end result--I decided to find a new OB and hospital, at 28 weeks I decided to go to the hospital where my neuro is because I figure 1) it's a much bigger hospital in a city near me, and so they probably have more experience with MS and 2) my neuro is there and I would think that they would be more willing to talk to him and at least consider my particular situation.

So my questions for the group--anyone ever been denied an epidural for labor/delivery just based upon the DX? Any issues that came up when discussing it with OB/anesthesia?

I'm really torn because I like my OB and it would be a lot easier for me and my family if I can deliver locally--but not if there are people there that won't treat me based upon a Dx. I'm trying to figure out if this sort of thing is common--I don't want to go through all the trouble of switching to a different hospital/doc and then having the same thing happen.

Many thanks for any advice.

Geekgirl

I had a med-free birth but the placenta didn't pass. My OB told me that if I had an epi then he would have just "gone in" to clean me up, but I needed some kind of anesthesia for the procedure.

The anesthesiologist showed up and said he would give me an epi but strongly recommended general anesthesia because of the MS.

So, in my experience, your old anesthesiologist is not alone in being reluctant to give an epi.

[samandmattsmom]

I was denied an epidural/spinal with my second son...and I did not find out until I was in labor! I wound up having to have a c-section and they knocked me out for it. With my 3rd child I had a repeat section and the gave me a spinal block. I did not have any trouble with it whatsoever. Good luck. One thing that they mentioned to me was that sometimes it takes a while for the numbness to wear off and it can make it harder for MS patients to walk afterwards. I hope this helps.

[Alyms79]

That also to me sounds like a "I don't wanna be sued"!! I had both of my kids before dx,and used epidural on both. NO headaches,no complications. It is completely safe!!

Congrats on the new baby!!

[Tawanda]

epideral: big dissapointment IMO

I also smell an "I don't want to be sued" scent in the air with your situation. I had the epideral when I had my daughter. When I put the pieces together, I had M.S. for at least 10 years prior to diagnosis, meaning I had M.S. when I gave birth and when I got the epideral. I'll bet thousands of women gave birth under the same circumstance...undiagnosed M.S., used epideral, and came out just fine.

I've only given birth one time, but it seemed to me by the time I got the epideral, I had already been through the worst of the child bearing process (nearly blacking out twice during the process and put on oxygen). I don't think my experience was that different from "natural child birth" (which incidentally my sister did FIVE times!) I thought epideral was a pass from the pain of childbirth, but now I think that's a crock. Either it's a crock or they completely screwed up by giving me the anesthesia too late, or they did not give me a high enough dose to be effective. It simply didn't work! I suppose perfect timing is almost impossible in a delivery situation. Every woman is different. Some women would probably sing the praises of this drug.

When all was said and done and I was holding a healthy 6 pound baby girl, I laughed, cried, and pretty much left the whole birthing experience in the rear view mirror. I guess what I'm saying is although the the epideral didn't seem to help in my case, it didn't do any harm either.

Good luck.

[joyful mommy]

I have had three epidurals...only one since being diagnosed. I had no problems with them or any complications. With my last baby (post diagnosis) the ob and anesthesiologist never even questioned the ms. Or my ability to have an epidural. Good luck with your new baby!

[onlyairfare]

I had two pregnancies where epidural was considered, and it was fine with both OB and anesthesia both times. The first time, for vaginal delivery/VBAC, I decided to wait a little until it "really hurt" before I got a needle in my back, and next thing I knew I was completely dilated and it was "too late" for the epidural. The next delivery I had a medically indicated repeat C-section with epidural, no problem.

However, a few years later I needed knee arthroscopy for a torn meniscus and the anesthesiologist really didn't want me to have spinal anesthesia, he wanted me to have general. Though general anesthesia is quicker and easier for the anesthesiologist, I wanted to be awake. Anesthesia wouldn't budge until I told him that if I could not have regional (spinal), I would tell my orthopedic surgeon that I would have to cancel the surgery (I was already in the OR at this point!) since I did not want general anesthesia. Then he caved and said OK, have the spinal.

I truly believe that it was not just the "easy factor," but that he was afraid that if I had any MS neuro problem post-op, a definite possibility with an MSer, he would be blamed and sued because I would attribute it to the anesthesia, not the MS. Since all my other docs had thought that epidural or spinal was fine despite MS, and my experiences went well, I don't see any reason a patient who wants epidural shouldn't get it.

BTW, I wanted to be awake to make sure they did everything right - no "wrong knee" surgery. My doc operated on the correct leg, and since I was awake I got to watch the whole thing on the video screen. It was neat. But after the surgery, the nurses tried to put me in the wrong bed - somebody else's dirty bed, when I had a fresh surgical incision! Since I was wide awake and told the nurses I wasn't getting in a dirty bed, they went and checked - sure enough I was right. Imagine if I had been groggy from general anesthesia - I'd have been put in a dirty bed with someone else's germs. Yuck! Let's hear it for regional anesthesia!

[geekgirl]

Thank you all so much for your thoughtful replies and for sharing your experiences--I really appreciate it! I'm going to try another doc/hospital and see how I do, and also see if I can work with the folks at my local hospital. Thank you again!!