Expert: Dr Ian Jackson - please note UK based - 10/13/2008

Question
hi, im 37 weeks pregnant and happened to be reading one of my baby magazines and came across an article on the epidural and the fact that if you have scoliosis a lot of doctors won't give it to you. I read that some are willing to try but that it's risky, likely not to work, and will permanently make your scoliosis worse. I have never mentioned to my dr. that i have scoliosis because i didn't think that it mattered. I plan to discuss this with her at my appt. on wednesday but wanted to get a second opinion. During my pregnancy, my dr. has never really comforted my concerns and merely brushed them off. I've done some research and it seems that getting a c-section is my best (and safest) bet, due to the fact that i'm no longer willing to try the epidural and i'm definately not willing to have natural childbirth. but my dr. HATES doing c sections and only gives them if absolutely necessary. I'm concerned she will want to try to give the epidural anyway and i feel that the risks outway the benefits and i'm not willing to do that. My scoliosis is bad enough as it is and can only be fixed with surgery, i am not willing to make it permanently worse for an epidural that may not even work. I was wanting to know if you felt that a c section is necessary or what is exactly, and if i should try to switch dr's last minute to find one who is willing to do it the way i feel most comfortable. thanks

Answer
Amanda
I realise this is an anxious time for you and that you are very intelligent but I am going to be quite frank - so apologies in advance!
You don't mention how bad your scoliosis is. I suspect it is reasonably mild as you don't mention having any problems during your pregnancy. I think you are putting the 'cart before the horse' and have possibly been doing too much reading on the internet which can give you quite a warped sense of what is needed. I am particularly concerned about the c-section bit and the 'I'm no longer willing to try the epidural'
The important thing here is to explain calmly about your concerns and a brief bit about what you have gleaned form the internet and then listen to your obstetrician. They are the expert and more critically they are the expert looking after you - they know your condition and will advise appropriately what is safe for you.
I suggest you ask to see the anaesthetic team who look after the patients in your hospital. They can examine your back and let you know if they forsee any problem - that way they will know about you and you will know if there is actually an issue here.
I have successfully provided epidurals for many women with complex back problems including those whose backs are so deformed they have to use a wheelchair and whose breathing at the end of their pregnancy was extremely difficult. So there is no reason to rule an epidural out - the anaesthetic team are there to advise on that.
Finally many women still manage childbirth without epidurals so I am concerned as how there is a jump from 'I can't/won't have an epidural' to I must have a C-section. C-sections are not without their own risks and so I am not surprised your obstetrician is not keen. Childbirth is still a natural process.
So that is my advice. In the UK you can always ask for a second opinion if you do not like what your obstetrician is saying but there is no Obstetrician offering c-section 'on-demand'.
So I have been frank but hope that you see some sense within what I have suggested. I wish you all the best for your delivery.
Kind regards
Dr Ian Jackson