Anyone else 'tricked' out of epidural?(1004 Posts)
I went over my birth notes today at the 'Birth Reflections' service at my local hospital. (In order to get closure and prepare for No 2!)
To cut a long story short, My previous labour was 27 hours from start to finish although I was only admitted for the last 7 hours.
I asked for an epidural no less than 6 times during this period and was given the excuse that I needed to be 4 cm before I could get one.
Suprise, Suprise, no one would examine me to check how dilated I was and so then it became 'too late' to give me once I had reached 10 cm.
Despite Nice guidelines saying that no woman should be refused an epidural (even in the latent first stage!) apparently the hospital have their own policy.
I am SO ANGRY about this and feel that I was ignored and treated like a small child. Incidentally, the hospital are unapologetic about this and refused to say sorry about the care I received. The most that they would conceed was that they had 'somehow failed me'.
Why is this still happening to us in the 21st century? Anyone else had a similar experience? What can we do about it, and how can we prevent it happening for subsequent births? It's time that midwives stopped deciding for us how much pain relief we need and consult with us regarding how to make our births more comfortable. Not saying that all midwives are like this, but mine was a particular dragon....
I don't want this to turn into a debate on the pro's/cons of epidurals as this has been done to death elsewhere...
Did you see One Born Every Minute this week? Fairly similar case there.
I wasn't tricked like that, but I was refused one because they could apparently only have three women with one at any one time, and they already had one woman with and two women waiting (and the anaesthetist was in theatre anyway), so it was tough luck.
I get that it's to do with hospital resources, but I was particularly annoyed because at the pain relief class the head anaesthetist (a woman) had been very smug about how great they were and how almost everyone asks for one in the end, even when they started dead against them.
I live in a rural area with only a MLU.
I specifically journeyed, by ambulance 1.5 hours to a CLU to get an epidural.
And I never let those lazy arse midwives forget it. I refused to get off the bed and harped at them. 'What if you have a baby before that?' 'I won't, lady, without getting what I came here for, got it?'
I even got others to ring them, asking if I'd got my epidural (they were just good friends checking to make sure I wasn't in any pain after such a long journey ). Yep, had my phone and was texting away, 'Still no epi'.
For 4 fucking hours.
My waters broke as it was going in. But I got the damn thing.
Midwife tutted, 'Slowed the labour right down.' 'My body, my labour'.
She got nothing but scolding right back at it because I'm not a schoolgirl, I'm a woman who knows her own mind, who came there to get treated, not lectured, not talking down to, not bullied.
It happens because they're trying to keep their costs down.
Also, because they don't want to sit one on one with a patient. They'll say they can't because they are short-staffed. And when someone has an epi, they can't be left on their own.
And because it is women who give birth and this is a misogynistic, chauvinistic culture that treats women like second-class citizens.
THAT is why people are treated like this.
And it makes me just as angry as it does you.
Till I got my fucking epidural.
expat, maybe you'd like to come and be my doula for next time I think I'll need an advocate if I ever go back!
I want to write to my M.P. about this. I don't see why we should carry on letting this happen to us. The only way I can avoid this happening again is to go private, but then I'm technically paying twice, once through my taxes and again privately.
I'm seeing the consultant on Monday so we'll see what he has to say about the matter...
They tried to put me off too. I was "only" 3cm dilated (not to mention exhausted after 29hrs of back-to-back contractions) so it was "too early for strong pain relief". Luckily, I got hysterical at this point and demanded they call the consultant in to give me a section - we agreed to compromise .
It still makes me very angry that I was made to feel as if I was not trying hard enough. I feel very sorry for any women who feel that they have to accept this. This paternalistic attitude to pain relief helps no-one.
See, even if you see a consultant, they'll pull that, 'Well, we can't guarantee'.
I think that's bullshit.
If I had had the funds, I'd have had a private CS. I suffered PTSD from the experience of drug-free childbirth.
It should not be forced on women who don't want that experience.
But because it's women and the NHS is cheap, it is.
There's also the culture in the UK that is very anti-pain relief, anti medication of any kind.
I got bluntly told no epidurals were available on arriving in the delivery room. ( I had in my notes about being frightened, wanting epidural etc etc) I broke down sobbing between contractions while awful midwife just stared through me and offered me NO support. I think I cried for about 10 mins (very scared of pain) and then I had to get on with it, the contractions were very close together.
Now as it turns out, we were in a homebirth suite where they didn't administer epidurals at all. But awful midwife didn't tell me that.
Everything turned out okay, but the manner of the midwife and the straight out dismissal of any pain relief options apart from gas and air was for me, very upsetting.
I am shocked that you weren't going to be allowed epidurals!
How controlling and disbelieving of you. It would make me furious too. I was lucky in all three of my experiences, I had heard tales but my consultant was pretty good each time.
With DD2, the anesthetist was in surgery, but I still got my epidural at 8/9 cm when he was available (consultant intervened again).
I think that any woman is entitled to the birth she chooses and that should be aided as much as possible.
OP, could you please post the link to the NICE guidelines you referred to? Would be really interested. Thanks.
That really is awful. My sister and my DH's cousin told me that they too begged for an epidural and weren't given one (all sorts of excuses).
With DD1, I (ashamedly) went in at 2cm and accused them all of being in cohorts and threatened litigation. I didn't get the epidural for hours and hours later and I'm not sure it had anything to do with it. DS and DD2 were within the high risk clinic and I think that helped with them (lovely consultant).
Yes, my experience largely the same. I did most of my labouring at home, the pain got unbearable, went to hospital, told I was 2cm dilated and come back much much later - no offer of any pain relief at all - but I fully dilated within the hour and was pushing in the car.
My notes clearly stated I wanted an epidural, that gas and air had previously made me sick. Guess what I was given? Gas and air which they took away after 20 mins as it made my pushing ineffective/me sick. All requests for pain relief were ignored. I wanted to stand up but mw insisted I lie down. I was pushing for 4 agonising hours, tore early on in that process high up and knew something was wrong. Baby born not breathing, rushed away. And no pain relief.
And that was just the start of the crap care in hospital. My notes later said the birth was mismanaged and traumatic.
For birth no 2 I was offered a guaranteed epidural, the longest I would have to wait would be 30 mins (mw didn't want me to have a csection). When I asked what would happen if someone else wanted an epi at the same time I was told "They'd be counselled away from having one" God help them if their 'counselling' was anything like mine. In the end I was induced, had immediate epidural, the whole labour took 5 hours and I was topped up at source so I felt nothing. It was an excellent birth and laid to rest the ghosts of the past.
and anyone else who needs it.
See page 21 for guidance on epidurals and how we shouldn't be denied it.
What a fucking joke. When I brought this up, the midwife said they were 'just guidelines' Great, so what was the point of spending millions of pounds of taxpapers money funding the research into it then...
To the others, I'm sorry that you've had these types of experiences. It is my belief that anyone requesting pain relief should get it. If you want a nice, natural, drug free birth, you should get that too.
We are women, not animals.
Never once had a problem with consultants. The second the consultant got involved, I was listened to.
Fucking midwives, however, like to keep you away from them because then they'll actually have to work and not fob people off.
I got told, with DD1, my first, who turned out to be OP and with her hand up cupping her head above her ear, that I wasn't in that much pain.
But she'd never had a baby. I told her where to go with that!
And complained about her formally, too.
I've never ever met more unprofessional healthcare providers than midwives, tbh.
There are lovely ones, but my experience of hospital ones is not good.
Yes, it's funny the way once a consultant gets involved, things get done.
I did have the same midwife for DS and DD2 though and she was fab also.
I had a midwife and my husband
shouting at me telling me quite firmly that I should maybe consider pain relief, because I was obviously in pain, and despite all my denial I actually was having contractions and was in labour, and was attached to a drip which was causing a lot of pain.
After reading all the natural birth stuff during pregnancy I was so terrified of pain relief and the cascade of intervention, that I didn't want to allow it. I'm glad they convinced me in the end, and I'm glad that I wasn't in an anti-pain relief hospital.
Oh, one other point with mine
I'd wanted a home birth, but on the day was told that they weren't able to give me any pain relief at home (even gas and air). So I transferred into hospital specifically for pain relief. When I got there I asked for an epidural, was told not possible. I asked for pethidine, they said they'd sort it, went away. Forgot about me. A while later, when we rang the bell to ask where the hell my pethidine was, they examined me, said I was at 10cm (too late for pethidine) and to start pushing.
Gas and air I gave up on as it was having no effect and just messing up my breathing. So I wanted an epidural, and actually gave birth without any pain relief. Fun fun.
Your stories are bringing back so many memories I went into hospital 8-9cms dilated, they broke my waters and the contractions got horrendous immediately. I went from in control to incoherent immediately. 7 hours of agony later our dd was born, I had a double extended episiotomy all on gas and air. I was pushing for 3 hours. My dh was black and blue from rushing from side to side trying to stop me lurching off the bed trying to avoid the pain. The epidural I was promised didn't materialise. I've not been brave enough to have another baby and dd is now 7
It's brutal and wrong on so many levels. I didn't realise it was so widespread
The only reason I got my epidural was because I was a home birth transfer to be put on an induction drip and I refused to let them put the drip up until the epidural was already in place. I got it in half an hour then.
All the other people in my antenatal group had to fight and I think only one other out of 8 got one.
'I had a double extended episiotomy all on gas and air.'
See, I just don't get this. I watch 'Emergency Bikers' and the paramedics are injecting people who might have a broken ankle full of morphine, but if I had 5p for every women I've read about on here in the past 6 years who's had episiotomies or even instrumental deliveries on G&A I'd be rich.
It seems to be that if it's childbirth it's okay to cut a person's genitals with a scalpel with no pain relief (because G&A is not, IMO, and it doesnt' relieve pain for everyone).
It's a travesty.
expatinscotland you're absolutely right
Yep, I had an episiotomy with no pain relief, even gas and air. He injected local anaesthetic first, but cut instantly after the injection, so there was no time for it to take effect. Only time I screamed during the whole thing!
I don't blame the obs for that - they were concerned about DS's heartbeat and trying to get him out as quickly as possible - but if I'd had the epidural I'd asked for earlier I wouldn't have felt it.
(Oh, and he cut with scissors, not a scalpel. Shocked my husband somewhat!)
I'm 35 weeks and this is my deepest fear about giving birth. I'm no shrinking violet normally but when in the throws of contractions it is just too much to think I'm going to have to get into an argument and try and persuade the midwife to give me medicine that is my basic right to have. I've been trying to pep up my husband (who is generally regarded as the nice one) to become demanding and be my advocate but it will be almost too much of a change of his underlying personality although he will do his best
I do feel that because this is purely a female procedure it doesn't get focused on and these types of issues go on without any changes. And yes, I'm a bit of a feminist.
Rhian82, my god.......
It's not really as bad as it sounds - I mean, the principle is bad that they don't give pain relief when asked for, and I'm ready to shout and make noise about how awful that is. But my personal experience wasn't hugely traumatic - the memory of the pain faded quickly, and both DS and I were fine afterwards.
I don't want to scare pregnant women, I'm sorry!
The question is though, what can we do about this??? If we all keep quiet and accept that this is our fate, nothing will change.
We are intelligent women, if we want an epidural and accept that this may bring further intervention, what right does some bloody midwife have to withhold it?
Who can we lobby over this? I'm standing up for women everywhere who are treated in the most barbaric, prehistoric way - all in the name of childbirth.
Oh, and BTW, the midwife yesterday would not accept that anyone purposely witheld the epidural. Even though, I know that this routinely happens to thousands of women across the country. It is Scandalous!
"Fucking midwives, however, like to keep you away from them because then they'll actually have to work and not fob people off.
Thats not really true. As a midwife I'd say its a lot less work looking after a woman with an epidural. I love it if a woman wants one.
Then why keep fobbing someone off who continually asks for one?
But that's been the experience of nearly everyone on this thread, many of whom got pain-relief free deliveries they did not want, some, like Starlight, with major emotional problems afterwards.
The only time I tell someone that they can't have one is if the ward is busy and the co-ordinator in charge of the ward won't allow it for safety reasons.
Or if the woman is 3cm or less and the co-ordinator won't allow it as ita against hospital policy. Now I've always been told that if you have it prior to 4cm your body could stop labouring, etc. Am off to have a look at the NICE guidelines though as haven't seen a bit about women in the latent phase should be allowed them. If it does say that I'm going to bring it up with the l/w manager and see if policy can be changed. That link doesn't work though, am off to google.
But that has not been the case for many of us here, Viva.
And also, what the gist of the thread has been is why should anyone be turned down for one ever?
Recommendation on timing of epidural analgesia
Women in labour who desire regional analgesia should not be denied it, including women in
severe pain in the latent first stage of labour.
That is very interesting. I'm definetly going to bring that up at work. I know what they're going to say though - they'd be worried about people in the latent phase of labour "bed clocking for days". We have 10 rooms on l/w, most of which are full. We have to prioritise. If we end up with a couple of women at 2cm with epidurals we're going to end up not having room for people coming through the door at 6cm, or even 10cm and pushing.
I have to say I agree with this and I'm a water birth/hypno birthing breath through it type but when DD3 was back to back and we'd reached the 24th hour of labour and I asked for an epidermal only to be told it won't be long, the anesthetist's is busy with somebody having REAL problems you do feel close to thumping somebody.
My advice is if you know you want one, demand one before you get into the whole gown, patient on the bed scenario much easier to be assertive stood upright and fully clothed as a member of the public.
Expat - thats what I'm saying. Its not right that people are turned down for epidurals but its not always the individual midwife. I suspect a lot of the time it will come down to space and staffing constrictions. I was looking after 2 labourers last week, both of who were begging for epidurals and neither could have them as I couldn't give one to one care. Its not safe to give someone an epidural and then not be with them.
I am offended a little by the attitude towards midwives recently on MN in general (OBEM thread and particularly at the language used here and also the generalisations which I feel have been made.
I don't think the 'fob off and actually have to do some work' comment is accurate or fair. Like Vivalebeaver it is actually easier to look after a lady with an epidural.
Pain relief in labour should be women centred, however, it should also be safe. It is not the fault of the midwife if the anaesthetist is busy. They do not only do epidurals in labour; they are often also covering gynae and are involved in the emergency care of poorly high risk women too. I frequently have to run a high risk delivery suite and a midwife led birthing unit attached ( that is 15 beds and 2 theatres) often with only 5 midwives. It is not down to me (or any other mw personally) that midwives go off sick and that we are under resourced but it is down to me and my colleagues that care is provided safely. As you know
epidurals demand one to one care: you can do the
maths, as they say, with the numbers I have
The timing of epidural administration is contentious.
Whilst I am aware of the NICE guidelines (needed to
refresh myself on the wording re latent phase) I do not
believe it is always appropriate to administer one when
labour is not established because of the cascade of
intervention. Also labour is unpredictable and can
progress very quickly. The siting of an epidural can be
dangerous if certain positions cannot be adopted due
to advancing labour. An epidural can take up to a
couple if hours to be prepared for (Ivs sorted,
equipment obtained etc) sited and to be effective. This has to be considered along with if delivery is likely.
God I feel very upset that I have to defend our practise when we are truly doing our best within the rubbish resources we have. I appreciate that individual women are involved here but I find the generalised verbal abuse and swearing towards us inappropriate. The individuals who have suffered as described should justifiably take their cases forward but the suggested conspiracy (just reading the title of the thread) is un
called for. The fact is the NHS often can't provide - the pot isn't a bottomless one. Women need to be aware of what happens in their unit but there is always the option of The Portland.
Women need to be aware of what happens in their unit but there is always the option of The Portland.
And yet the argument against private schools is that if they didn't exist state schools would improve - does that not apply to the NHS which we all contribute towards then ?
The fact is we have too many people, too many women giving birth and the NHS can't cope, but that's not actually our problem is it, there are enough bloody managers they need to find solutions, perhaps they could call a meeting about it ?
This is not, and was never intended to be a 'midwife bashing' thread. However, in any profession, a number of individuals may not be operating in accordance with the protocol laid down. Please, Please try not to take this personally, as it's not a reflection of you, the individual
It's just a place where we can vent about our experiences and hopefully bring about change.
Unfortunatley, the point you have highlighted is the very one that I'm concerned about. If you personally believe the NICE guidelines are wrong/contentious, then you/your unit are not going to follow them and therein lies the problem.
Shouldn't women be told the exact reasons for witholding pain relief, rather than be fobbed off/told lies?
I.e. in my case, they could have just said, we'r short of midwives tonight, we can't give you one to one care. Yes I would have felt a bit let down, but I wouldn't have felt tricked.
I know the NHS resources are rubbish, however there are a number of ways in which clear, open and honest communication between intelligent women and the caregivers can make things a whole lot beter.
Have you thought about taking them to court - since they've breeched NICE guidelines and obviously distressed you, maybe you could get someone to take the case on.
They'll probably change their "policy" if they have a judgement against them
The problem then is that you are just taking more money out of the NHS where it is so desperately needed. Court cases cost thousands and I don't see how this would help.
I'm not seeking to blame any individual for the care I received, I just don't want this standard of care to be 'the norm'
Liznay, yes that is exactly what should happen and it is unacceptable that it doesn't. Really interesting point about the NICE guidelines: I am not sure that we are bound to them: they are a best practice guide, not a policy. Will look into that.
I had this experience with DS2 "It's too soon. It's too soon. Oh no. It's too late."
I was cross but never took it up with them. They'd cover their arses somehow.
And if that's midwife bashing, then I feel somewhat entitled, as there are two midwives in my extended family, and I get the impression that they both despise labouring women who can't pop out their babies quietly and with minimum pain relief.
Because I didn't suffer any of the complications some of you have had; I can honestly, hand on heart thank my m/w for 'tricking' me out of my epidural.
It turned out to be the most eurphroic feeling that I would have missed otherwise.
Isn't that what midwives strive for? Go on girl you can do it, you have it in you to get this job done etc.
I feel so for those who were blatently ignored. Such a tricky one for me to fathom!
Starlight, the mws that do the classes don't tend to work on a delivery suite!
I'm in Australia & had a similar experience with the public health system here. 48hrs stop-start labour then put on syntocinon with promise of epidural - one ob even said "you seem to have a low pain threshold"!!! Surely number 1 on the list of things NOT to say to a labouring woman!! Took 3hrs of back-to-back contractions to dilate from 3cm to fully dilated & when I thought they were finally getting the stuff ready for the epidural, it was the baby tray. But then another hour of pushing after that.
DP had to beg on my behalf for even gas & air as I couldn't draw breath between contractions to talk. I was given it but not shown how to work it so only ended up using it to bite down on - had very sore jaws the next day! Honestly, if men had to go through it there wouldn't be stories like these.
Isn't that what midwives strive for? Go on girl you can do it, you have it in you to get this job done etc.
Having had three births without any more than gas and air I can conclude that yes you probably can do it, but if you don't want to you shouldn't have to.
I asked for epidural and was fobbed off with pethidine, midwife saying that there wasn't a consultant available, then it was all too late and was finally given a spinal block in order to do a forceps delivery.
But if the anaesthetist was unavailable, they are unavailable. Like I previously posted, pain relief falls down the priority list compared to emergencies. I would put an epidural in myself if I could but I think I have taken over quite enough medical tasks without the pay!
When told I would have to vaginally deliver my twins at 34 weeks because I had reached 10cm so quickly I thought I was going to pass out. I knew from my first delivery that I labour really well, but can not push for love nor money. For some reason it doesn't come naturally to me...
So after coming round slightly I asked sarcastically, suppose I'm too far gone for an epidural then??
Oh no, I was told, as its twins we can let you have 1. And I did get 1.
Ended up with a emcs anyway cos of wonky cervix!
I have read this thread with interest, even though I have not been denied an epidural I am more interested in the discussion about midwives.
I have just given birth to my son (6 days ago) in Torbay hospital and ALL the midwives were fantastic, helpful, supportive, empathetic and totally on my side. I was given my begged for epidural within 15 mins and whilst we were waiting for the dr all my drips etc were fitted and ready. The siting of the epidural took nearly an hour (ow), but the mw was fantastic.
I had a c-section in the end, but cannot fault any of the staff at all for all my time in hospital.
6 years ago I gave birth to my daughter in Northampton general. Same scenario, got the epidural when I needed it and ended up having a c-section. HOWEVER, that is where the similarity ends, apart from a couple of the mws I had, all of them were not really that interested in supporting me (thank god my mum and exh were there) and at least one was very nasty to me and derogatory about how much pain the VE's were giving me.
I had an epidural, but as it was New Year's Eve they all buggered off at midnight to watch fireworks on TV whilst I laboured. My Mum told me how at least one mw alluded to her that I was not being very brave about things (gee thanks). And don't even get me started on the after care! I was allergic to the dressing the put on my c-section scar and it took all my skin off when it was removed and I was denied a dressing, so left with a large open wound that stuck to my clothes for 3 days until I left hospital.
There are many more things I could tell you about my treatment at Northampton, and whilst the birth was not traumatic, being made to feel insignificant and pathetic by health professionals who clearly didn't want to be there made a lasting impression on me.
So I guess my question is, NHS resources aside, how can the care of midwives at 2 different hospitals be such polar opposites? It doesn't make sense, but thank God Torbay Hospital restored my faith in the whole birthing process, despite the birth being more difficult and painful than my first experience.
I'm a little surprised about people talking about one-to-one care for epidurals. I had an epidural from the get-go with DD3 (induced on synto, as I was a VBAC) but the mw left DH and I alone. I'm not complaining - that suited DH and I just fine. But are you all saying she shouldn't have left us? She popped in and out, making sure we were OK, and DH knew where the call buttons etc were.
All in all, it was a fab birth - DH was my one-to-one carer and, once I got to 10cm, the mw was great and really helped us to have a great experience. This was after having a failed epi with DD1 (ending up with em c-s under GA as the mw then would not believe me that the epi was not working).
I am so sorry for those of you who have had such terrible experiences, having been there with DD1
Any lady with an epidural or receiving continuous electronic fetal monitoring should have constant one to one care.
When I bilaterally dislocated my knee I was given morphine, but it wasn't even a tenth on the pain scale, or as prolonged, as my enforced pain-relief-free birth of dc1.
I am a rationale adult, tough cookie usually, have a good understanding of my body & do know of the amount of pain I can tolerate. To not listen and act upon a woman's desire for pain relief, when she is at her most needy & vulnerable, is a source of great sadness & anger.
By the time I left hospital after my first i was showing signs of PTS after a catalogue of horrible or just appallingly inept mw led 'care' that had lasting repercussions for me and my dc.
We were seriously going to drive 100 miles to a hospital with a good reputation for childbirth when I started labour, if consultants hadn't taken over and I agree with Expat, once consultants became involved in my subsequent pregnancies, my care immeasurably improved. I also have to add that once my births became radicalised the quality of mw care was excellent.
er medicalised, not radicalised!
I really don't think the quality of care a maternity unit provides can be measured on whether they provide epidurals on demand. What about all the things that have been proven to reduce the need for chemical pain relief, like one to one midwife care, good support, nice surroundings, encouraging homebirth. Bascially all that starlightmackenzie said except I have never had a pain free birth!
The thought that women might be offered epidurals in latent labour (except in extreme circumstances) horrifies me really. The implications for later interventions would be enormous.
I had a similar experience in Belgium, in hospital for 9 hours, first told it was too early to have an epidural, then told it was too late. But it was not because the midwives were lazy, far from it, they were incredibly supportive in encouraging me that I could cope.
And they were right, I did cope, and I had a far better experience then many of my friends who have had epidurals.
KangarooCaught - Maybe that's just what we need, Radicalised births!!!
That might be the mw aim...pain-relief free, natural birth...but it wasn't what I clearly wanted or needed. To counsel women away from using pain relief, because MW know better for my body, horrifies me.
I was induced for my last birth. I knew they'd get me to try other things first so I had the maximum dose of Diamorphine, still couldn't cope so asked for an epidural. She tried to talk me out of it with the usual "you're doing so well, you don't need one, etc etc" so I cried and flapped and asked repeatedly until she gave in!
My mum said it took 2.5 hours from when I first asked for it to when I actually got it. Very glad I asked ASAP - I'm pretty sure that if I'd gone into labour naturally & spent a long time at home before going in, I would not have got that epidural.
We've gone slightly off topic though here...
The point being that if a sensible, intelligent, woman in pain asks for something, then it should be given. Otherwise, there should be a discussion about why it's not available. The final decison should be made by the woman in conjunction with the doctors in light of the risks presented.
If you can cope with the pain, then great. If someone can help you cope, then that is also great. However, what is not so great is when someone tells you that should be able to cope and ignores you when you are at your most terrified. This is deplorable and shouldn't be current NHS practice.
Kangaroo, in my experience this isn't why epidurals don't happen. It is the operational constraints that prevent it being administered on demand. Like the mws who have contributed to thread have said, I have absolutely no problem with any form of analgesia as long as the safety of mum and babe are not compromised.
'I do not
believe it is always appropriate to administer one when
labour is not established because of the cascade of
intervention. Also labour is unpredictable and can
progress very quickly. The siting of an epidural can be
dangerous if certain positions cannot be adopted due
to advancing labour. An epidural can take up to a
couple if hours to be prepared for (Ivs sorted,
equipment obtained etc) sited and to be effective. This has to be considered along with if delivery is likely.'
So you're admitting that you make the decisions here regarding pain relief, not the patient who is in pain and asks for an epi early on. Even though NICE guidlines say it doesn't matter if she is in established labour or not. YOU are making that executive decision because you are trying to prevent this so-called 'cascade of interventions' (has there been any definitive study of women having had epidural pain relief and then requiring interventions and factors such as baby's size v. her pelvis, position of baby, cord round neck, etc. because it seems anecdotally that a lot of these women had deliveries which may have or did result in intervention anyhow) never mind what the patient wants.
We on this thread are saying the labouring women should decide that, should even decide the type of birth she wants.
You're upset and offended by comments here. How touchy! Are you like that in real life? That easily offended by strangers?
Because if so, it's not hard to surmise why midwives can get a bad rep.
Many of us are upset and some of us have developed serious conditions like PTSD, some have chosen not to have any more children, because of how they were mistreated by the very healthcare providers who were supposed to help them.
No, Expat. Nowhere have I admitted that I make the decisions - I was attempting to present some general info. I think I have been misunderstood. Like I just posted, dont care what pain relief a woman requests - it is her choice. I do care that safety is not compromised.
I have no problem believing operational restraints are a factor. But they didn't meet my needs re ANY pain relief and as I said upthread, I have problems today that had they listened to what I was saying could have been prevented. At my local hospital the rates for epidural (and this may include other pain interventions, not sure) it about 30% yet at an Oxford hospital where the anesthetist also worked, it was closer to 60%.
And this is why I want my mum with me when I give birth, as well as my DH. DH is v supportive, but there's a reason we've nicknamed my mum the Yorkshire Terrier and I want that fighting spirit fighting for me if I'm in pain and no-one's listening.
I really shouldn;t have read this thread when we're about to start TTC - it's putting me right off! Think I might just get DH to boink me on the head with a brick when it all kicks off (joke).
I agree that any rational woman should be entitled to pain relief when requested.
I always wanted an epidural, I never felt the inclination to try without. I just wanted to go in and have a baby as painlessly as possible.
Beatrice - the 'rational' in your sentence is annoying me. Are you suggesting that irrational women (whatever irrational is) should not automatically given the pain relief they want?
Lack of pain relief is not just a problem for women in labour; it's a problem for many people in acute and chronic pain.
I think rational is the best way of describing what I mean.
I don't know in what circumstances you would find an irrational woman, or as you say what irrational is.
I just prefer it to "sensible and intelligent" which the op used.
[rash-uh-nl, rash-nl] Show IPA
agreeable to reason; reasonable; sensible: a rational plan for economic development.
having or exercising reason, sound judgment, or good sense: a calm and rational negotiator.
being in or characterized by full possession of one's reason; sane; lucid: The patient appeared perfectly rational.
endowed with the faculty of reason: rational beings.
of, pertaining to, or constituting reasoning powers: the rational faculty.
proceeding or derived from reason or based on reasoning: a rational explanation.
The problem with using a word like rational is that it is open to interpretation, and many people may deem a women screaming and writhing in agony as irrational. A woman in labour probably isn't a calm negotiator.
The WHO definition of pain is very simply what a patient says it is and the pain relief should be given according to the patient's level of pain, according to the patient.
it's not about tricking, i totally agree with laluna....
it's a logisitcal staffing issue if you are not given the epidural straight away, not so the MW can see you suffer
I agree that it would be great if every woman got an epidural as soon as she asked for it, or could delvier in water, or at home, or whatever her particualr request mmight be
but on short staffed labour wards, its not going ot happen and mws can't always offer the support a woman needs to keep her going without the epidural, and that is a shame
Yes that is much better belgo - I really just tried to think of better description than ops which I thought was open to more interpretation.
Whilst I agree that many women suffer the consequences of not receiving the pain relief that they request, there are also a great many women who are really pleased and proud of themselves and grateful that midwives encourage them to manage without. Who end up labouring with gas and air and are Happy at the end to have done so.
They are SO many birth plans which state 'I don't want an epidural' yet a lot of these women underestimate the pain of labour so change their minds half way through. They (hopefully, and i know many don't) get their epidural.
There are also those who state in birth plans 'I don't want an epidural' who, perhaps in transition, beg for one, but it is often too late by then. They then end up without and are really fine with that because that is what they wanted in the first place.
When I went into labour spontaneously (waters broke 4 weeks prior to scheduled ELCS)and I went into hospital the midwife that I intially saw wanted to know why I was scheduled for a section when I explained that it was complicated and that all of the details were in my notes and that I would be having an EMCS if this very situation arose. The midwife huffed and puffed and left me, not to return. After 6 hours of extreme pain from labouring (still no EMCS yet) with no pain relief another midwife came into the room I was in to retreive a piece of medical equipment that was not in her room. I screamed and begged for some form G&A or and Epidural whilst I waited for a theatre to be availble. She tutted, open a cupboard and tossed the gas and air hose at me and said if you were in so much pain you should have just grabbed this!!
Ummmmm...yep like my DH or I even knew that the G&A was in the cupboard or that we could 'just grab it'. I was completely ignorned for 9 hours of labour. The shift changed, a new midwife and consultant came on and I was rushed to the theatre for my section as I was so close to birth. This proved to be even more stressful as my contractions were seconds apart and my epidural did not work the first time and they had to do it again! Had they been more prepared with the pain managment the rush and panic could have easily have been avoided.
I received a Diclofenac suppository for pain relief immediately after my EMCS and was offered no further pain relief. I stayed in the post operative suite for about 4-5 hours after the birth of DD while waiting for a room on the ward and then I had to walk to my room (no wheelchair, not wheeled on bed, no further pain relief and epidural worn off). Yep that's right I walked to my room.
It is interesting to see the differences in maternity care between here and in North America (where my family and many friends are) and the care is OB/Gyn led rather than midwife led.
All of my friends who have had children that wanted an epidural were given one before they were in any significant amount of pain. They are told to start the pain relief before they 'really need it' as this is when it is most effective and can be best controlled. This seems to make the most sense to me. I suffer badly from migraines and am under the care of a neurologist who time and time again tells me to ensure that I take my medication prior to the pain exacerbating as this is how pain medication should be taken.
Most of my friends back home talk about enjoyable family events where they experienced very little pain because pain relief was given early, topped up regularly if needed and if any interventions (episiotomies, forceps, etc) were needed they were often un-noticed because of the excellent pain management.
think conspiracy is too strong a word.
but definite reluctance without a doubt.
i think it does take resources away as so many women are saying they were left alone for hours at a time.
with an epidural they can't.
Yep, I had to beg for gas and air, none was forthcoming, o was lay prone on the bed in agony... Went in at 9pm, didn't get examined til midnight when I was told it was too late as 9cm... I was a wreck, and then the worst insult was afterwards when the "lovely" midwife was stitching up my tear (3rd degree), I was basically told to get a grip and "focus" on my baby to get me through the barbarity... Ok so I h1d some anaesthetic at this point, how dare I scream?!
first time i was told to keep waiting until it was too late.
second time there wasn't an anaesthetist available.
third time i'll be going in with guns blazing.
I'm probably going to make myself pretty unpopular here but I have to ask, do women honestly believe that they should be given an epidural when not even in established labour? Seriously? The latent phase of labour can go on for days! It can be uncomfortable, yes, painful, sometimes, tiring? Yeah usually.
As for midwives making decisions on behalf of women? Well sometimes we are unable to offer a particular service, sometimes it is unsafe for us to do so and sometimes it is completely inappropriate for us to do so. If that is perceived as us making decisions on behalf of our clients then so be it. We train for years to understand the pregnant body, the mechanisms of labour and ways in which to help avoid that cascade of intervention as best we know how. I have no desire to trick anyone out of an epidural, at all. However I will first of all offer coping strategies as far as I can. I will offer 'lower' forms of pain relief to begin with, starting inevitably with gas and air, moving on to an opiate and finally to an epidural. Sometimes women find a level of pain relief they can cope with, sometimes a woman comes in demanding an epidural and with a bit of time and patience and support that woman can cope with the pain and give bith without the epidural they felt they could not manage without a few hours earlier. I am trained to help you cope with your labour. I am trained to offer you ways to cope. I am trained to be with woman. I am a midwife and that is always what I strive to do.
I am so saddened by this thread and the view that women have of midwives. We do our best with what we have to work with. Sometimes that is not enough staff, sometimes not enough equipment, sometimes not enough time.
I appreciate your point DrMcDreamy but you have no way of knowing whether she will be in this phase for hours or days.
If the patient is in severe pain NOW, something needs to be done to help her NOW - if that something is an epidural (ie G+A ineffective, she's exhausted, opiates not tolerated etc) then that is what she should have regardless of her progress measured on the partogram.
It doesn't matter what you are trained to do if your patients are left on their own in labour for hours and hours and hours.
Is it any wonder they ask for epidurals?
There's not a one of us here who wasn't left alone to labour for hours on end with no support at all.
I could train to study the mechanics of the male body from now till the world ends, but far be it from me to decide for him if and when his male bits are in pain. I'd like to see the reaction if a female urological healthcare profession told a man that!
It seems to be when it comes to labour women are made to feel they need to put up and shut up.
Nowhere else would you find an area where so many in pain are dismissed with approaches such as 'Well, latent labour can last for days (but also not) so if it's painful for you, take a couple of paracetamol and get on with it'. Or where people are offered only paracetamol after a major abdominal operation.
I mean, is it really that hard to puzzle out, that if someone is left in so much pain for days on end, they won't sleep well, so when they finally move into labour, they're already knackered, which probably means this whole 'cascade of interventions' which all midwives seem to think is the work of Satan, is even more likely.
A trained chimp could probably work that out.
I nearly asked for an epidural when I went into hospital with pains at 34 weeks. I had a UTI
So your answer is give everyone an epidural,if they want one, even in latent phase (which you acknowledge can go on for days)?
Labour is painful. If you don't want to experience any pain whatsoever we should probably be offering epidurals at conception.
Ahhhh Belgo, UTIs in pregnancy can be as bad as labour. I've seen people in screaming agony with them.
I had morphine for something that comparably to giving birth was a bit painful (busted kneecap/dislocation), yet for labour no you must suffer? Cos it makes giving birth so much more worth-while that you endure agony? It's bollocks in the 21st century. Must tell my dentist to just get out the pliers.
Some women I have cared for need epidurals to have their waters broken. Before labour even starts.
Not done lightly but when it is the labour can be so long and she is on the bed for ages with the much higher risk of DVT.
I agree with Dr mcdreamy that labour is painful, even the early stages. Everybody knows that. But some people are so taken by surprise by it. They think its just going to feel like strong periods pains. I often find myself thinking, God if only you know what's coming, this is nothing! BUT it is these women who you just know will probably need an epidural at some point down the line, so you just go with it and offer the pain relief. And that's absolutely fine.
Others come in at 6cm coping fine and only beg for an epidural during transition. It is these women who I really really try to get through with support and encouragement because they are so almost there and in all honestly, by the time the venflon is in, the drip set up, the equipment got ready, the anaesthetist gowned up, the epidural in the right place, the test dose given, the full dose given and then the pump set up, she would probably have had her babe in arms by then anyway.
yeah you're right drdreamy, let's leave them in agony shall we? After all, you do know best, I mean you've studied for years...
My 2nd birth was awful. I laboured and gave birth on my own with only a midwife there. My DH was an hour late after the birth. I wanted an epidural and was fobbed off and I am still cross about it now. The pain was herrendous .....crucifixion would have been kinder !! No joke! They said it was too early for an epidural althought I was well into labour with good contractions, and a good 'show'. When is needed to push they didnt even take my knickers off for me. . .i was in agony and could do nothing but hold onto the bed post , crying and screaming. I had PTSD and it was very traumatic. The pain was very scary.
So if anyone reads this and is having her first baby. . . .Have an epidural. . .its brilliant !! Just been really firm about the apin relief you want and push for it. I had no 'spokesman' (DH) there and I think that was half the problem .
P.S. I had epidurals with the first and third baby and its was fantastic. . . what a marvellous invention.
I commiserate and fully sympathize with you poor mums who like me didnt get one. . .
This thread does seem to pint towards the fact that in many cases, the pain relief available is not adequate. Epidurals may not be recommended before established labour, so what is recommended? Why isn't there more research and investigation into adequate pain relief during labour?
Many of my friends who had epidurals during labour were still not comfortable during labour, and some had serious side effects after the epidural.
As I previously said I find it very interesting the different attitudes and procedures in different countries.
In North America pain relief (usually epidurals, as G&A is not as commonly used)is given during the latent stage IF it is required and requested for pain. Yes, no-one can determine how long this stage will be but women are given this so that they can rest, sleep, remain calm, etc so that when they need to be awake, centered and have lots of energy to push they are able to do this comfortably and give it everything they've got.
When the G&A was shoved at me I had not been examined, nor was I examined at any stage. I only had a monitor on me for about 30mins (until the paper ran out), which I then removed and turned off (no-one else to do it) so I could move around to more comfortable positions as I wasn't given any pain relief.
'Labour is painful. If you don't want to experience any pain whatsoever we should probably be offering epidurals at conception.'
And that's not rude and dismissive?
Because that is a big part of the whole problem.
'Labour is painful,' is an umbrella used not to listen to women, not to meet their needs, much less attend to them.
Because guess what? In 2011, it doesn't have to be so much so, any consultant or anaesthetist will tell you this.
I don't think I ever advocated leaving women in pain. However I don't think it is appropriate for maternal choice to be the ONLY criteria for getting one. We have to work safely and in everyones best interests.
I'm also surprised to hear the one-to-one care thing as we were also left alone, but I gave birth in France so maybe the rules are different there. The other thing that differs from what I've read here several times is when the anaesthetist gave me an extra dose of the epi (without my permission, but that's another story) she justified it afterwards by saying it was to speed up the dilation - which seems to be the standard 'belief' over here.
Just for the record my midwives were lovely and looked after me very well, but equally the only pain relief available in France is an epi and most women have them so they're more geared up to providing them on demand.
DrMcDreamy - It's funny how they work 'safely' in other countries where adequate pain relief is offered to women when it is required. It is not just North America, there are other countries where epidural pain relief is offered automatically. Somehow women manage to birth in these countries and have positive outcomes.
Midwives in the UK seem to often think that somehow a birth is not 'worthwhile' unless you experience pain.
'But some people are so taken by surprise by it.'
And some people have a baby that is in a tricky position that is known to be more painful.
My first was OP and had her hand up by her head cupping it above the ear.
I had to beg and wait 5 hours for an epi because 'It's after midnight'.
Even after I got it, they put a canula in and gave me NO fluids.
By the time a midwife called in the consultant, and the anaesthetist to top up the epi, I was 32 hours with no sleep and from eating and drinking. He went spare that I'd had no fluids and was exhibiting signs of dehydration in the June heat of the hottest summer on record in the new century.
My second was born with no pain relief (I took one puff of G&A and barfed) and it was 1/10 the pain of that first one.
My third, again, I knew something was off from even before the get go. I knew, and I know my body.
Still, hours and hours waiting for the epi.
It failed to bring my BP down. It was still 190/115, I'll never forget the look on the consultant's face. I had two pushes of Labetalol.
He broke out the ventouse.
The baby was over 2lbs. heavier than my eldest, who was heavier than her sister, and had cord wrapped round his neck.
I wasn't listened to the entire time except by the anaesthetist and consultant.
I was left, completely on my own as I had no birth partner, for hours, stoned on diamorphine.
I was told, since it was my 3rd, that I knew what I'd got myself into.
By 'one' I meant an epidural. Insert embarrassed face smiley.
The rate of C section in the USA is however massively higher than the UK. They also pay for their care. The recovery time for C section is so much longer than vaginal birth. I understand where the OP is coming from, but please do not midwife bash, they do their very best in a system where they do not have the support that they fully need. Yes a woman should be able to ask for her epidural and be given it if the situation allows, but sometimes it is just not possible, be it because the anaesthetist is busy or the unit is understaffed. But one thing I am certain of, no MW will deny an epidural "just because it makes life easier"
The best way to get an epidural is pay for it.
They are expensive.
Gas and air is not.
The NHS has not got enough funds for medicalised labour.
Go private next expat.
"The best way to get an epidural is pay for it." - Barbarism at it's best!
If your rich thou shalt not suffer, otherwise too fucking bad!
'Go private next expat.'
There will be no next time. DH has been sterilised and received the all-clear and I still use a NuvaRing on top of that.
Guess that's just tough for all those women who are too poor to go private, though.
In those countries that manage much higher epidural rates on demand, how many of those are free at the point of access? The NHS is a wonderful thing but it isn't a bottomless put. By that I mean not just the expense of an epidural but the cost of the midwives needed to ensure everyone can have an epidural if they want it. I'm banging my head in despair that somehow the fact that if we say the anaesthetist is busy it's our fault, if there isn't enough if us to give one to one care it is our fault, if it is the wrong time of day, yep midwives fault again. Never the busy anaesthetist because he's a doctor off saving lives and that is terribly important work, never the consultants fault because they won't work a night shift leaving us with skeleton medical cover, never the managers fault for running a ward on the bare minimum to ensure nobody dues, fuck good care, who needs that?! No it's those pesky midwives who who like to see poor women suffer. I wonder why we bother.
For dues read dues. Decking sausage fingers and iPhone do not mix.
harsh but true, it costs money
and the NHS aint got much money
Many of them are free at point of access...epidural is the norm in Canada, France, Italy, Turkey, etc.
DrMcDreamy, I fully agree with you. Living in a country where we pay a monthly fee for private health insurance (practically compulsory) as well as fees up front - 22 every time you want to see the doctor anyone? - I still don't understand why we Brits are so against it. The NHS is not a bottomless pit. Sure I pay a lot for healthcare but I can chose which doctor to see, which hospital to go to, no waiting to get tests done, very little for operations. But of course all this comes at a cost and even the French understand the government can't finance it all.
I would be willing to pay such amounts, Fenouille. I, too, have lived in France.
BecauseItoldYouSo of those countries you mention I wonder what the section/instrumental rate is? Or maternal/neonatal mortality and morbidity?
Where else in the NHS do you get to demand your own choice of medication? I'm not saying epidurals shouldn't be available, of course they should but sometimes we have to accept they are not appropriate for everyone. It is our job as midwives to educate and help people understand that, antenatally ideally. I know that might sound patronising. It really isn't meant to.
Reading this it really dawned on me what happened with DD. Meconium in the waters meant CFM so the MW was in with me anyway - ergo I got the Epi - no reason not to I suppose.
Expat - <<standing ovation>> I went into that birth armed with every form of self help & pain relief that I could muster because I was convinced that I wouldn't be listened to. It is no way to go into childbirth is it?
DrMcDreamy - Educate and Understand?? Someone can understand fully what their own level of pain is, that is not for a midwife or anyone else to determine. Every person has a different pain threshold and nobody knows what that is except the individual. In any other area of medicine you are asked what your pain levels are and those are respected and the appropriate drugs given, this has nothing to do with 'Educating'. Yes it is a HCP's job to be understanding and that means LISTENING to women. This dosen't seem to happen very often here.
Oh and if you want to look at the rates DrMcDreamy you can do that here.
In Developed countries the rates are quite on par if not better than the UK (i.e. Canada).
Imagine other areas where you would tell people in agonising pain, 'This is the NHS, we must watch costs. Two paracetamol (or nothing) for you because your pain is temporary.'
I've broken bones and had 4 knee surgeries, 2 pretty major, where I was offered more pain relief.
'Expat - <<standing ovation>> I went into that birth armed with every form of self help & pain relief that I could muster because I was convinced that I wouldn't be listened to. It is no way to go into childbirth is it?'
I went in, three times, believing I'd be listened to. I was only once, because I gave birth 20 minutes after arrival by pure chance, too late for any form of pain relief but G&A, which doesn't work for me.
I'm past childbearing now.
But that doesn't stop me concluding, 'Well, done now, sod everyone else.'
One of the MW from our local hosp. dislocated her shoulder badly. When she relayed the story at BF peer support training we took great pleasure in taking the piss with the "take 2 paracetomol & have a warm bath" quips. She was most disgruntled.
Yep educate. Not gonna apologise for choice of words in that respect. By that I mean women need to be educated that epidurals are not always available, it is not always in the best interests of the woman and baby for an epidural to be administered (ie, fully and pushing with vertex visible) and if an epidural is denied why this might be the case.
All this midwife bashing is really sad. I think one of the problems is that you will never have met the midwife until you are in labour. If we had proper 1 to 1 midwifery throughout pregnancy not just in labour, then you would be able to get to know each other, and the midwife would know which women were happier being encouraged to manage without and which would need an epidural. As it is, it's one size fits all.
But instead of bashing the midwives, bash the politicians who can't be bothered to do anything about it. And yes, the NHS has scarce resources but I am quite sure that they could allocate them better, if the will was there.
you do have a good point drdcdreamy.
there isn't enough money to provide epidurals all round with 10 anaesthetists on board and enough mw's on duty to provide one-to-one care.
we're reasonable. we understand that.
what we're objecting to is being patronised, lied to and treated like less than human.
Yes fine I can understand that. I really don't know what else I can say. I fear our points of view are never going to meet in the middle.
I am bloody annoyed by this thread!
"As for midwives making decisions on behalf of women? Well sometimes we are unable to offer a particular service, sometimes it is unsafe for us to do so and sometimes it is completely inappropriate for us to do so. If that is perceived as us making decisions on behalf of our clients then so be it. We train for years to understand the pregnant body, the mechanisms of labour and ways in which to help avoid that cascade of intervention as best we know how. I have no desire to trick anyone out of an epidural, at all. However I will first of all offer coping strategies as far as I can. I will offer 'lower' forms of pain relief to begin with, starting inevitably with gas and air, moving on to an opiate and finally to an epidural. Sometimes women find a level of pain relief they can cope with, sometimes a woman comes in demanding an epidural and with a bit of time and patience and support that woman can cope with the pain and give bith without the epidural they felt they could not manage without a few hours earlier. I am trained to help you cope with your labour. I am trained to offer you ways to cope. I am trained to be with woman. I am a midwife and that is always what I strive to do."
How bloody sickening! Seriously! What an absolutely disempowering, paternalistic pile of BOLLOCKS.
I was referred to a consultant anaesthetist before I gave birth due to a potential spinal issue which might have impacted upon pain relief options. I was happy to consider anything but wanted to be informed/ready etc.
He said, bluntly: "there's no shame in it and the only shame there should be is on any professional who makes you feel that you are weak for having your own individual pain threshold. It's your body and it's your choice. We have anaesthetic blocks for many procedures that are potentially less painful than labour. If you want not to use analgesia, that's fine too. Just don't let anyone else make that decision for you."
Brilliant, brilliant man.
How dare you use your position of power to "coach" a woman who has no contraindications for analgesia into a position that she is explicitly verbally telling you she does not want to be in. If you have medical evidence for this, fair enough.
I am an NHS professional. I know all about resourcing issues in my own field. I won't make excuses for the impact that it has on patient care or justify clinically decisions that are cost-based.
As expat says, for many who request an epidural, a "cascade of interventions" might be an inevitability in any case e.g inductions/large baby and small pelvis/funny positioning etc.
There are women on this thread who have suffered PTSD as a result of their experiences and yet you write this? Shame indeed!
Margles - totally agree that any anger may be better directed at the politicians. Labour promised one to one care in labour by 2008. Has not happened.
Tory manifesto promised 3000 more midwives. Cameron has backed down now saying that latest birth rate forcast figures show a downward trend in the birthrate so he's saying there's now no need for these midwives. However the figures he's quoting were available when he made the promise. So why change his tune now?
NHS is run by accountants and politicians and this needs to be changed. In the patriarchal society that we're in obstetrics is the lowest rung of NHS budget priority.
"But instead of bashing the midwives, bash the politicians who can't be bothered to do anything about it. And yes, the NHS has scarce resources but I am quite sure that they could allocate them better, if the will was there."
Every clinician who defends decisions that are made on cost-based grounds without taking issue with it and pushing for better care for their clients is also culpable. They don't have to do it in public - there are mechanisms within the NHS to raise concerns about patient care with reference to dignity and patient experience etc. Nothing may ever come of them, but it is not just for politicians to address.
Justifying and colluding with decisions that are resource-led is unprofessional and against HPC standards. It is terribly sad when clinicians become so worn down by resource issues that they start to believe the "clinical" reasons underlying service delivert yet if they defend decisions that primarily related to cost, well... they deserve a bashing.
Any of us who begins to believe our unique service model rather than evidence/NICE guidance is guilty of this. If you train for years to know what to do, you should have enough knowledge to respect the evidence and should act in accordance with this, regardless of your personal views on resourcing. If you can't, you need to flag this up as appropriate, not just shrug your shoulders and say: "it's the NHS, innit?"
working9while5 sorry you feel this way. I will not apologise for doing my job. I don't coerce anyone, I don't deny anyone, I work with women, I listen to them. If they want an epidural they'll get one however it is in everyones best interests to discuss this first.
'Yep educate. Not gonna apologise for choice of words in that respect. By that I mean women need to be educated that epidurals are not always available, it is not always in the best interests of the woman and baby for an epidural to be administered (ie, fully and pushing with vertex visible) and if an epidural is denied why this might be the case.'
And yet, NO ONE on this thread was one of those people who first begged for an epi in transition. They were all people who were fobbed off till it was too late or who had to fight for their epi long before they were fully dilated.
This is not about women in transition begging.
This has all been people who were induced, OP, what have you, fobbed off till it was too late.
That is wrong, wrong, wrong.
And yet immediately, it's assumed they are all so stupid, it is midwife-bashing.
Still,the assumption they are stupid and ignorant.
I was one of those people, but I knew it was too late. I am not a moron.
No Expat, being referred to as a f@@king midwife, that's midwife bashing.
'He said, bluntly: "there's no shame in it and the only shame there should be is on any professional who makes you feel that you are weak for having your own individual pain threshold. It's your body and it's your choice. We have anaesthetic blocks for many procedures that are potentially less painful than labour. If you want not to use analgesia, that's fine too. Just don't let anyone else make that decision for you."'
Brilliant, brilliant man.
My husband had a vasectomy last year. His choice.
I showed him this thread.
He said, 'If that chap (the consultant) had told me he was going to cut my bollocks with nowt but gas & air, I'd have told him to get knotted, got up and walked out. I can't imagine getting cut in the fanny like that, it's not even on the outside. FFS.'
Oh, yes, lala. Focus on that to excuse a littany of other women telling you they felt fobbed off, patronised, not listened to, scolded, etc.
Go on then, do it and don't bother to ponder why this thread and the others like it even exist.
Dismiss it on that one comment the way so many here have had pain so bad it gave them PTSD dismissed.
Your job is not
"Sometimes a woman comes in demanding an epidural and with a bit of time and patience and support that woman can cope with the pain and give birth without the epidural they felt they could not manage without a few hours earlier."
"I don't coerce anyone, I don't deny anyone, I work with women, I listen to them."
You describe a woman in an early phase of labour "demanding" an epidural, which you then help her to "cope" with (against her express verbal wishes). Again, as expat has said, there is no disagreement with you supporting a woman to cope without an epidural where there is a genuine, evidence-based medical reason why she should not have one.
You won't apologise for an anti-woman view that women "demanding" epidurals need to be coaxed into "coping" without with "time" and "patience" and "support".
Patience is an interesting choice of word here. You are being patiend with their demands, yet also listening to their views and not coercing?
First line should read "Your job is not to tell people that you have listened to them while doing something different".
Not by me, they weren't. You are making this personal. Don't judge me, you know nothing about me.
Oh fuck it think what you like. You're right, all midwives hate women, want to see them in pain and lie to them to stop them getting an epidural.
DrMcDreamy - You say that you don't coerce or deny anyone in one post yet you say "I have no desire to trick anyone out of an epidural, at all. However I will first of all offer coping strategies as far as I can"
That sure sounds like coercion to me.
When I had surgery last year there was no problem with putting me on a morphine pump when I complained about pain, so that I could control my pain relief. Most women are educated enough about the pain relief on offer and expect to recieve it when they ask for it. You are told in ante-natal appointments the pro/cons of having a baby in certain circumstances i.e. Homebirth - No epidural availble. Hospital Birth - Epiduruals, Pethidine, G&A, etc. You go into labour armed with this information and your decsions should be respected.
If someone does not want any pain medication or intervention then they will often opt for a MLU or Homebirth. If someone wants to know that various forms of pain relief are availabile to them (not knowing in advance what their pain levels will be of course) then they will opt for a hospital setting.
We are intelligent and educated grown adults and deserved to be listened to and treated as such during one of the most vulnerable times in our lives.
Yep mcdreamy, that's why I became a f@@king midwife!
"Oh fuck it think what you like. You're right, all midwives hate women, want to see them in pain and lie to them to stop them getting an epidural."
I had great midwives. I am judging your words, not the whole profession.
So, when anaesthetist is with another lady and unable to administer an epidural, what do you think the midwife should do? I am genuinely interested in what your expectations would be.
Incidentally, it is shocking that you would engage with women about your profession on a forum in this way.
It is wholly and deeply unprofessional. I post on a forum here with reference to my profession and very often, posters will mention shocking examples of poor practice carried out by fellow AHP's. Where possible, I put it into context in terms of the NHS etc but I would never deny or put down a service user's opinion of their own experience. I feel ashamed sometimes, yes.. I can often see both sides.. but this is just your job. You are interacting with people who have been very seriously affected by clinical care and denying their experience of their own life with no compassion, simply concern for your own point of view.
It is disrespectful and unprofessional and I can't understand why you would engage in an inflammatory way.
Again, I had great midwives. No issue getting an epi. All went well. So I am taking issue with the way in which you are representing your profession, not your profession.
*DrMcDreamy - You say that you don't coerce or deny anyone in one post yet you say "I have no desire to trick anyone out of an epidural, at all. However I will first of all offer coping strategies as far as I can"
That sure sounds like coercion to me.*
We must have different definitions of coersion then because in my book, listening to someones requests, offering them other options and then ultimately doing what they ask is not coersion.
You tell the truth and you don't try and spin it.
"I am afraid the anaesthetist is with another lady and we don't have anyone else who can offer this procedure. I'll keep checking for you."
Then ask her what she wants in the meantime with reference to coping strategies etc and if that involves her telling you to a) fuck off and/or b) the place is a disgrace etc, nod sympathetically etc etc and either just look and act empathetic and do whatever it is you do to help her stay as calm as possible while telling her that you will be happy to support a complaint later if things don't change etc.
However, trying to convince the lady that she doesn't want what she wants because you can't provide it is disrespectful and patronising.
In that case I bow out then working9while5. I might be many things but reckless with my job is not one of them.
I will however say this. I am sorry for every woman that has a poor birthing experience, it should be one of the happiest times of a womans life. I am sorry to each and every woman who feels the midwife was at fault. I am sorry if you did not get the pain relief you required and I'm sorry for those whose life has been tarnished because of this. We work within restricting conditions. Most of us do our very best. Sorry if that was not up to standard.
"I might be many things but reckless with my job is not one of them."
How is this reckless with your job?!!!
working9while5, your assertation that I am being unprofessional, if that is the case then I will not continue, bring the profession into disrepute is a one way ticket to unemployment. I aint taking that risk.
I had this.I had been warned by someone that my particular hospital wasn't keen on epidurals and they would go out of their way to not give one. (I didn't really believe as it was my male boss and i foolishly thought he couldn't really know). I should have also taken the hint when the midwife at the antenatal was very anti an epidural. Again I thought it was just her personal opinion and wasn't too concerned.
When giving birth first time I arrived at hospital 7cm dilated. after about half an hour I asked for an epidural and got a little prepared speech about how the anaesthetist was currently involved in an operation at another location but she would 'try' and speak to him and 'maybe' he would be there in about an hour but it may be too late so we'd see how it goes.
Roll on nearly two hours. I was now 8cm (everything slowed down once I got into hospital) and in absolutely agony and completely losing it. Begged for an epidural and was it was now too late but they did give me pethadine (not sure if they'd already given it me at that point).
However it was another 4 hours and another lot of pethadine before I actual gave birth. DS was very groggy and lethargic and ended up in SCBU for 4 days. intially there was even talk of oxygen deprivation but I firmly believe it was down to the second lot of pethadine being given too close to the birth.
Second time round they said I was too late for an epidural but in all honesty they were probably right as DS2 arrived and hour and a half after my arrival.
working9while5 - Thank you for articulating so well. You have said what I am sure alot of us feel, very well.
Sorry, we cross posted. I thought you were suggesting that supporting a patient to make a complaint would be an example of being reckless with your job.
I think you do right. Mumsnet is a very public forum and unlike others, if you say something in the heat of the moment that is unprofessional you can not easily have it deleted.
It's a "do no harm" thing. I think you can share a lot here that you wouldn't with a service user as it is an anonymous forum e.g. you can be honest about the resource constraints in a more brutal way than you might if involved in direct care but your comments cannot be a personal response e.g. based on your reaction to the "fairness" or "unfairness" of comments made about the profession.
I don't make apologies for others in my profession either. Or the NHS. I do know I have offered care, especially in the early stages of my career, that I look back and shudder at and I would wholeheartedly apologise for that if I could. However, I do my best now and hope I am offering a good service, but we have to be ready to change if the feedback suggests otherwise. I know being a "reflective practitioner" is a bit of a cliche, but I do think we need to learn and not defend. I have found MN to be really useful in terms of really "getting" where we fall down in terms of patient experience and in changing my own practice as much as I can within the constraints in which I work. I hope I offer information that is helpful, in return.
Just think we all need to be as careful about taking things personally in this sort of context as we would in RL.
I do think this is misogyny in action.
I'm very lucky: I can't speak from personal experience of a mismanaged labour. I had DS in a MLU, he was delivered by a really good, caring, very experienced midwife, and I was fine with water and gas and air: I went in not wanting an epidural as I'm squeamish about the idea of a needle in my spine, and I didn't get to the point where I was tempted to ask for one. Even so, I'm pretty shocked at some midwives' attitudes to pain in latent labour. My personal experience was that getting from 1 to 3 centimetres dilated was the hardest bit: once I got to 3 centimetres my pain was taken seriously, I was allowed to get into the pool and actually, from that point on, I was completely fine. But until I got to that point, I was in the most pain I've ever been in in my life (other experiences include appendicitis and a dislocated shoulder) and was being told "well, take a couple of paracetamol" (not by the MW who eventually delivered DS).
I can't think of any other circumstances where a patient is in that much pain and HCPs dismiss it. There was a good article in the Guardian a while ago saying that obstetrics is about 50 years behind other areas of medicine, and I do strongly suspect that it's because there is still an attitude that women should put up and shut up. Yes, resources are limited - but pain relief is non-negotiable in most other areas of medicine. Childbirth is much more like emergency surgery than it is like elective: you can't put it off till the anaesthetist is available, so hospitals need to prioritise it, and they just don't.
Oh, and I had a meeting with an anaesthetist before DS was born, because I wanted to be as prepared as possible for anything that might happen, and she reckoned that it's hokum that epidurals slow labour down: women ask for them because they're having long labours and are exhausted and can't cope any more. And, reading this thread, it looks to me as though unless you have a long labour, you may very well not get one at all, which must also skew the statistics.
You tell the truth and you don't try and spin it.
"I am afraid the anaesthetist is with another lady and we don't have anyone else who can offer this procedure. I'll keep checking for you."
Absolutely. And in the meantime, helping with correct use of g&a, pethidine, back massage, well anything really than facing the god awful prospect that they are going to do absolutely nothing.
I also take issue that recovery times for vaginal birth are quicker than and c-section...not if you suffer a birth injury such as a 3rd degree tear. With my csection I was so well provided with meds, I was very rarely in discomfort and recovery was rapid. Yet after my 3rd degree tear, I was in more pain for weeks, and given nothing stronger but ibuprofen & I am not recovered now.
DrMcDreamy: ' If they want an epidural they'll get one '
This isn't necessarily true. That's the point.
Just don't bloody lie to us.
I went in to my first labour thinking I had choices. There was a lot of MW talk about pros & cons of epidural.
No-one - NO-ONE - ever said: 'But it's quite likely you'll be in screaming agony, the anaesthetist will have a higher priority to attend to, & you'll just have to get on with it.'
I eventually got my epidural 7 hours after the MW had agreed I needed one. I was fine after that.
I'd've had a far less terrifying experience if I'd been prepared. It was quite literally hellish; agony physically, but also more distressing & demeaning than I'd've believed possible.
& then I had PTSD & antenatal depression during my pregnancy with number 2.
In the event, I had a painful delivery with no analgesia (AGAIN no epidural available - until too late this time), but, well, I knew it hadn't actually killed me the first time, & I got through it.
I was quite relaxed about having number 3!
I'd say 95% of my terror, & subsequent trauma, was because I wasn't mentally prepared for 'no epidural, tough shit' being an option.
It comes down to honesty & respect. I didn't feel like I got much of either.
tell you what.
I think maybe a new system should be put in place. When you get your positive pregnancy test, you should book in for your caesar at 36 weeks. Under GA. Go to sleep, and wake up when the baby's ready to start school. No pain. No feeding problems. No pesky night feeds or nappies or potty training.
Childbirth is painful - it is common sense - think about the mechanics, about what comes out of where. The real problem here is not midwives or epidurals, it is that pain is not part of life any more. Our lives are comfortable, sanitised, we don;t have to cope with stuff, we just take a pill or sue someone and it all feels better.
You're missing the point.
For one, childbirth really doesn't HAVE to be painful.
For another, if it's going to be painful because the budget isn't there for effective analgesia, then it's not unreasonable for women not to be finding that out during labour. Often first labour, when you've really no idea how bad it's going to get.
I coped fine with my 2nd & 3rd labours. I knew it was likely to bloody hurt, & I'd probably just have to get on with it. I also knew I'd survived it once!
Totally different scenario from 'I'd like that epiduralyou promised I could have now please, I'm in a LOT of pain & I'm scared because I don't know how much harder it's going to get' & being told 'Ah...in a few hours. Maybe'.
Kaykay - replace the word 'childbirth' in your post with 'tooth extraction' and see how that sounds?
'So, when anaesthetist is with another lady and unable to administer an epidural, what do you think the midwife should do? I am genuinely interested in what your expectations would be.'
Tell me the truth, then! Stay with me. Tell me the truth and then stay with me. Don't lie to me and assume I'll believe it.
All I wanted is for someone to do that.
I wanted someone to tell me I could get off the bed and birth that 9.5lbs boy.
I wanted to know she'd stay with me.
But I knew she couldn't so that is why I wanted an epi.
I was on my own, fgs. Yep, I know it was my 3rd, but I was 100 miles from home and I thought I might die, or my baby, who could have.
Instead I got told how I should buck up because it was my 3rd.
Would I see my own daughter through such a thing? Like HELL.
'The real problem here is not midwives or epidurals, it is that pain is not part of life any more. Our lives are comfortable, sanitised, we don;t have to cope with stuff, we just take a pill or sue someone and it all feels better.'
Oh, okay, so is death. Let me go tell that to all who are going through that now whom I know.
Let me tell my pal on here who lost her baby at 37 weeks.
It's all life's big circle!
Get friggin' real.
My first and third births where the lowest points of my entire life.
I was patronised, I was lied to, I was left completely alone in pain and antagonised for it. The aftercare was a joke.
I have permanent psychological scars from it all.
I wouldn't wish this on all but my worst enemy.
As a result I will strongly encourage my two daughters, if they chose to have babies, to go private if I have to sell my saggy body.
I'd gladly do it if it meant they never know what I do.
Is anyone listening? Because no one was those two times I was begging for epi.
I knew something was wrong because I have been living in my own body far longer than any healthcare professional.
I know myself far longer, but still: belittled, fobbed off, had to make a fuss.
I'd get sacked for treating my clients the way I was treated.
'So, when anaesthetist is with another lady and unable to administer an epidural, what do you think the midwife should do? I am genuinely interested in what your expectations would be.'
Tell the bloody truth then, for starters.
Stop treating women like they're morons, even if they are teens, they have the measure of you, they are not idiots.
Don't swan off.
Treat women like people.
I have just read this posted by a midwife (vivalabeaver) upthread
"I was looking after 2 labourers last week, both of who were begging for epidurals and neither could have them as I couldn't give one to one care."
I mean how is this allowed. Two grown women who (presumably) were told in their antenatal care that they could have an epidural if they wanted one, were not in the event allowed to have one. That is utterly disgusting.
I think there is a load of shit spouted that 'the body is perfectly designed for childbirth'. Is it fuck.
Expat I am really sorry what you went through - it sounds like a fucking nightmare. Too damn right you are still angry. It sounds utterly aawful what you went through - and others on this thread. A bloody episiotomy on gas and air? It is absilutely fucking disgusting.
I am still fucking furious personally after being refused painkillers after an op this week, and some ghastly nurse having a row with me at 5 o clock in the morning whilst I was crying in pain.
If and when I have another baby (mind you I am having second thoughts after this week) I am going private, fuck it.
I am so proud of the welfare state and would cheer the the NHS to the rafters normally, but the service is primitive and third rate in so many cases.
Pain relief for labouring women should be on demand, and available for all.
Before DS's birth (in the US) we went to a refresher lamaze class in the hosp and at one of the classes the head of anesthesiology made an appearance and reassured everyone there that it was a woman's god-given right to have pain relief during labour and no-one should feel bad asking for it.
Fast forward to scheduled induction on a Monday morning -- had to argue with a
stupid bitch nurse who pretended not to understand English to get her to numb the back of my hand before inserting a massive IV needle and starting up my pitocin drip, waited and waited for the anesthesiologist to come by and put in the epidural needle -- the window of opportunity was actually predictable since I was on pitocin -- and he never came.
They apparently had a huge number of walk-ins and they had booked the maximum number of inductions for first thing Monday morning, and some women had then required c-sections right at the predictable time when I would have been having my epidural (that I had a god given right to) if they had bothered to have enough anesthesiology staff on duty. DS was 9 lbs 4 ozs and had to be pulled out in the end with a vacuum thingy. The (Scottish) anesthesiologist arrived just as my doctor picked himself up off the floor where he had fallen in astonishment when DS was weighed (they had predicted he might be as big as 8.5 lbs..) and apologised profusely to me. He was the only doctor I have ever heard apologise in the US (it's frowned upon because of fear of lawsuits), and it wasn't even his fault.
I still hate that nurse. I had her again when DD2 was born two years later, to my horror, but I was mentally prepared for her that time, and DD2 arrived less than 45 minutes after arrival at the hospital anyway.
I had an episiotomy with DS, but had local anesthesia administered by my OB/GYN. No gas or air in the US or I would have been sucking it down. And the lazy
bitch nurse left me alone for about 45 minutes at lunchtime contrary to all regulations I found out later; no-one on a pitocin drip is supposed to be unmonitored...
This was private care in a university hospital in the country that says it has the best healthcare in the world... Sorry to any Americans around, but it stunk. I had used the same hospital for an operation the year before - major abdominal surgery, and the difference in nursing care between post op and post natal defied description. I firmly believe it was because the post op section had men as patients too, not just women like the maternity wing.
well, here's another horrible truth:
i can afford to go private and i did for my first two births and am for the 3rd in just 9 weeks now.
first time i was fobbed off so it was too late.
second time there wasn't an anaesthetist available.
so despite paying through my nose i still didn't get anywhere near adequate pain relief.
i paid for the obstetrician but was still subjected to the mw who refused to phone her for me and left me alone for hours at a time all the while lying through her teeth.
not all mw's are as awful as the one i encountered for birth no. 2 so i'm not knocking them all or the profession.
unless you're prepared to hire your own anaesthetist and all that they need you still get no guarantees.
unless you go to the portland and live in a hotel nearby for the last bit of your pregnancy. if you can afford it.
I actually used to work in a hospital - a small consultant led unit, not a MLU where there were no epidurals between midnight and 8:;00am. There wasn't an anaethetist to do them. I used to warn women at 11:00pm that if they thought there was any possibility they might want one to get it NOW.
Yes me. I was tricked out of an epi the third time. I'd had two quite straightfoward and reasonably quick births already, with just gas and air and TENS, but my stitches after DC2 were an awful experience and the local anaesthetic didn't work at all so I said all along that I wanted and epi for birth 3.
They kept ignoring me, patronising me, or changing the subject during the early stages when I asked for an epi, and when I started to beg for it they said 'Yes, yes, the anaesthetist is on his way, he'll be here in 20 minutes, etc, etc, and two hours later he still wasn't there and the baby was born. No stitches though thank God.
'I firmly believe it was because the post op section had men as patients too, not just women like the maternity wing.'
That's the heart of the matter.
fellatio, those are tactics my dd2's nursery use to tell her that i'll be coming soon: ' yes, mummy's on her way...'
so bloody patronising.
Hi, I'm new to the board.
I have been reading this thread with great interest. From reading all of the above posts, I am getting the feeling that some of the posters are more angry about being lied to, rather than not getting an epidural?
I have had 4 babies, 1 labour was managed on co-codamol in latent stage. I was offered pethedine and G&A with all 4 and declined, an epidural was never mentioned. I requested pethedine with all four and was declined as I was too far gone and delivered soon after.
I am actually quite grateful to the midives that supported me to go drug free. They realised that I was probably in the transitional stage of my labour and that pethedine would have affected my babies at birth.
Now, although I acknowledge that every woman has a right to manage her pain with everything that is available, I can't get my head around the fact that we are told to steer clear of anything that may harm the baby i.e. smoking,alcohol, drugs during pregnancy and yet during labour we are offered very strong opoids that will clearly affect the baby. Opoids of any sort including fentanyl administered by epidural will cross the placenta and have an affect on the newborn. I declined pain relief, not for myself as yes labour was agony, but for the sake of my babies. I somehow didn't like the idea that the first hours of their life would be spent drugged up to the eyeballs.
I don't think that my pain threshold is any higher than the average person, a dodgy gallbladder gave me proof that I don't tolorate pain very well. But labour pain is somewhat different,firstly, it is not a constant pain, it comes and goes with contractions. It builds up,peaks and then wears off.My body was working hard to help my babies.
But one point I would like to make is that good support from my loved ones, helped me to overcome each contraction. I was told by my OH, my mum and my cousin that I was brave, fantastic, amazing and that helped me through.It made me feel proud and good about what I was doing. And afterwards, looking at each baby, the feeling that I had acheived the birth through my own strength was priceless. I am eternally grateful to my loved ones that they had enough belief in my strengths and to remind me at a time when I needed it most.
elbow - I am glad your pain was manageable
By my fourth labour - my contractions,when they started, were almost continual with no let up. My contractions were on top of one another right from the start.
With my fifth labour it was evident that the midwife did not believe i was even IN labour and i contracted from 0-4 centimetres in ten minutes
I feel it is attitudes like yours that - unfortunately- lead to women NOT getting the pain relief they need in childbirth.
We ALL want what is best for our babies and loved ones and I would never judge a woman's devotion to her unborn child on whether or not her agony let her to scream for pain relief that crosses the placenta
Welcome to MN
Thanks for your response Paula.
I am by no means trying to turn anyone agains pain relief. My point was, it isn't about the devotion that a woman has to her unborn child, more the view that maybe more support would be better placed.
We (women) have been having babies since time began. I can't help but feel that childbirth is being sold to us as an illness that can be remedied with pills and anaesthesia, whilst we hand over the control over our bodies to health care professionals.
I do know how continuous pain feels.5:10, lasting a good minute or more, brought on by syntocinon was my labour number 4. Yes agony! But I knew that there was a reason for the pain and I knew that it wouldn't be forever...that was my mantra.
The beauty of labour is that it is not an illness, we know that there is an end in sight and we just need the support to get there.
That said, no woman should be told that she is NOT in labour if she feels she is. Early labour can be excrutiating, probably made worse by malposition. That said, our body is probably trying to let us know that we need to help it along, try a different position, walk,rock, squat. And when this happens, we should ignore our body, have an epidural, remain tied to a monitor and then maybe lose the power to push the baby out, end up with a trial of instrumental birth or a c-section? I just wish that there was more support in the labour room...
Elbowgrease, that's your experience. You really can't say that you "know" what another woman can cope with because you could manage.
"A minute or more" doesn't sound like continuous pain to me. Continuous means continuous e.g. no breaks, at all. Some women with back-to-back babies sometimes have the experience that there is intense back ache which overrides the actual experience of contractions. I had a back-to-back baby and didn't have this experience. Some women feel intense pain in the tops of their thighs. I didn't have this experience. Not everyone has a rising/fading experience of contractions.Not everyone is free to walk/rock/squat (medical need for continuous fetal monitoring) and are already tied to a bed etc.
As for equating having an epidural with "ignoring your body", are you serious? So if you are having a chemical induction which overrides your body's natural mechanism of labour, that's an okay way to medicalise labour/ignore your body yet having an epidural to manage this artificial level of pain is not? Surely, if you believe that childbirth should remain entirely natural you shouldn't have accepted a synto induction as, well, women have been having babies forever?
You are being wholly unreasonable to extrapolate from your own experiences in this regard.
And on the feminist issue:
Friend had appendectomy. Post-operatively, she was brought meals, bed pans etc. She was chastised for going to the toilet a few days after the operation as she had had "major surgery".
Friend had c-section. Called nurse to help her get 9lbs 10oz baby out of cot beside bed to feed. Told that there was no one to help so she would have to "get on with it". Friend made do by scooping up corners of sheet to use as makeshift hoist for baby as was unable to get out of bed . Stitches ripped and became infected. Friend was very poorly.
Working, totally agree with both your above posts.
A point I meant to make earlier is that pain relief for a late abortion is treated in the same way as pain relief in labour - i.e. you don't get anything much. And Elbowgrease's point about the well-being of the baby obviously doesn't apply in that case.
I had an abortion at 18 weeks. (Please no-one flame me: the baby was wanted and planned but had triploidy and wasn't viable, and I had pre-eclampsia.) I had to have labour medically induced, because that's the standard procedure for . I got sodding paracetamol. There was no earthly reason why they couldn't have knocked me out with morphine - I didn't have to be in any pain at all, but I was just expected to put up with it. In fact the care was generally appalling, and with hindsight I should have complained, but DH and I were both too shocked at the time to be in a state to complain.)
Sorry, above post should say "standard procedure for an abortion at that stage".
petsville i am so so sorry - that's appalling on so many levels . big hugs xxx
elbow : "The beauty of labour is that it is not an illness, we know that there is an end in sight and we just need the support to get there." Sorry - no, not in my case. I had 3 MWs, a doula and DH offering me the "support to get there" as well as all the hypnobirthing techniques I had been practicing. All of it useless. A "friend" ofmine "helpfully" told me that I coudl have coped without an epidural, because if I had given birth when they did not exist I would have had to. Well, yes, technically. Just as someone undergoing amputation would have "coped" in the days before anaesthesia. And we would have all "coped" with high levels of infant mortality in the days when epidemiology was poorly understood, sanitation was non-existent and medicine was less advanced. A completely useless and facile argument.
As for the point that women have been giving birth for millenia - well yes they have. And not without experiencing often terrible and life-limiting damage. Problems which women in developing countries still face due to the lack of adequate midwifery and obstetric care - obstetric fistual being a case in point.
I'm really pleased that you could cope. Some women do have births that are more manageable than others. Leaving aside questions of induction and management of the labour, perhaps some women are just luckier in this respect than others? Just as some women are luckier in pregnancy than others with fewer and milder symptoms.
There's a similar list of experiences on the Gas & Air thread. All I wanted was something better than paracetamol after my section, and it took forever. I also had to do the hoist thing for my baby as I was sick of waiting for someone to bother to come and help me lift him out of his cot.
Compare that to a minor op I had a couple of months later, the nurses were queueing up to give me pain relief and when I said I didn't need anything, looked at me like I was insane.
Interesting how when any discussion talks about the inadequacies of our health care system, someone always comes on to post about how they did it all drug free and are really proud. Good for you Elbow, I just wish that everyone could feel as elated as you quite cleary do about your births.
Maybe we should all just put up and shut up, after all women have been having children since time began - we should just accept that this is our lot! Trouble is, it's this attitude that stops reform and if everyone felt like this, we'd still be tied to the kitchen sinks without the right to vote.
petsville, I'm sorry for your loss,
Petsville I'm so sorry for your loss I had an intra-uterine death at 17 weeks and was induced. I was offered an epidural as soon as my contractions started - I declined, but got a morphine pump instead. To offer you nothing but paracetamol is inhumane.
I'm glad that not everyone gets such rotten care - very sorry for your loss too, Phlebas.
I'm really tired of the "women have been giving birth for millenia" argument. Well yes, they have. And people have been having broken limbs, pancreatitis, tooth extractions and all sorts of other painful experiences for just as long. Funnily enough, no-one tells you when you have your wisdom teeth out that you ought to do it "naturally" and that if you'd had it done pre-anaesthaesia you would just have had to cope.
Like Panzee, I've been offered all sorts of pain relief after a minor op, where I really didn't need anything much. I find the difference in attitude wherever giving birth is involved to be extraordinary. I honestly can't see any explanation except misogyny - that these things only affect women, so there's no need to try to make them better.
Sorry, should have been "millennia" - typing with DS on my lap!
I think we ought to answer Liznay's question about what should we do about this? We drone on about how the Taleban treat women - the NHS is not much better when it comes to providing pain relief for women in labour.
So sorry to hear about your loss and horrendous experience Petsville, and for your loss too Phlebas.
I don't know, in terms of 'campaigning for change' for me there are three main issues:
1. The NHS's attitude to caring for women who are in early stages of labour, ie
- Treating them quite literally as whinging inconveniences who must be kept out of everyones way until they reach the magic 5cm (or whatever is deemed to be an 'acceptable' stage to start looking after them). And no, sending women who are frightened and in pain away to have a bath without even examining them does not constitute 'looking after'.
- Failing to address women's pain and anxiety early on means they go into the birthing process full of pain and anxiety. Which must surely make for more difficult patients and worse outcomes anyway? So who's the winner here )
2. Lack of realistic information beforehand - many first timers find their reality shockingly different from those nice ante-natal hospital tours you get, where you meet the anaesthetists who you will be lucky to lay eyes on ever again...
3. Lack of space/resources for labouring women, lack of midwives, lack of anaesthetists.. etc etc. Yes, we all know about that one and even the govt doesn't seem to dispute it.
But mostly it's about a change of ATTITUDE and treating pregnant women and their choices with respect.
Whooohee!! Misty Valley. I'll be the first to sign up to your campaign - you've SO right!!!
Finally something we can (kind of) agree on. It's not that as midwives we don't get the training to enable women to manage a drug-free labour but 99 times out of a 100 we aren't able to work in this way.
but is it really that rare? or are we just told that it is/should be? in my case I had the best possible facilities - a spanking new mw led unit, birthing pool, balls, ropes, stools, 3 fantastic mws, 1 amazing doula and my brilliant dh. we had been practicing hypnobirthing techniques and i was completely up for it. massively prepared. when it came to it, all useless. maybe I was unlucky. i thnk i was. but reading threads on mumsnet leads me to believe that although it may be unlucky, it may not be that rare.
Starlight and Dr McDreamy, you both obviously work in maternity services.
It is not true that the less pain relief a woman has the better it is for her and her baby. Yes, IF you are lucky and have a very quick, painless, straightforward birth and don't need pain relief obviously you will have a good outcome - that is self evident. And yes, if you have a nice midwife it makes labour pain less frightening and easier to bear but a normal labour can be unendurable agony simply because of physiological reasons and complicated labour can be psychologically damaging in the long term.
The WORST outcomes are from women who don't get the pain relief they need- linked to depression and PTSD, fear of ever getting pregnant again, relationship breakdown.
Even in the best circumstances, with the most supportive midwife, labour pain can still be severe enough to cause psychological damage. Nothing will change until health care professionals can get their head round this and provide women with effective pain relief when they ask for it.
Midwives are not analgesics. The best most supportive midwives respect women and provide pain relief when the woman asks for it.
I don't believe it's that rare. I was one of the lucky ones: I never felt that the pain was unbearable, that I was about to lose control, that I wanted to die - any of the things that other women have said on this thread. It really, really hurt, but I could cope. But I had a near-textbook labour and delivery - DS was in exactly the right position, labour progressed without stalling, I was calm and relaxed once I was in the birthing pool and was supported by a midwife who really knew what she was doing and listened to what I was saying. Even so, I had a long second stage and I was beginning to think I just couldn't do it by the time DS emerged. If there'd been any complications, or if I hadn't had that one-to-one care (which loads of women don't), I'm not at all convinced I could have managed without serious pain relief. In my NCT group, I was the only one who didn't need a Caesarean or an assisted delivery - we're all quite old, which may be relevant - and consequently the only one who didn't ask for an epidural.
Sorry, Starlight, I read your comment about the less pain relief a woman has the better it is for her an the baby and I thought you were a midwife!
Humble apologies and I do agree totally about the barbaric mess we are in over this.
Isn't part of the problem, though, that women are too hard on themselves? Why is 'drug free labour' such a competition? Each to their own and people should be free to do what they want but there is a bit of one upmanship about this, isn't there?
Think there should be a counter revolution - what about some T-shirts with 'Epidural and proud of it' or 'Epidurals rock'.
I donate to the nct so they can campaign for improvements to maternity services. they might seem all lentil weavery but are also a political campaigning body. not sure if there are others as well? maternity services are chronically underfunded and no politician could give a toss unless they start getting letters and petitions at the very least. up until the 60's it was routine to have episiotomies and enemas - regardless of medical need, up until the 80s women could be forced to have c sections or else be 'sectioned' as being mad for refusing. Campaigns change things.
Mercibucket - Aren't the NCT a bit anti towards epidurals though because they see them as 'interventioins'? There's a lot on MN about their attitudes to pain relief. Do you think they would really be 'onside' about this?
I know a lot of people think it is all 'breathing exercises and yoga poses' with the nct but they are at heart a political campaigning organisation. this is the link to some of their current campaigns and there is a feedback form you can complete if you want them to campaign on other issues - might be as good a place as any to start. It's rebranded as the 'national' not 'natural' childbirth trust so challenge them on that!
I can't honestly see them thinking every mother should be given epidurals as standard, no, but this is about funding (lack of), adequate staff (again, lack of), caring attitude to women in labour (once again, lack of) - all good campaigning issues. If women want epidurals and make an informed decision to ask for one, it's appalling that they are ignored. If nothing else, checking out the NCT links might give some ideas about a separate campaign and how to approach it.
You need to have a think about your objectives. Is it epidurals on demand for everyone no matter the circs, is it more staff so you can have that 1to1 care so perhaps the epidural isn't necessary. Good luck.
Yes, certainly my image of the NCT is one where people are pushed down the 'natural' route.
In practice it probably depends on the people holding individual classes, whose personal agendas and opinions will vary a bit.
It seems like a smooth and pain-relief-free birth is promoted as the holy grail of 'lifestyle' experiences. The fact that it might well not actually BE like that, especially with the NHS's lack of resources and attitude to labouring women, seems to be brushed under the carpet, not least by the NHS itself.
Hold the front pages. I reckon Starlight and I are in agreement.
"I suppose my objective would be that all woman requesting epidurals on demand get them, but that this would be a rare request because all women who can manage without are adequately supported to not NEED to ask."
I would agree with that.
I'd add a caveat though - 'support' shouldn't equal active persuasion away from pain relief at any stage if that is what the woman wants.
I'd see support more as giving the woman CONFIDENCE that
a) the health professionals who are looking after her are actually DOING that (by listening, performing examinations, being physically present and sympathetic etc)
b) keeping the woman fully informed as to what is going on with her body (if that's what she wants)
c) listening to women and responding to their requests
d) not making assumptions about individuals (eg I can tell just by looking at your face (rather than your fanjo) that you're not in labour)
to give just a few examples - I'm sure there are many more.
@ Elbow -- It seems very inconsistent to say the least to accept the medicalisation of pregnancy by avoiding all the forbidden food, drink, etc., but when pain relief is allowed it is eschewed.
And pain relief is fine, despite the opinions of some, because if there was any likelihood of it causing problems it would not be offered, thanks in part to the litigious nature of US society.
Why not epidurals on demand, DrMcDreamy? With the best 1 on 1 staffing in the world, I asked for and got one for DD1's birth. I didn't ask for one and didn't have one for DDs 2 to 5. I reckoned that after pushing out DS at 9 lbs 4 without one, I could probably deliver a can of paint sideways. I don't think the level of staffing has anything to do with it. It's all about the level of pain the individual woman feels she can take, and I don't know why this can be ignored in favour of some objectives that have nothing to do with good medicine ('first, do no harm') and all to do with some philosophical notion of what constitutes a proper birth experience.
Misty, totally agree that all women requesting epidurals should get them but not sure about the caveat that epidurals should be a rare request.
Childbirth pain is real and extremely severe for most women - it isn't in the mind. There is no other situation in the NHS where people are expected to endure that level of pain without proper pain relief.
Having had a birth with and without epidural (albeit administered by a skilled anaesthetist so itworked) I don't understand why there should be an expectation that woman won't want epidurals by choice. My non-epidural-pain-relief denied birth was horrific (followed by clinical psychology treatment for trauma) and the epidural birth was painless calm and wonderful.
There are a lot of women who have a burning desire to experience natural vaginal birth and there are those of us that don't. The experience of grunting and groaning in agony I found degrading and my overwhelming feeling on holding my daughter was not joy but huge regret that I had brought a female child into the world in a society that treated women with such brutality.
So yes, let's just have that health care professionals let women have pain relief when they say they need it - no caveats
I've had one hospital birth (with epidural) and three home water births.
I found the whole hospital thing completely disorganised, filthy, uncaring (apart from the mw who sat with me during the epidural, who was very professional and kind). I had to threaten violence in order to be taken seriously enough to get an epidural and I did actually attempt to fling the gas and air tank across the room at one point. I was in battle mode the whole time.
During the home births it would never have occurred to me to have any pain relief as things were organised, clean, calm and efficient and I just got on with it.
Moral of the story? Treat women like birthing cattle and stuff them in institutions, and don't be surprised when they ask for strong pain relief, as it is an alien environment.
As soon as I went into hospital to be induced (2nd child)I told the MW I would like epidural when the time came.
What a surprise, they told me no one was available when I could bear the pain no more. I found most of the MW's very uncaring. I'd had an awful delivery the first time around, I told them this. I have a bit age gap between my children as I was really put off giving birth again.
What is the point in birth plans? They are meaningless in reality!
Both midwives and nurses, (in the NHS), work extremely long hours, frequently without breaks,stay late are required to update themselves and learn throughout the whole of their careers.
Many a maternity/other hospital unit would cave in without the goodwill of these people and the negative and ill informed attitude of some of the public is something they face daily.
The majority of midwives are desperate to provide as good a service as they can, under extremely stressful conditions and often have chosen to become midwives so they could be 'with woman',trying to help her have the best birth experience possible, not because thay are control freaks who love to watch women suffer.
The reality of many services within the NHS is that if a unit stays open and the place is running, it is because of alot of goodwill by staff,a point always ignored of course by most,so services and staff can be cut even further. Never mind about the people on the front line killing themselves, sacrificing huge chunks of their own family lives and time to keep a place going.
What has this got to do with anything? Alot, epidurals do have their place, definitely, but there is usually a good reason why a woman may not be able to have one at the precise moment of request.
RUSerias, I don't think anyone is trying to suggest that midwives and nurses, as a group, want women to suffer or don't care, and it's quite possible that a lot of the insensitive behaviour people experience is because midwives are very tired, stressed and overworked. However, it doesn't seem helpful to imply that women who have had such bad birth experiences that they've been left with PTSD (as some posters on this thread describe) are expressing a "negative and ill informed attitude". I don't think anyone on this thread would dispute that maternity services are under-resourced, but you seem to be blaming women for the cuts in services.
Could you address the issue, raised by a lot of women on here, of women not being told the truth by HCPs? If there's a good reason why I can't have something, I would want to be given the reason, without flannelling. Clearly this doesn't always happen - see a number of women on this thread who've clearly been fobbed off as though they were nursery school children. There may be a good reason why a woman can't have an epidural, but don't you think it's reasonable, at the very least, to explain that reason?
Just to answer some of the above posts:
I never said that I know that another woman can cope just because I could.
"A minute or more" doesn't sound like continuous pain to me. Continuous means continuous e.g. no breaks, at all.
Continuous, compared to 5:10, lasting a minute or more? is that not more or less continuous? It means that I had around 30 seconds to recover before the next set in. But to you it doesnt sound like continuous. Hmmm, see how easy it is to not believe someone?
And I was one of the lucky ones at 19, afraid, in a foreign country and totally oblivious to what was going on? Ok, if you say so. I suppose everyones experience was more horrific than mine then.
I agree that having a chemical induction which overrides your body's natural mechanism of labour. Not having an epidural was my way of gaining some control back. My personal experience, sorry for sharing. I was just trying to bring a bit of balance to the discussion, seeing as anyone who is pregnant and reading this thread may be terrified by the pictures some of you are painting.
On the whole I agree with some of the points being made here. Denying women pain relief on request per se is not acceptable. Lying or not believing a woman is not acceptable.
PYBF: I feel it is attitudes like yours that - unfortunately- lead to women NOT getting the pain relief they need in childbirth.
I never said that women should be denied pain relief. But lets just bear in mind what an epidural can lead to before we go about selling them as the best invention since baked bread. In essence, an epidural puts you straight into a high risk category. It can lead to morbidity and even mortality, for mum, babe or both. They dont always work and the window of pain caused by an insufficient block can sometimes be worse.
I would like to see other changes to our system that may help women, such as true continuity of care, real support, parent education with realistic goals, and last but not least, women and midwives united in their goal to make childbirth a better experience for us.
Elbow grease "In essence, an epidural puts you straight into a high risk category. It can lead to morbidity and even mortality, for mum, babe or both."
This just isn't true - not in the normal sense of medical risk.
Severe injury from epidurals is vanishingly rare and in the case of labour pain analgesia most cock ups have been due to gross negligence (wrong drug, wrong place). I don't ever recall a baby death. That does not mean epidurals are risk free - there is risk of headache and various rarer side effects but in general it is regarded as a very safe procedure.
I do agree with your comments about changing the system though
RUSerias -- are you serious? These people are paid and are actually public servants if they work in the NHS. It's not a vocation and they're not just doing it out of the goodness of their hearts. They are no more altruistic than any other medical staff in the NHS, whether they work in kidney dialysis or post op for prostate cancer patients or pediatric leukemia. And their units are not going to be shut down if they don't have the attitude that they are sacrificing their lives for some higher purpose and make their patients adopt the same attitude.
Why do you think women's healthcare should be seen as different from anything involving other sections of the population? Women's taxes pay for the NHS just as much as men's do.
Why should it be women who must smile and accept that there are somehow not enough anesthesiologists or anesthesia to go round so they should be the ones to smile sweetly and let it be given to someone more deserving?
Elbow -- 'In essence, an epidural puts you straight into a high risk category. It can lead to morbidity and even mortality, for mum, babe or both. They dont always work and the window of pain caused by an insufficient block can sometimes be worse.'
-- please do not scaremonger about epidurals. If they were that risky and that ineffective, on the whole, they would not be offered. On the whole, they work. Occasionally they are ineffective. Women and babies are not routinely dying because of epidurals. I take specific issue with your statement that having an epidural places a mother in a high risk category. Here's a sensible discussion of the pros and cons of epidurals.
Elbow - recent research shows that epidurals are low risk. They have been associated with more intervention such as the use of a ventouse or forceps, although it has been noted that mothers experiencing longer and more difficult labours in the first place are more likely to request spinal pain relief in the first place.
As starlight pointed out earlier in the thread, childbirth is not about performance.
mathanxiety: I suggest you read past the potential benefits and read further down about the potential risks.....
Also, "I take specific issue with your statement that having an epidural places a mother in a high risk category."
Maybe you should read the NICE guidlines a bit more indepth.... Normal birth is defined as that without surgical intervention, use of instruments, induction, or "epidural" or general anaesthetic....
and "Before choosing epidural analgesia, women should be informed about the "risks" and benefits, and "the implications for their labour...."
Those being...It is associated with a "longer second stage of labour" (not so good for the bladder) and an "increased chance of vaginal instrumental birth....."
Also "It will be accompanied by a more intensive level of monitoring and intravenous access...." Now why would you have to do that if there were no risks?
I do belive that women should be able to access whatever pain relief they need to cope with labour...However, it should be "INFORMED CHOICE" and should contain info pertaining to the risks as well as the benefits.
Couldn't agree more Starlight, which is why I think it is time that we start to have open and honest discussions with the midwife, long before the baby is due, as I would have loved a pool birth, but didnt fit the criteria (although my community midwife later said that I could have had one at home) and I dont understand the need for starving women in labour.
Maybe then, we wouldn't get tricked out of what we want. Maybe we could start being treated like grown women with brains who have certain expectations and if these are not possible, then an explanation of why our requests are not possible to fulfill would be better accepted.
Jetli, where did I mention that childbirth is about performance?????
And that is the crux of the matter really. As a midwife you have no idea of the level of antenatsl education a women who walks through your door had had. He'll you don't even know if they can read. That is what I was alluding to earlier with antenatal education. If your midwife was sure that get client knew the pros and cons if each type if pain relief a whole lot of time and angst would be spared. As it Is your midwife meets you for the first time in labour and has to gauge how much you know re pain relief and what you need explained and discussed. I can understand completely the school of thought that says no matter what in those circs If you request an epidural you should get one but if we go down that road the volume if complaints we'd get saying "no one explained I might end up with a longer labour/forceps/ventouse/stuck to the bed on Continuous monitoring/could have had pethidine etc and I feel cheated" would increase proportionally . We're in a bit of a lose lose situation.
DrMcDreamy - would you say that what tends to happen then is that women are discouraged / prevented from having epidurals just in CASE they are too stupid / ill-informed to know the risks?
Not at all, i can't speak for anyone but myself though. I don't discourage or prevent epidrals, I try and make sure that anyone requesting one is fully informed of pros and cons of having one though. Ideally I'd know they were aware of these before hitting delivery suite but unfortunately I can't. I'm sure here on MN we're all educated women aware of our choices but it is surprising how many are not or do not have access to the appropriate information.
'Normal birth is defined as that without surgical intervention, use of instruments, induction, or "epidural" or general anaesthetic....'
In that case hardly any birth is 'normal' and hospital birth makes absolutely no sense for most women. Childbirth is risky in and of itself. It is also very painful and that pain itself can slow labour.
"Before choosing epidural analgesia, women should be informed about the "risks" and benefits, and "the implications for their labour...."
Those being...It is associated with a "longer second stage of labour" (not so good for the bladder) and an "increased chance of vaginal instrumental birth....."
Also "It will be accompanied by a more intensive level of monitoring and intravenous access...." Now why would you have to do that if there were no risks?
-- It's not a question of high risk with epidural vs. no risk without. And there is no risk associated with more monitoring, just the opposite. It may not be the same as labouring in your sitting room however.
More monitoring in itself carries no risk, maybe some discomfort but that discomfort may be far less than the pain the epidural has eased - a trade off that many women would like to be able to make.
Another article on epidurals here Not only is an epidural considered to be overall helpful because pain that a woman cannot endure is not considered to be a positive thing and character builders of this sort are not considered worthwhile inflicting on women by the medical profession in general, it is administered at the request of the patient, despite your dire prognostications that it might kill her and harm the baby. Obviously the benefits far outweigh the risks or no-one would get it.
And as for the increased monitoring -- yes, this happens, and the reason is so that there will be as few harmful side effects as possible. Most women are happy to trade off the increased monitoring and other (relatively minor) necessary precautions in order to alleviate the pain.
All patients who receive any kind of anesthesia must have their vital signs monitored and the baby in the case of a labouring woman will also be monitored. There is no increased risk associated with the extra monitoring. Most women who have an epidural, and their babies, are fine afterwards.
The increased risk of intervention, forceps, c-section are definitely present (though they can be necessary even without an epidural) but again, what is so horrible about any of these procedures and increased monitoring in and of themselves unless 'doing it all yourself', or going natural is your be all and end all; performance, in other words as one of the main criteria by which to judge the delivery?
'The reason that the problems are rarely challenged legally is because they are often not quantifiable. That doesn't mean they don't exist.'
There is absolutely no medical procedure available in the US, and no associated risk, that has not been subject to the intense scrutiny of the actuarial profession. Every procedure and every medicine that is available for pregnant women has been examined with a fine toothed comb and quantified by the private insurance companies (who operate with profit in mind) that pay for most healthcare in the US and who also insure OB/GYNs.
Neurosurgeons and obstetricians pay the highest insurance premiums because their specialties deal with the highest risk patients, highest risk situations, and the areas where the most can go wrong, with the most devastating results. They are the most likely specialties to be sued when the worst case scenarios happen. The procedures they may attempt and the drugs they may use are in effect regulated by the insurance companies that pay them. Best practice manuals spell out what they can and shouldn't do. Insurance companies have a huge input into these guides. In court, a neurosurgeon or obstetrician who has deviated from such a manual will have it waved in her face.
I do agree about the nonsense of telling women they can prepare a 'birth plan'. It is downright cruel. The only part of mine that had any relevance was the note that I am allergic to aspirin and latex. I only got to use the fancy birth center room that featured prominently in the brochures once out of 5 times.
MA "And there is no risk associated with more monitoring, just the opposite."
I think you misunderstood me here, women are monitored "because" of the risks associated with an epidural.
"Most women who have an epidural, and their babies, are fine afterwards." But there will alays be them that aren't.
"Most women will come through childbirth without feeling cheated at not having an epidural although they requested one and were denied one for various reasons." But others will carry the scars of PTSD and feel cheated.
"The increased risk of intervention, forceps, c-section are definitely present(though they can be necessary even without an epidural) but again, what is so horrible about any of these procedures....?" Are you being serious? Maybe a few mums who have ended up having these procedures may want to share how they found their experience, especially if it was an emergency situation. And what about the recovery rate and implications of said interventions?
"There is absolutely no medical procedure available in the US, and no associated risk, that has not been subject to the intense scrutiny of the actuarial profession." And yet they have the highest fetal mortality rates amongst developed coutries.
Anyway, please read my posts more carefully, I am by no means implying that women should be denied an epidural and we shouldn't just make sweeping statements because we don't like the facts. If there were no risks, they wouldn't have to be pointed out would they?
I believe that in spain if you want an epidural you have to go to a session first to hear the disadvantages and sign a consent form before you go into labour
Everyone who has any kind if anesthesia is monitored. Including women who have epidurals. The risks are no higher than anyone undergoing any kind of anesthesia. All anesthesia carries risk. All patients have these risks explained to them before all surgeries. All sign statements that they understand the risks. Epidurals do not carry more risk than other forms of painkiller or anesthesia. The fact that there is some risk does not mean the risk is alarmingly high or should make you think twice about it, any more than you would be put off anesthesia for an appendectomy.
'What is so horrible about any of these procedures?' -- well I have shared mine upthread; I delivered DS who was 9 lbs 4 ozs having been induced early in the morning on a busy day in the hospital. No forceps used but a vacuum extractor helped pull him out, and a fetal scalp monitor was inserted into his scalp by a doctor with hands that were rather large. And I had an episiotomy, with a pudendal block. I recovered just fine, and so did DS. He had a high apgar score, born nice and pink, crying loudly. I could have done without the excruciating pain all day from the pitocin though, and I would have liked not to have felt every single inch of DS's progress through my vagina and also the insertion of the scalp monitor and the vacuum thing. I could have done without the feeling of being treated like a slab of meat that had somehow managed to get a baby stuck inside me... And I was monitored from the start, as once you are induced you get the same monitoring as you would for an epidural.
The fetal mortality rates in the US are very high, mostly due to lack of maternal access to prenatal care, and the resultant phenomenon of mothers arriving at public hospitals where their prenatal history is not known, where they may have serious complicating problems, where conditions like gestational diabetes are undiagnosed, where maternal health issues like inadequate nutrition or poor lifestyle choices have resulted in very low birthweight or premature babies. Additionally, many women take the risk of travelling to the US late in pregnancy to deliver there as citizenship is granted to all babies born in the US. For the majority of babies delivering in the US, a good outcome can be predicted.
Aaah MA, you are in the US?
As far as I am aware, women in the UK are not monitored constantly if they have G&A or pethedine. It's intermittent unless there is an issue with the baby i.e. the midwife may hear a deceleration and therefore start to monitor continuously.
I think there are many differences in how childbirth is achieved in the US compared to the UK.
For instance, women are not expected to undergo surgery as soon as they step into a hospital to give birth, so we dont have to sign anything, unless we want an epidural or we are going to have a c-section. Then we undergo the same pre-op measures. It was the same in another European country where I gave birth.
Another difference is that midwives are the main caregivers in normal labour in the UK, not the obstetrician. They are only called in if there is an issue.
Well done by the way! 9lb 4 oz is a respectable size! You grew him well.:D But were you not allowed to get up and mobilise whilst being monitored? I wanted to move and I was helped by my midwife to sit on a birth ball and stand, leaning by my bed although I was monitored. I suppose things are done differently where I am.
I was offered an epidural when I was induced but I declined it. A few of my friends have had inductions and they were also offered an epidural, as it is an unnatural labour. Some had one and others declined. Maternal choice. It feels very different to starting off by yourself, I must admit.
I was for the birth of the DCs. Youngest is now 9. Childbirth is achieved basically the same way, but the waiver signing is definitely different. You sign a waiver stating you understand that the medical staff may perform certain procedures, and a HIPAA form with details about release of your medical information, before you are even admitted. They also ask for proof of insurance and you have to sign forms related to insurance too. I was signing the forms when my waters broke about 20 minutes before DD2 was born and the receptionist outside the triage area planted a form in my wet lap for me to initial because I had missed one of the Xs the first time round.
Women are not expected to undergo surgery in US hospitals when they arrive for delivery, just as in the UK. The expectation is that the birth will be vaginal unless there are previously known conditions that would indicate the contrary or unless circumstances demand it as labour goes on. The signing of waivers and consents to blood transfusions, administration of fluids, medically necessary administration of medicines, etc., are standard when you go to any hospital for any procedure. There are bits in the forms about waiving your rights to sue, blah blah, but there are loopholes of course -- I actually remember little about the various forms I signed (surprise, surprise) as my mind was elsewhere. It seems like another world with everyone looking over their shoulders at lawyers. However, the risk aspect of it both in the US and the UK has more to do with the looming lawyers than high medical risk, or risk that is higher than most medical in-patient experiences. Patients must be informed of the risks because theoretically they can opt not to be treated -- not really a choice for women in labour but they are patients and therefore have to be informed because informed consent is a cornerstone of doctor-patient relationships everywhere.
But the process of birth is more or less the same. (Although I have never heard of anyone having G & A in the US and had to look it up when friends mentioned it when we all compared notes.)
I was not mobile for any of my 5 deliveries. So much for the birth plans. I had monitoring for all, just as my sister and friends did in Ireland or the UK for theirs even though just one of mine involved an epidural, and episiotomies for all but the last one, birth plans tossed out the window and 'medical necessity' in their place. I was allowed to get up to use the loo once during labour with DD4, bringing my IV hook with me. That was the one and only time I got to leave the bed, ever, during labour.
I was induced 3 times out of 5, with no epidural for any of the inductions (twice because I opted for none, once because the hospital was really badly run and pain relief for women wasn't a high priority) but a shot of something for nausea during late first stage twice as the pain was making me sick and I was using my stomach muscles too early.
I used a midwife practice for the last birth too. Apart from the birth of DD1 and DS I was actually not attended by my doctors at all. DD2 (spontaneous labour) arrived an hour before my own doctor did at the hospital. A flaky first year resident attended (she kept on saying 'Don't worry, I can deliver this baby!' in a panicky voice and was steadied by a good nurse -- I kept on thinking, 'I'm not worried, I've done this before, probably more times than you, and actually I'm the one delivering the baby. I just need you not to mess up my rear end too much afterwards when you stitch me back together again..'). For DD3, I had one resident (second year this time) and a great nurse named Roxanne -- again an induction but with a cervical pessary, not pitocin, and no sign of a fully qualified obstetrician until the next morning. For DD4 I was induced first with the pessary and then with pitocin so I was there for 48 hours, with one trip to the loo before they started the pitocin. Midwives came and went according to their shifts. All the official doctors and the midwives sent bills afterwards. The residents were paid by the hospital so no bill from them.
AFAIK from the experience of friends, monitoring in the UK was constant at least a few years ago (maybe ten years ago?) when they had their epidurals, with the baby's heartbeat and their blood pressure monitored (which is what I had for mine). Most went through labour hitched up to monitors that beeped and banged the whole time. Maybe hospital policy or maybe their conditions required it? Two were private patients and one was NHS. None could get up and walk around, so in that our experiences were eerily similar. All had been shown the birthing ball and the pool, etc. Amazingly, it was empty and suspiciously spotless when they took their tours of the hospitals, but full when their turn came...
I'm glad I never gave birth in the US, tbh, though I was born American.
My husband and all my children are Scottish, I am a British national/dual national and have lived here for 10 years.
Although, often enough, I am treated as if I should have no opinion on British life, don't understand any of it (that is true about England and Wales, as I have never lived in either) and I should, with my family, 'go home', though my children and husband are every bit as Scottish as any other Scot born.
(I often wonder if my friends who are Pakistani or Indian/Scottish would get the same treatment, but that's another story).
I think if you pay taxes somewhere your opinion should count there, and I think if you are a taxpaying woman the health service should deliver whatever it promises to you, because you have paid for it.
If I had not been given an epidural I know that I would never have another vaginal delivery. I'm in no way "traumatised" (don't want to belittle the experience of those who have had really bad births) but the pain of the 30 mins waiting for the anaesthetist after my waters broke (I was at 6cm by then and had laboured at home for 15 hrs doing ok before coming to hospital) will always be with me in "Top 10 worst experiences of my life". I had a great, supportive midwife helping me with the gas and air and supporting me to remain mobile but I was not coping in any way whatsoever. I was a sobbing wreck.
I live overseas so had an obstetrician led delivery. We talked about all the options beforehand and she said
"It's up to you, but what I'd say is that whilst I agree that a pain relief free birth is a completely natural thing, 35 year old women having their first child is not a natural thing. Older women having their first child tend to have longer and more painful labours than younger women. Don't ever feel that you're losing face by saying that you need an epidural."
I am so glad I asked when I did and SO grateful that I only had to wait 30 mins.
I was actually offered an epidural repeatedly during my first birth, and was told I was getting one for a manual placental removal regardless that my notes specifically say I should not get one due to my history of low blood pressure (actually had a anethesiologist tell them off for the latter, she was absolutely marvelous after dealing with midwives and nurses who acted like my almost-dying reaction to the injection was my fault).
I had a horrible, life threatening reaction to the "completely safe" injection to speed up the placenta. I was put in the high dependency ward with women who'd had horrible complications to epidurals and spinal blocks. None of us expected to be there, but it happens. All medicine has some likelihood of causing problems. I think women should be given a full discussion of pros, cons, and risks of the different things that can be done during labour, birth, and third stage. If there is time for a home assessment for women who want home births, there should be time for a run down of the medicinal interventions - other than just handing out pamplets.
I mean, my husband had to go in before his knee surgery, discussed his previous reactions to medicine - particularly anesthetics - and given a list of every littlev thing that could go wrong against why it was worth the risks. I don't see why a similar thing couldn't be part of standard NHS antenatal care. As someone who had an unlikely reactions, it would have led to a lot less 'what could I have done differently' feelings to know that, although unlikely, X% of women do have a bad reaction regardless of anything else' and this would hopefully allow women to get whatever care wanted during such a difficult time if there was a signed paper saying 'yes, she knows the risks and thinks it is worth it'.
ok I feel I want to respond to some of the things said in this thread
firstly - why has noone swore and cursed either a: the system
or b: the anaesthatists.
It appears to be 'bash the midfwife'. ther midwife does not put in the epidural - the anaesthatist does. The midwife phones the anaesthatist to organise it - if they are too busy saving someones life/ baby's life having a PPH or emergency section, then that is not the fault of the midwife.
Also - epidurals do affect the mode of delivery. There is copious amonuts of research stating that yes, they can lead to higher instrumental deliveries/sections. It can lead in later life to pelvic floor problems caused through pushing too long - it is much harder for women to push effectively when they have no urge to push.
When women are in labour, they need to mobile to facilitate the birth mechanism - an epidural does not allow this. Being on CTG does allow for this - if women are told to stay on the bed and that they cannot go to the toilet, then that is wrong. If you have drips attatched, you can wheel them to the toilet. Likewist the CTg can be tempoarily disconnected to allow this.
I am pleased to be able to work in a place that does not have the problems that most of you are discussing - if women require an epidural then they can generally get it - as long as the anaesthatist is free - if not, they are told and given an approx time scale for when they will get it.
Epidurals do not lead to caesareans. Have a look on the obstetric anaesthetists site.
There is a possible link to increased instrumental but this is disputed with some studies showing a link and others not. The difficulty is that women who request epidurals are those may have obstetric problems to start with so does the epidural cause the problem or is it the result?
Ther definitely was a difference with the old style epidurals but the evidence for the newer lighter epidurals is mixed.
The obstetric anaesthetists association consider you increase your chance of having an instrumental delivery by 7% if you have an epidural but that may be much less if you give birth in an upright position - there is a big uk trial going on at the moment.
There needs to be much more effort to improve pain relief for women - labour pain is one of the severest pains known yet it is the only one that people are expected to 'cope' with rather than have relieved.
In fact, research into obstetric analgesia is way down the priority list - women's pain doesn't matter - we're second class citizens where the health service is concerned.
This is the one area that we do not have equality - totally appalling - some of the posts on this site where women are talking about their experiences would not be out of palce in the Amnesty International Mag...
I am also shocked at the blame being directed at midwives. If there is not anaesthetist or he/she is dealing with an emergency it is hardly the midwife's fault.
"There is a possible link to increased instrumental but this is disputed with some studies showing a link and others not".
Would LOVE to see a study where one arm compared outcomes for low risk mothers having elective epidurals, the control arm being low risk mothers who are given one to one care all the way through labour by a midwife they've met before, who have access to a birth pool and are encouraged to mobilise.
Reckon the outcomes would be very different!
And would also like to know if any studies comparing outcomes for epidural vs non-epidurals control for the impact of continuous care in labour. We know continuous care is linked to lower rates of c/s and instrumental birth, and we know that in the UK at present many women spend a good deal of their labour alone (unless they've had an epidural, in which case they'll have a midwife with them all the time).
Ushy - I think the thing that's worth remembering with pain in labour is that experiencing severe pain in labour is not necessarily linked to women reporting lower satisfaction with the birth or to poorer psychological outcomes, hence perhaps the lack of motivation in addressing it.
What Ushy said- if men had babies there'd be more anaesthetists. It's barbaric to expect a woman in severe labour pain to wait 3 hours or just to be fobbed off. It's another example of the infantalisation of women. "There, there dear, you did it, it wasn't so bad was it? and you've got your lovely baby now, and didn't jeopardise his health by that fraction of a percent by asking for an epidural."
My local hospital generally achieves one to one care in labour whether an epidural is in place or not.
But surely it underlines the higher risk aspect of them if other units, who are unable to achieve 100% one to one, give one to one with epidural.
I had one to one continuous midwife support and had been mobile for the previous 12 hours of my labour. Still had an epidural. No disrespect to midwives but no amount of breathing was going to get me through the referred pain in my hip that made me feel as though I was being racked.
BaggedandTagged - there is good evidence though that overall if women have one to one support from a known midwife they're much less likely to need pain relief in labour.
Wanted to add, that I wouldn't want to see the wider availability of epidurals without a corresponding rise in the number of midwives.
Cleofartra, there are loads of studies that show that severe pain leads to worse outcome for women - PTSD, depression etc.
Look what women are posting on this thread as well. These are real women talking about real experiences and how their lives and mental health have been affected by the barbaric attitudes to pain relief within maternity services.
I agree that one to one care is good but labour pain is real pain - it is not in poople's head! Women want good 'one to one' care and the pain relief they ask for.
The post delivery pain and trauma (physical, emotional/ mental) from a section or an instrumental comes into the PTSD / depression studies too.
"Look what women are posting on this thread as well. These are real women talking about real experiences and how their lives and mental health have been affected by the barbaric attitudes to pain relief within maternity services. "
But the stories here are fundamentally about unsympathetic and unresponsive 'care', women not being listened to and women feeling disempowered - all of which are linked to poorer psychological outcomes (and physical outcomes!).
It's not as simple as more pain = worse psychological outcomes.
"I agree that one to one care is good but labour pain is real pain - it is not in poople's head! Women want good 'one to one' care and the pain relief they ask for".
But not all women are primarily concerned with having the least pain possible in labour.
Different women want different things. Some will want the maximum amount of pain relief. Some are more preoccupied with having a birth which isn't interfered with.
What all women want is to be listened to, and to be given the best opportunity to have the birth they want - with pain relief or without.
I totally agree that MW provision needs to be better and that it is a critical factor in positive birth experiences. Women need to be able to have one person to support them throughout labour and we cant all afford to rush out and hire a doula.
It just concerns me that women are saying "I am in agony. I can't bear it. Please get me an epidural" and are not being taken seriously.or made to wait 3 hrs. I mean, it's almost as though they know you cant actually "die of pain" so there's no downside to refusing.
It may be a factor in the rise in elective c-sections possibly? I'm not sure I'd have a natural in the NHS.
"It just concerns me that women are saying "I am in agony. I can't bear it. Please get me an epidural" and are not being taken seriously"
Think it's a very good idea for women (or their birth partners) to insist that a request for an epidural be written in their notes at the time it's made.
"It may be a factor in the rise in elective c-sections possibly? I'm not sure I'd have a natural in the NHS."
Yes - can see the logic here. At least if you're having an elective you can pretty much guarantee you won't spend most of the birth alone or being looked after by one very stressed and busy person!
I agree with you Cleo, about women wanting very different things.
Some women will complain if they were offered pain relief !
I made them put it on my notes that I only consent to receiving oxytocin if I get an epidural first. So that is exactly what happened. Although I reminded them of it every hour just in case.
Cleofartra - "But not all women are primarily concerned with having the least pain possible in labour."
No problem. But the posters on this thread clearly think pain WAS an issue.
Absolutely agree women need to be listened to.
"I want an epidural" means "I want and epidural"
Not getting an epidural for someone who says this IS unresponsive and unsymapthetic.
There seems to be a bit of a golf between midwives and some groups of women over this.
Quote MA:"AFAIK from the experience of friends, monitoring in the UK was constant at least a few years ago (maybe ten years ago?) when they had their epidurals, with the baby's heartbeat and their blood pressure monitored (which is what I had for mine)." Yes they probably would have been monitored throughout "because they opted for an epidural, which puts you in a higher risk category". As well as all the above mentioned risks, you are also at risk of DVT from being immoble for such a long time with excess fluid on board due to the pregnancy.DVT was shown to be one of the leading causes of maternal death in the last CEMACH report.
As for being pakistani, polish american, everyone should have the same treatment, regardless of whether you have paid in to the system or not. If you are not a UK taxpayer, you should expect to get billed for your treatment and pay up. The NHS does not have a bottomless pot of funding. In comparison, a friend of mine was treated for a sprained ankle in the US last year, he was sent an enormous bill for the treatment he had received.
The rise in c-sections could be put down to defensive practice and is probably more due to the NHS not wanting to be sued.
In response to Ushy re: research on the Obstetric anaethetists site.....
What about other research - cochrane reviews etc.
you cannot take seriously research undertaken by 'interested parties'
Its like believing research undertaken by say...Nescafe coffee saying Nescafe is the best to drink - we have research to prove it!
from the Cochrane review 2011...
Epidurals are widely used for pain relief in labour. There are various types, but all involve an injection into the lower back. The review of trials showed that epidurals relieve pain better than other types of pain medication, but they can lead to more use of instruments to assist with the birth. There was no difference in caesarean delivery rates, long-term backache, or effects on the baby soon after birth. However, women who used epidurals were more likely to have a longer second stage of labour, need their labour contractions stimulated, experience very low blood pressure, be unable to move for a period of time after the birth, have problems passing urine, and suffer fever. Further research on reducing the adverse outcomes with epidurals would be helpful.
Sorry - have been lurking on this threat and not posting but Alimati's quote above is interesting (and surprising):
"There was no difference in caesarean delivery rates"
I would have though C-section rates would be higher after epidurals simply because they'd be happier to agree to an epidural if they thought someone was having a complicated labour or one more likely to end up in c-section anyway.
Having cared for lots of women with epidurals my personal experience is that epidurals do contribute to higher section rates.
yes dreadingwedding - higher risk women are often encouraged to have an epidural for various reasons, and yes, for various differing reasons they are more likely to have a section
Lots of the side effects noted all contribute - malposition of baby - how can you move baby into a good position if youre unable to mobilise.
Maternal pyrexia - what happens to mum happens to baby too - if mum has a high temp, then baby will, its heart rate will go up and it will become distressed - therefore emergency section.
Dropping blood pressure - seen it once and was very scary - emergency section as baby distressed
Also - needing contractions stimulated - oxytocin drip - baby often becomes distressed. Chance of hyperstimulation, distressing baby and causing a bradycardia (emergency section) or even a ruptured uterus(maternal and baby death potentially)
Epidurals are not a decision to be taken lighlty.
I do also think they are a God-send to those women who need one
Alimat - I have seen such emergencies too. The times where the horror of a dramatic prolonged dangerous dip in babes heartbeat, immediately following an epidural siting, still makes my blood run cold.
Someone on this thread described midwives as lazy-arsed. I can assure whoever that was, that my arse moved not at all lazily, and in fact very quickly, to maintain the safety of those mums and those babes.
""I want an epidural" means "I want and epidural"
Not getting an epidural for someone who says this IS unresponsive and unsymapthetic.
There seems to be a bit of a golf between midwives and some groups of women over this."
If you can find a way that helps midwives to know for sure that women know and understnad the pros and cons of what they are requesting without us having to explain it to them first then yes we'll agree at the first instance of asking a woman should get the epidural they are requesting.
Until then we have to go through all of their options and discuss this with them. It's our jobs on the line if not.
and its also not informed choice.
I fear many people who may have a bad outcome, would then go on to sue the hospital as they werent told that epidurals can cause forceps deliverys and 3rd tears and both faecel and urinary incontinence for the rest of their lives.....
or would they just say - well, I asked for an epidural, i wanted one,its my decision, I didnt want to hear the full facts so its my fault
The monitoring is there because an epidural can have an effect on blood pressure (a positive effect if you have hypertension) and your temperature, but neither condition is considered enough of a complication to indicate against epidurals for the vast majority of women. There is often monitoring of your contractions because the attending nurse can't necessarily tell from your facial expression or other outward signs how your contractions are going, because you're more relaxed and not feeling the worst of the pain. You are at no higher risk for anything than anyone else who has any kind of anesthesia; everyone who is anesthetised is monitored for temp and blood pressure and in the case of an operation, oxygen. All medicines come with some risk, even aspirin, nsaids, cold remedies or acetaminophen. To suggest that an epidural is the riskiest and that increased monitoring proves it is a misstatement of the situation.
The practice for hospitals in years past and for many individual doctors even now is to have women lie on their backs for the whole of labour and undergo monitoring whether they had an epidural or not. It makes access for internal exams and external exams easier. The DVT risk obviously isn't something that concerns the medical profession all that much at all. I think you're far more likely to experience DVT on a long plane trip than during labour.
Monitoring during labour is not in and of itself a bad thing. Some babies experience distress and in order to try to ensure a good outcome for all, monitoring can keep track of how the baby is doing, which can prevent unnecessary cs's. With DD1 I was monitored because there was meconium present when my eaters broke and her heartbeat was fluctuating in response to my contractions (this was hours before the epidural, when I was still in my room) and so I was already being monitored by the time I had the epidural. No harm done.
In the context of the mention of uterine rupture (a very, very rare event and not one usually associated with epidurals), monitoring is always done for a VBAC, which is the main condition associated with uterine rupture. Other circumstances associated with uterine rupture are very difficult forceps deliveries or difficult manual removal of the placenta, external cephalic version or some other issue like a car accident. The overall risk of uterine rupture is miniscule however.
90% of uterine ruptures occur at the site of a previous SC scar or a scar from any other uterine surgery. Even at this high association with presence of scars, if you're a good candidate for a VBAC, your risk of a rupture is about 1%. Again, the monitoring is there to ensure prompt action can be taken if indications are that the baby is in distress. Uterine rupture occurs in 1 out of 15,000 pregnancies. I am gobsmacked to see it referred to as some sort of routine risk associated with epidurals. It is a very, very rare occurrence even among women at high risk (and the risk factors do not include epidurals). at the scaremongering here.
'Chance of hyperstimulation, distressing baby and causing a bradycardia (emergency section) or even a ruptured uterus(maternal and baby death potentially)'
Please do not say "chance" without also stating that this "chance" is very, very slight indeed.
I think Alimat was referring to use of syntocinon when talking about ruptured uteruses. So perhaps more a risk of using syntocinon to augment labour because of a potential slowing of things due to the epidural rather than a direct risk related to the epidural itself.
I would think that too.
Labour frequently slows down with an epidural, hence more likely to need syntocinon and all the accompanying risks.
Yes it is hard to give all pros and cons for ANYTHING. Some aneasthetists require a consent form for an epidural. I don't blame them because of potential complaints afterwards of "I never knew it would XYZ" (trauma as detailed by above posts).
erm.....did i say it was routine...can you highlight the bit where I stated it was routine please?
Do you not want to be told of it...put your head in the sand...lalalalalalala - cant hear youuuuu.
Also - can you highlight the bit where I said an epidural was the riskiest???
When you sign your consent form for a section or any operation you are told of EVERY potential risk - generally none of which i have seen thank God. Why not for an epidural
As far as DVT risk - you are wrong - more and more women are prescribed a low molecular weight heparin following labour to prevent this. If you have read the causes for maternal death in the CEMACH report then you will already know this is the highest reason for maternal death. It is a BIG concern for the health service otherwise they wouldnt prescribe it - its very expensive and we all know the NHS wouldnt waste money on something that wasnt a 'concern'
where I work, if youre a smoker and your labour is longer than 12 hours - then youre prescribed it - its thats big a cause for concern!!!
Also thank God we are a bit more educated than just looking at the grimace on a womans face to tell how much pain she is in. bloody hell - if only it were than easy. CTG is crap at telling you about contractions - its tells us if youre having one or not - palpation of the abdomin tells us far more.
The monitoring of the contractions is for us to know what the fetal heart is doing in relation to contractions - does it decelerate during or after - how long - is it a reassuring decel or non-reassuring.
CTGs are not used lightly as they pick up ominous signs that may or may not be a cause for concern - more often than not, they are of no concern, but the only way to tell is by taking a fetal blood sample - not pleasant in labour and very worrying for parents.
There are lots of reasons why women are monitored - not just for epidural, but if possible we try not to.
Again there is lots of reseach saying how many false positives there are with CTG - ie - saying there is a problem when there is not
Im takling you are of American origin when you talk about doctors preferring you to lie on your back.
Midwives dont want you to lie on your back and be subservient. We can examine women in all sorts of positions!!
She's Irish, Alimat. Is it okay for Irish to disagree with you?
'Do you not want to be told of it...put your head in the sand..'
I already knew of it because I'm an educated, intelligent person who really doesn't need harridan healthcare providers on a power trip deciding what is best for me and my body at a time when I feel I'm in great enough pain to need epidural pain relief, which was the entire point of the OP - that women are not listened to by midwives all too often.
And your rants are pretty much proving her point.
'Midwives dont want you to lie on your back and be subservient. '
I wanted to lie on my back and have epidural pain relief. I couldn't care less if that's not what the midwife wanted, it's not about what she wants.
Is it that hard to understand, not all women experience pain the same way and some want regional pain relief?
but mathanxiety is proving she isnt educated saying things like monitoring is fine and no problem. And midwives use the 'grimace' technique to work out strenth of contractions.
..and flying on a plane is a bigger risk for DVT.
Ive just worked out what it costs the NHS to prescribe the course of heparin injections for someone who requires it for 6 weeks (alot of women) £995 per/ person. That is not done lightly
At no point ANYWHERE have i said I would refuse to get anyone an epidural if they asked me. As I said - I always phone up and if there is a problem i inform the woman.
My 'rants' are because there is so much ill-informed info on this thread that i couldnt hold back anymore.
An ill-informed woman in labour is terrible - you need all the facts - not fiction.
(Someone much higher up the thread mentioned getting an episiotomy without anaesthetic and with scissors - shock horror, not with a scalpel. Can you imagine the devastation caused by a scalpel cutting through a perineum straight onto a baby's head - that why we use scissors. And EVERY one I have done or seen , is performed with local)
If people hate midwives so much, then i suggest they look into freebirthing
I guessed she was american by using the the phrase 'individual doctors' - who deliver in USA - its midwives who examine and deliver in the UK
Also the use of acetaminophen - again an american term, im guessing she means paracetamol
and I expected her to disagree with me
Well then, it's probably best not to make such assumptions then. Canadians also use such terms.
And the poster is Irish.
'And EVERY one I have done or seen , is performed with local'
Loads of posters on here over the years who've had episiotomies with G&A only, no local.
Alimat, the risk of uterine rupture is 1 in 15,000. You are far more likely to be run over by a bus. By a bus with a specific number.
I am not running around saying lalala with my fingers in my ears. a 1 in 15,000 risk is a tiny risk.
'I fear many people who may have a bad outcome, would then go on to sue the hospital as they werent told that epidurals can cause forceps deliverys and 3rd tears and both faecel and urinary incontinence for the rest of their lives.....'
Epidurals and forceps deliveries -- likelihood please, compared to forceps deliveries without epidurals?
Forceps deliveries that cause lifelong incontinence and 3rd degree tears -- likelihood please, compared to forceps deliveries that do not have these consequences?
You are making giant leaps, huge assumptions, and conflating unrelated risks. The risks you have outlined are incredibly small and not directly related to epidural use.
and its fine if you want to lie flat on your back with an epidural - as long as you know it increases your risk of long labour, malposition, DVT and instrumental delivery.
After we have 'fully informed' you as is in our job description - you can do what you want.
If we dont do that - we would be stuck off and lose our jobs
Sometimes there just isn't the time to infiltrate with local anaesthetic and wait for it to take effect sometimes that babies heartrate is a deafening thud of less than 60bpm, sometimes we're terrified that the episiotomy isn't going to do the trick and we're going to have a dead baby on our hands. Other times midwives just get it wrong. Midwives are human. Yes we listen to our clients but sometimes it is helpful if that is a two way street.
As for lying flat on your back, great, that is what you want to do, we're trained to recognise though that particular position can impair not only the normal birthing process but venous return, leaving you feeling faint and not quite right. We have to tell you this stuff and recommend something else. If you choose not to take this advice, fine but we have to tell you. not to do so would be negligent.
then if women really have have has episiotomies without a local anaesthetic - they should complain. That is against guidelines and policies.
As i said - I have never seen one, and have never heard of one either. I do know that women are in second stage and very distressed and scared. The routine is - one contraction - use lignocaine. Next contraction cut and baby out.
Can you show me the evidence that states epidural use does not cause higher instrumental rates?
Alimat 1 - you quoted from the Cochrane review but that study was looking at epidurals as far back as the 1980s!!!!
You can't even remotely compare the lighter epidurals of today with them.
Here are some recent studies:
"This investigation shows no clear association between epidural use and caesarean section or instrumental delivery, indicating that there is no reason to restrict the epidural rate to improve obstetric outcome." Swedish study 2006
"Our study demonstrated no increase in the rate of operative deliveries in a population that suddenly received access to on-request labor epidurals." (Jacksonville - US)
More importantly this:
"Patients who received epidural analgesia in labour were more likely to consider their experience as favourable (85%) compared to those who went through labour without such analgesia (26%) (2007)
The basic problem I think that women attracted to midwifery as a profession tend to have very passionate views about intervention free childbirth and it means midwives being being unable to understand people like expat.
Loved your last post expat So short but so true!
this is the list of refernces used for the cochrane review
http://www.ncbi.nlm.nih.gov/pubmed?Db=pubmed&DbFro m=pubmed&Cmd=Link&LinkName=pubmed_pubmed&IdsFromRe sult=10796196
how dare anyone judge me as to what views I have on what labour 'I think women should have'
You do not know me, my history or my practice.
I said if expat wanted to lie on her back - thats fine by me. Do you not expect me to inform people of risks and benefits - just keep them in the dark?
The OP asks why she didnt get an epidural - it has been mentioned several times that anaesthetists are often busy in theatre with an emergency, yet it has turned into a 'lets hate and judge all midwives' thread
It's also worth noting that not all units use the newer 'mobile' epidurals. I know of none in my region. We still use a much heavier denser block. I guess our anaesthetists are sticking to what they know. When I hear of women walking to the toilet etc with an epidural in situ I'm amazed. In a good way. I'm sure those epidurals do have less impact on instrumental/section rates. Unfortunately as I said they are not necessarily used widely and until they are the risks that arise from epidural use will continue to be those quoted above in the cochrane review.
Monitoring is fine. What are the risks of monitoring vs. not monitoring? How many babies and mothers died before the age of monitoring, from conditions that would be detected by monitors and saved if doctors or midwives could have 'seen' what was happening and taken action in time? My great grandmother for one, and her second child.
I am educated enough to know the difference between a very tiny risk and a realistic risk, something you seem incapable of. There are risks and there are risks. On the whole, labouring on your back is not going to kill you or your baby or cause even small problems for either one of you. On the whole, walking around during labour is not going to kill you or cause problems for you or the baby. One the whole, having an epidural is not going to kill you or cause even small problems for you or your baby. On the whole, not having an epidural during labour is not going to kill you or cause harm to your baby. (It may leave you shaken to the core and at higher risk of PND later though)
It simply is not that much of a terrible, risky thing to have an epidural.
The grimace technique is something that belongs in the middle ages. My mum's cousin was a community midwife in rural Ireland many decades ago and delivered thousands of babies at home in the little farmhouses in her district. Some women were conditioned to make light of labour pains back in her day, and they may still be in certain cultures. Some women she encountered were completely unaware of what labour would be like and were hysterical when she tried monitoring them. Pain is highly subjective and physical responses to it are also highly individual. Mum's cousin 'lost' babies that could have been saved if there had been more objective monitoring, and she was a good MW, well trained, state of the art for her day. The use of objective monitoring is far more effective.
I am Irish, and delivered my babies in the US. Of the women I know who have had babies in Ireland and the UK, about half were attended by doctors for various reasons. I was attended by a MW for one delivery, actually the one with the most potential for complication due to my age at the time and gestational diabetes.
Heparin is used before general surgery for many patients who are at risk for blood clots and also for certain heart, blood vessel and lung conditions, not just for women after delivery. It's also used in NICUs to prevent clotting in IV tubes. Do you begrudge the other patients that £££ course of Heparin or whatever they need their conditions or for clot prevention? (The idea that the cost of medicine should be taken into account when deciding best practices is actually quite horrible). And how often is Heparin used after delivery, for six weeks? In half of patients? Two or three out of 10,000?
Only 1 - 2 out of every 1000 women will develop a venous thromboembolism, and the number of women who have a pulmonary embolism as a result of VTE is smaller still. Here are the risk factors for VTE during pregnancy:
* you have had a previous VTE
* you are very overweight
* you are over 35 years old
* you are immobile for long periods of time, for example after an operation
* you have pre-eclampsia
* you are recovering from a caesarean delivery
* you have another medical condition that predisposes you to thrombosis, such as active inflammatory bowel disease or some chronic kidney problems.
During pregnancy itself, blood flow to the legs is markedly reduced from about 16 weeks, with the minimum blood flow occurring at term. Pregnancy itself therefore, and not epidurals or lying on your back during labour for the sake of monitoring, often necessitates heparin use. And again, it is a very, very small proportion of the already small number of women women with VTE who will suffer a pulmonary embolism. It is a very rare occurrence therefore and not the huge problem that is bankrupting the NHS that you seem to suggest it is.
WRT uterine rupture 'can you highlight the bit where I stated it was routine please?'
You neglected to mention that the risk of uterine rupture is 1 in 15,000. You stated there was a 'chance', but didn't say what that chance was. You stated there was a 'chance' in the same sentence where other risks were casually mentioned (again without any statistics)... 'Also - needing contractions stimulated - oxytocin drip - baby often becomes distressed. Chance of hyperstimulation, distressing baby and causing a bradycardia (emergency section) or even a ruptured uterus( maternal and baby death potentially)' If you are going to mention a whole bunch of possible complications all in the one breath you need to mention the real life likelihood of all these potential risks, preferably vs. the risks of no intervention at all, and you need to mention the statistics.
I was forced to lie on my back and had my feet put in stirrups against my wishes.
I wanted to give birth kneeling upright on the bed, but this did not suit the midwife.
The reason that this has turned into a midwife bashing thread is that invidual posters have had bad experiences during THEIR births.
No one is saying that all midwives are uncaring and deeply unsympathetic to labouring womens' pains. This said though, some of the things I have read on this thread lead me to believe that my initial assumptions were right. Some Midwives are against epidurals and will do everything they can to prevent them. It's interesting that it's mainly been the midwives on this thread that have felt the need to scaremonger about epidurals, when most of us are already well aware of the (small) risks involved.
Alimat - I don't think anyone is judging you at all.
There is a real communication problem here - if grown, intelligent women posting on mw cannot get there message across how much more difficult is it going to be for people in labour?
There is a gulf between midwives and many of the general public. There was some male midwife claiming women didn't need epidurals and the internet nearly crashed with women screaming to rip his balls off Quite a lot of midwives were agreeing with him. (I'm not saying you would have done). There is a real problem with the midwifery profession not being on the same wave length as a lot of the women they care for. I think it is certainly in tune with the natural birth types but not everyone buys into that.
Isn't MW a good place to see if we can build some bridges and understand why that gulf exists?
The OP was not given a reason for not getting an epidural other than she was not 4cm dilated.
She asked six times yet no one would examine her again until it was too late for one.
'I asked for an epidural no less than 6 times during this period and was given the excuse that I needed to be 4 cm before I could get one.
Suprise, Suprise, no one would examine me to check how dilated I was and so then it became 'too late' to give me once I had reached 10 cm.
Despite Nice guidelines saying that no woman should be refused an epidural (even in the latent first stage!) apparently the hospital have their own policy.'
She felt she was not listened to and her needs were ignored.
No mention of anaesthetists being busy in the OP.
But plenty of people on here who were also not listened to and whose needs were ignored.
I think (and this is just a guess tbh) with regards to the OP, a vaginal examination is an invasive procedure, it can increase the risk of infection if the waters have gone by introducing foreign bodies to the vagina. We try and limit vaginal examinations wherever possible, normal protocol tends to state that we offer vaginal examinations four hourly, less if we have clinical indication to do so. It may be that the OP had a midwife who stuck rigidly to the guidelines and labour moved relatively quickly thus rendering the clinical need for another examination unecessary.
Maternal request can be an indication for a VE but it does have to be balanced against other factors.
Maybe the question is why 'clinical indication' does not seem to include horrible pain that a patient does not feel she can endure?
And don't you use gloves? Surely infection can be treated with ABs? Doesn't the doctor's gloved hands have contact with the uterus if there's a CS? If another factor is simply that not enough time has elapsed since the last VE, and the result of waiting is that labour will progress beyond the point where an epidural can be administered or that a woman will have to endure much more horrible pain than she would if an exam right there on the spot indicated she had reached the magic number or would by the time the anesthesiologist arrived, why not balance the infection risk against the much greater risk of horrible pain? Horrible pain is very important. It is a factor that should be taken into account surely?
There is an attitude that the pain is not all that relevant here while a multitude of other factors is; to the labouring woman it feels as if she is being treated as a mere vessel, slab of meat, etc.
You have correctly identified the issue of MWs sticking rigidly to their protocols though. How different would the situation be if the MWs actually felt they could make decisions and be more responsive to their patients? Again, it's only in the area of childbirth where the (100% female) patients are treated primarily (and for the purposes of saving money imo) by professionals who do not have the same education as doctors or the same decision-making powers, or the same status in the medical hierarchy.
And surely the risk of introducing infection into the vagina is the same no matter whether the VE is performed two hours or four hours apart? How does the interval affect the risk of introducing infection?
So poor OP got refused an epidural because she wasn't 4cm, but as she's not 'supposed' to be examined nobody can tell if she's dilated any more? Sounds like a lose-lose situation for her.
'Tis "Catch 22 -- The Maternity Ward".
to clear a few things up (as the OP )
I was admitted to hospital at 12 midnight and examined found to be 2cm - asked for epidura; - ignored.
1am - asked for epidural, told that I had to be 4cm
2am - begged to be examined, so that I could have my epidural, told that I had to be 4cm vbut they couldn't examine me until 4am due to protocol saying VE's no more than every 4 hours
3am, begged for epidural, told the same
4AM, begged for epidural, examined, found to be 10cm, was told that I was lucky that I had done it all by myself and ready to push now (despite no urges to push)
Baby not delivered till 7am, IMO in most part due to the fact that I was terrified of having to do it all on just G&A
mathanxiety, if you are VEing every two hours as opposed to every four hours surely it stands to reason that he risk of infection is greater the more examinations performed?
I take great offence at this remark:
"Again, it's only in the area of childbirth where the (100% female) patients are treated primarily (and for the purposes of saving money imo) by professionals who do not have the same education as doctors or the same decision-making powers, or the same status in the medical hierarchy."
Midwives spend 3 years studying, pregnancy, childbirth and the postnatal period in its entirety. 3 years on one subject. No doctor in the world gets that.
I'm so sad at how midwives are perceived.
DrMcDreamy we can only go by our own experiences. Some women feel really let down by midwives, and getting defensive is not going to address that.
FWIW I spent nearly 2 weeks in the maternity ward with placenta previa, and met a lot of midwives as a result. Some of them were lovely. Some were not. The lady who attended my own caesarean was fantastic. There are some who, if I ever go back and see them again, I will order out of the door. We are not denigrating a whole profession, but some of them are leaving a lot to be desired, and it needs to be addressed somehow.
They say whatever they want to suit them IMO.
When I was in labour with DC2 I had indie midwife but hospital birth (only in because was a VBAC). Had same experience as a lot of people on here - for 12 hours I was apparently "4 cm". I had 3 exams during this time. At the end of 12 hours I started screaming for an epidural because it got so painful and then 30 mins later the baby's head started moving down.
They basically lied because they didn't have a free delivery suite and I was meant to be on continuous monitoring for the whole labour because it was a VBAC. Never saw a continuous monitor or a delivery suite.
Sorry only just read the last page. Of course if you are the only one on the ward that day you will probably get the MW with you for the whole labour (except unless you are in the hospital where one born is recorded in which case she will be having a cup of tea and biscuits).
Sorry only just read the last page. Of course if you are the only one on the ward that day you will probably get the MW with you for the whole labour (except unless you are in the hospital where one born is recorded in which case she will be having a cup of tea and biscuits).
Yeah that programme is doing nothing for the midwifery profession.
Aaaah I have just sat and read all 12 pages after being pointed to this thread by a regular MN'er who thought I may (as a Midwife) find it interesting.
It has made me feel a whole load of emotions from sadness that some of you have had crap times, to Exasperation of some
know it all posters who seem hell bent on blaming the MW for everything. My BP is a little high too
Anyhow I just want to say for now, as someone else said - Midwives are the experts on normal childbirth. If a woman is under shared care then of course she has her care led by a Obstetrician alongside of a MW. The MW will try and keep everything as normal as possible within sometimes some really difficult circumstances. Hmmm I am rambling now but it seems some of you look at Drs like God like figures. Aneasthesists are usually available in our unit, yet sometimes women do have to wait. They may be with another woman, or in main theatres with car crash victims etc. It happens sometimes, and my tummy sinks when I tell women, as its a shoot the messenger worry.
Also someone said right at the beginning about breaking a leg or having a appendicectomy - you get LOADS of pain relief. Uh yeh, course it isnt natural to break your leg or have abdo surgery is it? Childbirth is a normal physiological process and hurts. It is meant to, and of course you can have relief from that pain - but if it isnt there asap for whatever reason then you have to go with other coping strategies/options until it does. I'd like to think a MW could help pacify a woman with other techniques until she can get her requested pain releif.
Whoever said that "Again, it's only in the area of childbirth where the (100% female) patients are treated primarily (and for the purposes of saving money imo) by professionals who do not have the same education as doctors or the same decision-making powers, or the same status in the medical hierarchy"
I would like to see any other profession where you stay on all the time after your shift so as not to leave a ward of women needing breastfeeding help/woman needing post op care/woman turns up in labour and there are no other staff to cover. Or a woman asks you to stay on after your shift and look after her, I have done this lots. Midwifery is more than a job.
I have nurse friends who once there shift ends they go. Simple as. Short staff? Call the site manager who will call in agency/bank staff. We would never have that luxury in Midwifery, we have on call systems to cover our shortstaff issues.
My nurse friends laugh at this. Last week a colleague did a late shift and was on call from 10pm - 6am, and had to stay on. A lot of the time you forget you have a bladder as you dont get time to pee, let alone grab drink/snack.
Ok I have just moaned about how crap it is and totally gone off the point, so I would liek to say I LOVE my job and would never do anything else. I am exasperated at the system, and when you come on sites like this and see the MW bashing it hurts. It makes me feel sad.
I also would like to say I really do think some of you sound like you would really benefit from Birth Discussion - that probably sounds patronising. It isnt meant to be. Just picking up on vibe.
Runs for cover
'I have nurse friends who once there shift ends they go. Simple as. Short staff? Call the site manager who will call in agency/bank staff. We would never have that luxury in Midwifery, we have on call systems to cover our shortstaff issues.'
I have plenty of nurse friends who stay on after their shift to do paperwork.
Getting wisdom teeth is a natural physiological process, too, but you're given pain relief when those come out and cause problems.
Dying is a natural physiological process, and it can really hurt, but no one expects dying people to just cope because it's a natural thing or wait hours and hours for pain relief (or maybe they do, considering how many posters on the assisted suicide posted about their experiences watching their loved ones die in agony).
Only in childbirth are you expected to just cope and patronised, bullied, made to feel weak or guilty and belittled if you don't 'cope' according to someone else's (a total stranger's) standards.
Maybe if some of these women had got the pain relief that they wanted when they wanted it they wouldn't need to be thought of as would 'benefit from Birth Discussion'.
Dying in agony? Well if they are in agony then surely they are in some kind of pain that has caused that agony no? So it becomes not physiological.
As for Wisdom teeth, I still have mine, does everyone always have them out? No of course not! It all depends on how they are coming through and if there is space etc. I wont go on about wisdom teeth though as its off the subject and I have left my old job as a hygienist behind a long time ago
Of course expat you seem to have a answer for everything, especially when a MW has tried to explain how life can be sometimes.
Yeh nurses do stay on and do paperwork. I didnt say all nurses did I?
I would say if a woman is in your words "patronised, bullied, made to feel weak or guilty and belittled if you don't 'cope' according to someone else's (a total stranger's) standards" and youa re implying of course its those pesky
lazy arse good for nothing bitter midwives doing the aforementioned things, then I say they are probably needing to give up the job. I have met some dinosaur Midwives in the past, and can see how some of these things may occur. I think it is less common than good care given. Obviously talking about how good your MW is doesnt get the headlines does it?
The alst poster who mentioned birth discussion - well no of course! But sometimes shit happens and in childbirth things can go wrong quickly, I have witnessed it myself as a Mum as well as in my job. And can honestly say I highly recommend it. It can bury a lot of bitteness, and negative emotions that some women carry with them. Regardless of how it has arisen.
'Dying in agony? Well if they are in agony then surely they are in some kind of pain that has caused that agony no? So it becomes not physiological.'
Ah, okay, so cancer pain is not physiological then.
Dying is just as natural a process as childbirth and for many, it hurts very much.
But most people would find it barbaric to expect someone who is undergoing the natural physiological process of dying to just cope, wait for hours, that's how it is.
You seem to have a very defensive answer for everything as well, seem to miss the point of the OP entirely, and again, basically illustrate the point the OP was trying to make, which is that it's not uncommon for women to not be listened to and their needs ignored by midwives.
Many of the 292 posts on here are from such women. But again, it's midwife-bashing when they share their experiences.
So here, have some more rope. You're doing fine.
"The alst poster who mentioned birth discussion - well no of course! But sometimes shit happens and in childbirth things can go wrong quickly, I have witnessed it myself as a Mum as well as in my job. And can honestly say I highly recommend it. It can bury a lot of bitteness, and negative emotions that some women carry with them. Regardless of how it has arisen."
For most women on this thread 'it' has arisen because they were denied the epidural they requested which if they had of received it would have meant that for them 'shit' happening would have been a lot more pleasant and bearable.
Cancer ISNT physiological.. Thats why the sufferers have syringe drivers/adequate pain relief in situ.
I am not defensive, I was trying to illustrate how it can be from the other side. The same as if there was a thread by Midwives moaning about women in labour. Would you not try and put your point across?
I try and do MY best as a MW, I want women to walk away saying they had a great experience of childbirth, regardless of mode of birth etc. I want them to say hey DHTPHTG was really suppoertive and listened didnt she. I want the best for the women whatever they want, I really do. I feel demoralised reading this, and sad as I said before that some women have had a shit time.
Yeh I will bow out, as
you some people do not like having their opinions challenged. I really dislike the term about being given rope too, there are better terms you can use and very insensitive too, especially to someone who has just lost a family member via this form of suicide.
"The last poster who mentioned birth discussion - well no of course! But sometimes shit happens and in childbirth things can go wrong quickly, I have witnessed it myself as a Mum as well as in my job. And can honestly say I highly recommend it. It can bury a lot of bitteness, and negative emotions that some women carry with them. Regardless of how it has arisen."
For most women on this thread 'it' has arisen because they were denied the epidural they requested which if they had of received it would have meant that for them 'shit' happening would have been a lot more pleasant and bearable.
So having birth discussion, saying how they felt, getting an apology isnt going to help? it may help towards closure. I personally found BD very very useful, and it closed some doors and answered a lot of questions.
Taking out wisdom teeth is not a 'natural physiological process'. But growing them is! Do you expect pain relief for the whole growing period then???
And just because you've had 5 children does not make you an expert in childbirth. How many labouring women have you seen?? And cared for??
As I've said before, way up this thread, sometimes putting an epidural in and it becoming effective would take a much longer time than actually having the baby. Particularly for a multip.
So I guess you could say that yes, I have fobbed women off when they are screaming for an epidural at 9cm. As a labouring woman, having a venflon put in, trying to sit extremely still, curled in a ball, whilst someone has a rather long needle in your spine is bloody difficult in the later stages of labour. And even if it goes in easily, the drugs need to take effect. And by the time this has all happened, the baby's head is usually almost out anyway!
Don't get me wrong, the above scenario would be totally wrong for a lady in the earlier stages of labour, particularly a primip, who is finding the pain hard to manage. In this case, an epidural should, if requested, be given asap.
As long as there is an anaesthetist free!!
I have been looking after one woman where her long awaited epidural was just about to be given. The anaesthetist had gowned up and then came the knock on the door. "cord prolapse, room 3, crash section'. He was out of that room in an instant. The lady I had to look after had to wait. Was not coping, in agony, and quite possibly has the problems of PTSD some of you have experienced. And that is horrible, awful for the woman and I know from watching her have to cope with more pain, extremely distressing for her and her partner.
But the other baby would have died if the anaesthetist did not go.
It's shit but it happens.
I know this next comment won't go down too well, but as a midwife and a mother of four (and yes I have laboured with and without an epidural) -
Childbirth hurts!! Did nobody ever tell you??
"Childbirth hurts!! Did nobody ever tell you??"
Missing the whole point of the thread - IT DOESN'T HAVE TO!!!
If you are VEing every two hours with the same pair of gloves you used on the last patient, then yes the risk of infection is higher. But with the usual hygiene measures in place, what is the real risk of VEing every two hours or two hours after the last one? You're going to have to do a VE right when the woman thinks she feels the urge to push even if it's been less than 4 hours since the last one anyway. If there was any really unacceptably high risk associated with VEs then they wouldn't be done at all.
For a lot of labours you might only get to do 2 VEs anyway so you're not going to exponentially increase the risk of infection by doing them two or three hours apart. What's the average length of labour and how long is the average woman in the hospital before giving birth? Long enough to do two VE's fours apart?
Again, you don't seem to be prioritising the suffering of the labouring woman and the issue of pain relief.
Well, it does have to to a certain degree doesn't it, unless you have an epidural before labour even starts.
Or just have one in place at conception. Problem solved
'I try and do MY best as a MW, I want women to walk away saying they had a great experience of childbirth, regardless of mode of birth etc. I want them to say hey DHTPHTG was really suppoertive and listened didnt she. I want the best for the women whatever they want, I really do. I feel demoralised reading this, and sad as I said before that some women have had a shit time.'
But still not acknowledging that women don't walk away saying they had a great experience if their experiences of pain are not listened to by their healthcare professional.
That is what this thread is about!
'Yeh I will bow out, as you some people do not like having their opinions challenged. I really dislike the term about being given rope too, there are better terms you can use and very insensitive too, especially to someone who has just lost a family member via this form of suicide.
Please do then, I've tried to commit suicide myself in the past.
If there are better terms I could use, well, they didn't come to mind.
So sue me.
Funny, all the midwives' comments on here just to go to illustrate so many of the points made on here by women on here.
So caring, so constructive about other peoples' pain and the relief for it they felt they needed.
I was one of those women who walked away feeling demoralised, I know not ALL women do walk away feeling euphoric about birth. I havent erked away from that have I? I am merely trying to say this is the care I give, and how I hope the majority of MW give.
This may have been asked but:
If the Aneas is tied up in theatre, or cant come pronto - who's fault is that?
Why dont some of you channel all of this negativity into campaigning towards making things better in the future? genuine question. Only this week there was news of Midwifery places being cut. This will just add to the already over stretched staffing levels and these problems multiplying.
Too many questions that if i answer i will be deemed wrong and judgmental and inconsiderate and uncaring.
However - your last post you say we HAVE to do a VE when the woman thinks she feels the urge to push.
No we dont. Sometimes we do, sometimes we dont - there are far more other signs to look out for other than feeling pushy.
As for just giving women antibiotics for infection - are you for real? you really think its ok to give women antibiotics in labour and to their baby, just so we can VE more often.
There is no average length for labour - once labour is established - strong, long contractions 3-4:10, shortening of the cervix, cervix being around 3-4cm dilated, then in primips we are happy with half a cm an hour. multips 1cm an hour.
But as there is still a waiting list for the Mystic Midwives Crystal Ball, everyone is different -it can be much longer or much much shorter.
It is not the gloves!! It is the risk of ascending infection, infection present in the vagina getting to the baby, especially if the waters have gone. Sterile gloves or not!!
And yes, the risk is small, but it is still there!
Oh, but don't worry about that, lets just give antibiotics out like smarties to cover that little problem.
'I would like to see any other profession where you stay on all the time after your shift so as not to leave a ward of women needing breastfeeding help/woman needing post op care/woman turns up in labour and there are no other staff to cover. Or a woman asks you to stay on after your shift and look after her, I have done this lots. Midwifery is more than a job.
I have nurse friends who once there shift ends they go. Simple as. Short staff? Call the site manager who will call in agency/bank staff. We would never have that luxury in Midwifery, we have on call systems to cover our shortstaff issues.'
And this horrible example of mismanagement simply would not happen if men were the patients or if there were more men represented in the midwifery profession. Shortstaffing happens when the medical needs, never mind the pain relief or breastfeeding needs of a whole class of patients are dismissed -- because childbirth is a physiological process maybe? Or maybe because women are invisible and their healthcare needs associated with childbirth are not considered a priority compared to the trials of motorcycle crash victims for instance? Or because the work of their mainly female midwives is taken for granted and not seen as a professional service because it is rendered by women in the main, for women?
The horrible mismanagement is equally visible when the reason given for not giving a labouring woman an epidural is that the very scarce on the ground anesthesiologists are elsewhere; why are there not enough anesthesiologists? And what the heck happens when there are two prolapsed cords at the same time? Who gets the anesthesiologist then? Gross mismanagement = not having enough qualified personnel available. More people should sue.
The gloves remark was tongue in cheek: yes I know it's not the flipping gloves -- But yes, let's give out antibiotics when women get an infection. What a novel idea! They don't have to be handed out like Smarties, just in the appropriate dose, for the appropriate infection. They kill infections in women as well as in men. They have been proved effective for decades. Is it preferable to avoid the very small risk of infection or have a woman endure agonising pain? What is your priority here? Avoid a small risk or prevent a huge pain?
The average epidural takes effect in 20 minutes, Poppyella.
Just read whole thread <quits ttc first child>
So why are there not more anaesthetists on maternity wards? Is this a silly question?
And if I am clear from the very start that I want an epidural and my DH is there with me fighting my corner, how're my chances?
so what infection would you treat?
How do you know the woman has an infection - on postnatal ward when she is pyrexic, at home when the baby dies of GBS?
Infections dont always show up straight away - they incubate, possibly showing up well after delivery.
Overuse of abx is real - MRSA proves that.
Its not such an easy option as just giving woman antibiotics.
If you have 2 emergencies at the same time you shit yourself! Really - its happens and its horrendous. I lose a few years of my life when it does happen.
Its not just anaesthetists, its doctors, scrub teams, ODPs, midwives that you need for each emergency.
I love my job, but at times i despair of how short staffed we are.Its not easy, its not safe and its not fair on women to have one midwife running between two or three rooms trying to offer her best to each family.
Unfortunately, midwives are the messengers and regularly get shot
I'm just wondering if any of you on here who have written of your experiences of dreadful treatment at the hands of midwives have contacted the maternity units and made your grievances known?
The thing is that nothing can prepare you for the pain of childbirth. And it's often shocking and overwhelming, even when the birth itself goes smoothly. Which of course, it often doesn't. Which makes the pain and shock all the worse, and sometimes truly physically and psychologically damaging.
And 'the system' will continue to be railed against for as long as it is perceived to be shrugging its shoulders and going 'yeh, duh... childbirth hurts, innit. What do you expect.'.
'The system' falls down badly when women first go into labour, and are left alone and ignored until 'the system' deems that they are far enough along be 'processed'. Then, it seems to be pot luck as to whether you are looked after well or not. During my pregnancy and while giving birth, I came into contact with perhaps 15 or 20 midwives, and one registrar. Some were great, some not.
I'm not interested in midwife bashing. The midwife who attended my labour was great, except for a bit of gentle fobbing off with regard to epidural. Which as it turned out, it seems I would have been better off having, as the registrar complained about me having insufficient anasthesia whilst she tried to stitch my fanjo back together after ventouse (I was unhelpfully leaping and yowling every time she stuck the needle in).
Oh and btw I encountered at least two midwives who used the grimace technique. The one who told me I wasn't in labour when I was (not enough cms grimaced, obviously), and even one at a pre-natal appt who claimed to be able to diagnose labour over the phone by the sound of a woman's voice . So they are around.
This is such an interesting thread - expat and mathanzxiety I pretty much agree with your every word. The midwives are not painting themselves in a good light at all, all patronising 'there, there, you don't know what you are talking about, I am the expert and I am right'.
Unrelated by also colouring my opinion is having a gynae operation last week and being refused pain relief post op, snarled and sneered at whislt i was crying in pain at 5am. I was ttc but tbh, after that, I am seriously thinking of stopping. The feeling of being disregarded and disbelieved about my own pain is so raw in my head at the moment. Normally I can stand up for myself - however, after 3 nights with no sleep, in pain from the op and feeling all at sea - I was NOT in a position to stand up for myself and I felt hugely let down by the HCPs I saw - a similar vulnerability you feel in labour.
I am tired of HCPs trotting out the same old 'the body is beautifully designed for childbirth'. No it is not. It is a series of compromises to ensure the continuation of the species with, historically, a fairly high attrition rate. In the 21st century we have modern methods of pain control, yet we are seeming to harken back to some halcyon day of natural childbirth which didn't, imo, exist.
"Which as it turned out, it seems I would have been better off having, as the registrar complained about me having insufficient anasthesia whilst she tried to stitch my fanjo back together after ventouse (I was unhelpfully leaping and yowling every time she stuck the needle in)."
So the registrar didn't stop and offer you effective anaesthesia? She just carried on with her assault?
Err not the midwife to blame then its the doctor, she's carrying out the ventouse and subsequent suturing.
I had had local anaesthetic, it just wasn't doing much. She stopped to apply more (I think, it was pretty hazy by that point) but seemed to be in a bit of a rush to be elsewhere.
When the midwife came back in after the stitching, she looked in horror at my fanjo, and said 'god, she's left you in a right mess' - whether that was because the registrar had to dash off elsewhere I can only guess. Probably, as I do recall that she had been quite hard to get hold of when DD went into distress.
I have been a midwife for almost fifteen years and many, many epidurals take longer than 20 mins to be effective. My own included. I have seen it with my own eyes!!
How many women have you looked after in labour math? How many labouring women have you actually seen? Often the pain is reduced during that 20 mins but the woman may also need a top up of bupivicaine for it to be fully effective (particularly to get rid of the 'pressure' pain felt in the later part of labour). Which needs to be given by an anaesthetist who is probably off in another room by then administering an epidural to someone else! So the woman has to wait.
And by this time, in some circumstances the baby would be born before the epidural works. Again, seen it happen - frequently!
During this thread math, you say that lots of things in obstetrics have a 'very small risk' - DVT, uterine rupture, infection (and what on earth have men got to do with that??) - oh, but as long as epidurals are in place, that's fine, we'll just treat with fragmin, antibiotics, crash sections, it's not a problem. So long as she has an epidural.
Two prolapsed cords - the one who prolapsed first would get the CS first. Unless of course someone has a magic wand and can suddenly make an anaesthetist appear.
So post-op patients, men and women alike, shouldn't be given routine ABs? Because MRSA exists? They are also routinely discharged before any infection might show up. If someone has a real bacterial infection that presents a real risk, then ABS are the way to treat it. You can't just fold your arms and say they're overused globally and therefore we're not going to use them any more. They do what they're supposed to do the vast majority of times they are appropriately prescribed and properly used. They have saved countless millions of lives.
Presumably women return to their doctor when they have symptoms of infection and get antibiotics at that point? If on the postnatal ward, then nurses and doctors can identify the infection and administer ABs -- no worse place to be sick than in the maternity wing of the hospital with all those staff members busy elsewhere though, so maybe the maternity wing is not the place to have an infection.
How many babies died last year from GBS?
How many women used to die from puerperal fever before ABs and sterile latex gloves?
To seriously say that risk of vaginal infection is a good reason to refuse a VE and an epidural for labour pain is really ridiculous.
mathanxiety I think you'll find the incidence of pueperal infection increased when childbearing moved from home to hospital. Mainly because doctors walked from post mortem to attending labouring woman without washing their hands.
Simplest way to reduce cross infection hand hygiene, prevention is better than cure always
By the way when I say 'the system' I don't mean midwives, I mean all the HCP's you encounter along the way, and the way the system itself is set up and funded.
Oh and GOML - I too get very annoyed when people bang on about women being perfectly designed for childbirth. It's a load of old cock. If we were, there would be no need to go near a hospital, doctor or midwife in the first place.
I particularly like section 1.3
again math - youre confusing and putting words in peoples mouths -
MRSA occurred BECAUSE of overuse of abx, yet you are saying its ok to offer routine use of abx to treat infection that may or may not be there.
You are also saying:
To seriously say that risk of vaginal infection is a good reason to refuse a VE and an epidural for labour pain is really ridiculous
who said that? - you said earlier that infection would not happen during VEs. We said it did. Noone said dont give an epiudural because of it.
re;GBS - a quick scan - in the USA 12,000 infants each year are affected by GBS. Of that 2000 will die.
In the UK 2000 babies will be affected, of these 1 in 10 of them will die
Still ok to offer more VEs?
Nobody said that. A VE is not an 'operation' so you are not 'post op' after a VE. Nobody said ab's don't have their place, of course they do. Nobody said that women shouldn't have ab's when they have symptoms of infection.
And ffs I didn't say that the risk of 'vaginal infection' should be a reason to refuse a VE or an epidural. The infection I was referring to was that to the BABY - ascending infection up the birth canal, such as GBS which I know you know can have horrendous consequences for the baby.
Of course VE's should be done, and not only at a rigid 4 hourly interval, but as and when the midwife sees the need. But oh no, don't worry about the baby or getting a puerperal infection that could hinder you actually caring for your baby - as long as you get a flipping epidural!!
You are totally missing the point. But I really can't be bothered to try and explain it to you any more, you obviously won't understand.
It takes 10 to 30 minutes, on average. It's not a big medical secret.
So a patient might need a top up? So therefore don't give one?
No, you can't predict how quickly a baby will make his appearance -- but again, that is no good reason not to give one surely? You don't know if it's going to take two hours more or six. Epidurals are still given in hospitals where pain management for women in labour is a priority despite the unpredictability of childbirth. It's a question of where your priority lies.
If you are going to insist that every woman in labour gives 'natural' birth a trial and to resist pain medication, then you will find all sorts of silly reasons not to co-operate with a patient's request for an epidural, many here on this thread. If that's what your hospital is about, then patients should be informed before it's too late to take their business elsewhere.
Epidurals were developed with labouring women in mind. The anesthesiology profession and the pharmaceutical industry are well aware of the circumstances of labour and how fast or slowly it can go. Yet they persisted in developing the epidural and in developing techniques associated with it, both for initial administration and in topping up, in monitoring of patients while it's in effect, and in researching the best window for the needle to be inserted -- they need to know how much a woman is dilated; yet another group of professionals is on here questioning the work of the anesthesiologists, making epidurals sound far more risky than they are, and putting up all sorts of really nonsensical objections to the process of administering them at the right time. It makes absolutely no sense unless there's an agenda of making women try birth without pain relief, a political agenda that actually disempowers individual women in the name of empowering them.
The risks I mentioned are small. And you are there to treat/ deal with the prolapsed cords and the crash sections etc., whether they happen after or without epidurals. You are a medical professional and that's your job. And so is pain relief when that relief comes with very, very small risks and great benefits.
"And this horrible example of mismanagement simply would not happen if men were the patients...."
My OH has been waiting for an op for 5 months. The op has been postponed twice. Once because the ward was needed due to the swine flu outbreak.People are always complaining about the dire care they or their loved ones have received in hospital. This is an issue within the whole of the NHS, not just the maternity service. Underfunded and understaffed and it is set to get worse before it gets better.
Oh another thing, the overprescribing of antibiotics causes Clostridium difficile.
I suppose the only way women can get what they need is to join your local MSLC as a user representative and have these discussions with the people who are in charge of your service. Bring all of the arguments that you have laid out here to the table and maybe they will realise that these issues need to be addressed before any other women are let down by the system.
20 minutes to set up and 20 minutes to work = 40 minutes when I went to school
're;GBS - a quick scan - in the USA 12,000 infants each year are affected by GBS. Of that 2000 will die.
In the UK 2000 babies will be affected, of these 1 in 10 of them will die'
And in the US approximately 3890000 babies are born every year. In the UK, 708708.
Bit of a difference in population there.
My last epi took 26 minutes in total from teh time he got going till when I was painfree. I timed it to focus on something.
Are those stats for GBS for all babies or just term babies?
math - i give up - once again you are putting non-sensicle words into our mouths
A fair few of us have tried to explain what we have to discuss with women, and why epidurals are perhaps not without side-effects - information that women are entitled to - to go into labour with the full facts, yet you still say all midwives have an agenda of putting you through the worst possible pain and laugh at you.
FFS - you pick and choose selectivley what you want to spout about - now its the fact that men are entitled to pain relief and women arent and that VEs arent done often enough and antibiotics are fine given out like Smarties.
night night, sleep tight
Maybe it wasn't much of a pain then expat if the test dose alone took care of it.
Routine use of ABs to treat infection that may or may not be there is done in post op wards. I did not advocate using ABs this way, however -- what I said was treat infection once diagnosed. Infection comes with symptoms and can be diagnosed and treated. A former SIL went home with a surgical sponge inside her after delivery, and she lived to tell the tale. An infection is not the worst thing that can happen to you.
Refusing to give a woman a VE on the basis that it might lead to an infection and might lead to getting a Rx for that infection is not going to make MRSA magically vanish. It is just one more silly reason to refuse pain relief to women, because apparently childbirth is a test of character and toughness and ability to endure pain unnecessarily, and not a temporary but very painful circumstance that can be made far more bearable by a simple and low-risk proceedure.
I did not say infection would not happen during a VE. What I said was that the risk is small and using that small risk as a reason not to give a VE that might be used to determine dilation so that an epidural could be given is ridiculous and shows a gross misplacement of priorities. Yes, increased risk of infection was indeed suggested as a reason a MW wouldn't do a VE within a four hour interval.
Why not give the raw number of births in the UK for 2008 and 2009 to show how few babies were affected by GBS?
2008 -- 794,400 live births
2009 -- 790,200 live births
Of this number a mere 2000 were affected by GBS, with 200 fatalities according to your figures. The risk is small.
Thank you for telling me my job. You are so very clever. I really didn't know I had to treat/deal with those things as a midwife.
I didn't say it was a 'big medical secret' at all, just stating facts as they happen in real life. I didn't say top up's wouldn't be given. They are of course given, unless the baby had been born, because that would be pointless wouldn't it.
I have never 'insisted that every woman in labour give natural birth a trial and resist pain relief'. I actually think epidurals are brilliant inventions. And I wouldn't in a million years question the work of anaesthesiologists.
And I am not putting up all sorts of nonsensical objections to the process of administering them AT THE RIGHT TIME. I am however, stating that it is fairly obviously (to an experienced midwife) that if a multip comes in in advanced labour, if she's had normal births last time/s, it is OFTEN the case that the baby would be born before an epidural has a chance to become effective. I have seen it happen - have you?
You are putting words in peoples mouths. Your belief that midwives might have 'an agenda of making women try birth without pain relief' defies belief actually. It is pure nonsense.
Anyway, it can't have been that bad for you otherwise you wouldn't have gone back 5 times so why get quite so het up about it all.
'Maybe it wasn't much of a pain then expat if the test dose alone took care of it.'
Of course, it was all in my mind, I'm sure.
It was 2AM and he said he wanted to go to bed.
It was far more effective than my last one in 2003 in that I felt nada until about 9AM, despite a 2nd degree tear and stitches.
But I'm sure you know exactly what went on, though.
Such superior knowledge as is present on this board.
Another thing, the reason why men get what they want is because they stick together. It's called power in numbers. They also beleive that they are superior, as do many women. Which is why they are paid more, have better career prospects and let's face it, don't stay at home to bring up the kids. For the most time, women do that. But sometimes we women have a lightbulb moment and this lead to women and midwives demonstrating side by side to make child birth better.
I find quite interesting the notion that if a risk is small it's unimportant. Not so if you are the one in however many thousand if affects. A risk may be small but if I we don't tell you about it and you're the unfortunate soul if happens to I'm pretty sure you wouldn't shrug your shoulders and say "ach it was only a tiny risk so I can understand why no one bothered to mention it". I mean hysterectomy is a very small risk at a caesarean section however you can guarantee the surgeon will make sure you're aware that there is the slightest possibility it could happen.
I know nothing for certain expat but at least I'm willing to admit it.
My throw away comment was just that, I thought throw away comment without foundation was the mainstay of this thread and so was just joining in.
Dr McDreamy you say if a risk is small it's not unimportant when you talk about epidurals.
Can I ask you how many women you inform of the risk of 4th degree tear and lifelong faecal incontinence from normal vaginal birth? That is far more common than any of the serious epidrual risks but I have never had a midwife mention it to me.
When you promote VBAC, do you tell women they are eleven times more likely to suffer uterine rupture and more likely that their baby will be brain damaged?
I think a lot of people feel that the risks of 'normal' birth (YUK what a term) are played down but any intervention like epidurals which might cost a bit more money and actually make life a bit better for women has to have every teeny tiny risk spelled out.
Actually I have no problem with spelling out all the risks - as long s you do it for everything and do not just cherry pick
The difference between a 'normal' delivery and something like an epidural is one is going to happen anyway regardless of the risks. By that I mean giving birth is not something we are 'doing' to you. If I give you an epidural I have to tell you the risks of my doing so. You are going to give birth whether I'm there or not, it is a normal physiological response to getting pregnant in the first place.
With regards to VBAC, yes it is discussed that your risk of uterine rupture is indeed raised, which is why at my unit you are given the choice of VBAC or ELCS, once in position of all the facts.
And also with regards to 4th degree tears and lifelong faecal incontinence. This is far more likely to be associated with instrumental deliveries. Which as we all know are further assosciated with epidural use.
Position of all the facts? Brain working faster than fingers there. I of course meant "possession".
Ushy that's true, the risks of vaginal birth are not just downplayed, they are not mentioned AT ALL.
Why - because 'the system' is set up for women to have a vaginal birth by default, and probably judges that it will make a lot of women press harder for electives.
But yes, all risks should be clearly spelt out beforehand.
Agree MistyValley, and as for epidurals causing fourth degree tears and more instrumentals, can I repeat myself?
Old epidurals did, the new ones don't seem to.
Effect on instrumental vaginal delivery (forceps and vacuum deliveries)
The use of epidural analgesia does appear to have an effect on the instrumental delivery rate. If you are saying your anaesthetist uses the old type - why don't you have a chat with him her and suggest they change over.
"A meta-analysis of RCTs comparing epidural with non-epidural analgesia during labour found that instrumental vaginal deliveries were more common in those receiving epidural analgesia, with an odds ratio of 2.19 (95% CI 1.327.78). This included 10 studies and 2369 patients of mixed parity. On the other hand, a more recent meta-analysis of 9 impact studies, including over 37 000 patients, found no increase in instrumental vaginal deliveries when the epidural rate increased by more than 25%. The type of epidural analgesia might influence spontaneous vaginal delivery rates (see COMET study)."
mathanxiety - the other very sound reason for not doing VE's is the fact that in many women find them extremely distressing and intrusive, and because of this they may disrupt the normal hormonal cascade of labour and result in a more difficult, prolonged and painful birth.
MistyValley - what would be the point in telling women all the things that can go wrong with a vaginal birth if you aren't offering them any alternative to trying for a normal delivery?
In any case, labour is a normal physiological process. Nobody sits us down and tells us about everything that can go wrong when we eat (choking, indigestion, food poisoning), or empty our bowels (anal fissure, constipation) do they? So we can consider choose whether to be tube fed and have a colostomy instead?
Jeez, what's the world coming to?
Ushy - can't see the problem with the use of the word 'normal' to describe a birth which happens spontaneously.
'Normal' walking is walking without the aid of a stick or zimmer frame.
'Normal' defecation is going to the toilet without needing manual evacuation of your stools, or laxatives.
'Normal' labour is labour which starts and is completed without drugs or instruments.
So no judgement there. Just an acknowledgement of the physiological norm.
Math - ages ago you asked how often we give out tinzaparin as you didnt believe it was a big problem for postnatal women dying of DVT.
In my unit I would think that 1:4 women go home on 7 days of tinz and around 1:15 go home with 6 weeks supply.
And lets just hope that all of these 'small risks' dont happen to yourself or anyone you know. Its not such a small risk when it happens to you
Can i just add - as midwives, a woman having an epidural is a dream to care for.
We get to actually look after only one patient, rather than runnning between three rooms.
We actually get to be 'with woman'.
We have a lovley, calm, sleeping woman, who we wake up when its time to push.
....so why then, when its such an easy shift, are we still defending 'normal birth' and suggesting that epidurals arent perhaps the greatest thing since sliced bread.
Hmmmmmmm - I wonder?
It couldnt be that we have the mum and baby's best interest at heart - how foolish of us
Agree MistyValley, and as for epidurals causing fourth degree tears and more instrumentals, can I repeat myself?
Old epidurals did, the new ones don't seem to.
Effect on instrumental vaginal delivery (forceps and vacuum deliveries)
The use of epidural analgesia does appear to have an effect on the instrumental delivery rate. If you are saying your anaesthetist uses the old type - why don't you have a chat with him her and suggest they change over.
Oh I do wish there was a laughing hysterically emoticon. It's not quite as simple as just having a wee chat with the nice gas man and asking him to use the nice epidurals that don't do any harm.
sorry Ushy - just picked myself off the floor from laughing -
just have a chat with the aneasthetist to change their practice - hahahahahaa - yeh right!
I have heard of these lighter epidurals, but in the 4 hospitals i have worked at, have never seen one - thats a fair few anaesthetists to change their practice. There is obviously some reason why they dont want to change their practice - if its so good they would have changed
It's the case, isn't it that almost all this research uses women taking opioid pain relief as the control group?
DrMcDreamy - "Old epidurals did, the new ones don't seem to".
Is this true for primips?
Cleofarta I was quoting Ushy with that sentence, sorry if that was unclear.
"sorry Ushy - just picked myself off the floor from laughing -
just have a chat with the aneasthetist to change their practice - hahahahahaa - yeh right!"
Doesn't this say something a bit sad about professional relationships? That's a bit scarey
I am late to this thread, but just wanted to jump on and defend midwives / labour/ drugs etc!
my first baby was back to back and in an aukward position - after about 26 hours of labour I was put on a drip and offered an epidural there and then even though my notes said I didn't want one... they did this in my best interests - they knew I was shattered (strong contractions for that whole time) and they knew they were turning the drip up high... they listened to my concerns, got the anaesthetist to talk to me and then WE agreed together to do it. It didn't work fully so I was given top ups and then a stonger dose of it - which was heaven. I ended up with a c-section and after checking babys position told me I had done the right thing and she was never coming out naturally.
My second birth I had been practicing natal hypnotherapy. I was much more relaxed about the whole experience. My early labour lasted about 3 days (plus longer stop starting)... but I coped far better because of how relaxed I was. When I was eventually admitted I had an AMAZING midwife, who really advocated what I was doing. I was up and about lots, as every time I laid on the bed I found it far more painful.
eventually she told me she thought I needed 'something' as I was clearly a bit frazzled (4th night, no sleep) - she suggested pethadine to help me rest, which I took.
eventually I was pushing without any control over it - and it turned out baby was again in a difficult position and it was putting pressure somewhere - even though his head was really high. They suggested an epidural to help stop the urge to push which I accepted. Unfortunately that didn't work, and when they saw me pushing uncontrollably with an epidural and gas & air and trying to breath through it they knew something was going on!
Both ended up with c-sections, it turns out I have odd shaped hips or something which prevented babies descending
but anyway - I digress... because of the length of my labours I have had experience of quite a number of midwives and have found all of them to be supportive and encouraging of my preferences, whilst still looking out for the best for me and my baby
so to the midwives here feeling they need to defend themselves- you do an ace job!
I'd say that it means we respect each others professional knowledge. An aneasthetist knows anaesthetics, if they are using that particular mix to create a dense block then it'll be for a good reason. It might be that they are unfamiliar with 'how' to create a lighter still effective block. It may be that the research from an anaestetic point of view shows that the denser type block is more effective. It could be for any number of reasons. It might be something such as their policies state that is the type of epidural they use. It can take years for policies to be rewritten. By all means we can have a chat with the anaesthetic staff but it is highly unlikely that it is us that will make the change.
Ushy - any thoughts on the fact that almost ALL these trials of epidurals compare regional analgesia with opioids? Cause we all know that women who've had opioids often spend much of their labour in a supine position.
mummynoseynora - you're absolutely right - most midwifes do a fantastic job.
I think what might seem like midwife bashing isn't actually that at all. People are asking whether midwives are giving the right information to women and respecting their requests.
What's being hightlighted seems to be that midwives are TRYING to do their best for women based on the information they have but they are being given in their training is way out of date. It is the other posters like mathanxiety who are ahead of the game.
It just makes me think the internet and mumsnet are amazing.
PS Cleo - impact studies include all women in a given hospital or location. Some will have opioids and some not.
Dr McDreamy "It may be that the research from an anaestetic point of view shows that the denser type block is more effective."
This was in NICE guidance years ago !!
"PS Cleo - impact studies include all women in a given hospital or location. Some will have opioids and some not".
According to this Cochrane review - Epidural versus non-epidural or no analgesia in labour,
"Twenty-one studies involving 6664 women were included, all but one study compared epidural analgesia with opiates".
Can you link me to the impact studies you refer to?
A couple of the posters here seem very angry with midwives inparticular, very angry indeed. Maybe those individuals should train as midwives and go on to deliver care in a way they see as appropriate.I am serias.
Not frustrated midwives are you?
"MistyValley - what would be the point in telling women all the things that can go wrong with a vaginal birth if you aren't offering them any alternative to trying for a normal delivery?"
Er - because then we wouldn't feel so patronised and left in the dark? It would make us more able to make informed choices? I don't see anything wrong with a pre-natal briefing including the following information:
'You are strongly encouraged to go for a vaginal delivery unless there are good medical reasons not to.
The chances of you having a normal vaginal delivery without the need for interventions are x%. If there are problems, this stuff might happen to you (info on ventouse, foreceps and emergency CS).
A vaginal delivery means x% risk of 1st degree tear, x% risk of 2nd, x% of 3rd, x% of 4th. Elective C-sections have risks x, y and z. The benefits of each are x, y, and z.
Your options for pain relief at stages a, b and c are x, y and z. Here is a list of their benefits and risks.'
Yes it might be a lot to take on board, but at least it will be honest and informative.
The Cochrane review is out of date - it is still being referred to but it included studies from the 1980s which is no good because those epidurals are completely different to the ones used today.
Segal did the study below looking primarily at c/s but also instrumental.
Google : Segal and Gilbert The effect of a rapid change in availability of epidural analgesia
Segal S, Su M, Gilbert P.
Have we got a bit off the tack of the OP?
I reckon we should have a Mumsnet campaing on this one.
"All women should have the right to update info about epidurals and be provided with one if they ask"
Can you imagine any male MP trying to oppose that one?
Oh hang on a minute, why don't we go back to the "good old days". Let's follow the American way and go and have a chat with the lovely gas doctor and tell him that we don't want pain thank you very much.
Taken from http://www.midwiferytoday.com/articles/timeline.as p
1914: Twilight sleep was introduced into the United States. Upper-class women formed "Twilight Sleep Societies." Obstetric anesthesia became a symbol of the progress possible through medicine.
1920: Dr. Joseph DeLee, author of the most frequently used obstetric textbook of the time, argued that childbirth is a pathologic process from which few escape "damage." He proposed a program of active control over labor and delivery, attempting to prevent problems through a routine of interventions. DeLee proposed a sequence of medical interventions designed to save women from the "evils" that are "natural to labor." Specialist obstetricians should sedate women at the onset of labor, allow the cervix to dilate, give ether during the second stage of labor, cut an episiotomy, deliver the baby with forceps, extract the placenta, give medications for the uterus to contract and repair the episiotomy. His article was published in the first issue of the American Journal of Obstetrics and Gynecology. All of the interventions that DeLee prescribed did become routine.
1938: By this time, doctors used "twilight sleep" in all deliveries
Women fought long and hard against "Twilight deliveries" and the right NOT to be treated like a slab of meat. Having said that, I know that childbirth is painful. It is the right of every woman to have evidence based information to choose what form of pain relief she wants. It is sad to hear that women are not listened to, but you can't downplay risks just because they don't fit into your plan of risk free, pain free birth.
And the 200 babies that died of GBS, please don't downplay that for the sake of trying to get your point across.
Why should we have to choose between 2011 and 1914 ?! Also, this thread is NOT a debate for or against epidurals.
I was shocked to see, on one born every minute, that the woman who wanted an epidural was told : "Not unless you win the lottery honey" or something similar.
That is the root of the problem: Money.
I had my babies abroad in a private hospital, and the cost of the epidural was around 800 pounds. Clearly, as it is not essential really, the NHS have a policy to do it as little as possible. It's about money.
"that the woman who wanted an epidural was told : "Not unless you win the lottery honey" or something similar"
No - she was asking about the cost of a private c/s.
I don't believe for one minute that midwives working at the coal face have any interest in denying women epidurals in order to save the NHS as a whole money.
Why would they?
Chandon - absolutely, the thread is about honest information and choice. And where choice doesn't exist, trying to establish exactly why.
We don't Chandon. But I was trying to point out that we have gone full circle. We live in a society that has the right to choose what we want. Sometimes we don't get what we want and then we look to blame someone for that. It seems that midwives who don't actually administer epidurals are being blamed for women not getting one, not the anaesthetist who actually sites it, or the hospital trust who buys them in.
And my post was also about how we have let ouselves be tricked into thinking that child birth is not normal by a man who is not capable of giving birth. He basically said childbirth should be taken out of our hands and placed in the hands of the doctor who delivers us from all evil, Amen.
Ushy - am I right in thinking that most of the studies referred to in the analysis you mention are done in US hospitals?
Given that many labours in the US are augmented and continuously monitored, that most women give birth in supine positions and there is widespread use of sedation, is there anything useful these studies can tell us about the impact of epidural analgesia on NORMAL PHYSIOLOGICAL LABOUR?
" We have a duty to provide optimal analgesia during labour. This is clearly achieved with epidural analgesia"
This comment from the conclusion of the study you mention says a lot to me. That hospitals have a duty to provide pain relief and sedation to women in labour, but not to provide optimal conditions for labour which might enable many women to cope without epidurals or opioids. In my view the way intrapartum care is often delivered in hospitals creates a necessity for widespread epidural use. But hey ho - medics like to feel needed!
I wasnt given an epidural with my first though I "d repeatedly as he was back to back. I ended up pushing too hard as that was the only thing that stopped the pain and had a third degree tear.
Would really like to avoid that this time! My question is how do I get the consultant to see me when I am in labour? Do I ask the midwives? What if they say no or say that he/she is busy?
What's being hightlighted seems to be that midwives are TRYING to do their best for women based on the information they have but they are being given in their training is way out of date. It is the other posters like mathanxiety who are ahead of the game.
- what we are being taught is not out-dated. At uni we MUST use the most up to date research for any essay/dissertation otherwise you will fail.
Likewise, all of our policies are updated every two year to account for new information.
Cochrane reviews are the 'gold standard' of research whereby they look at SEVERAL randomised control trials and collate ALL of the evidence available and the most upto date evidence on that subject - the epidural cochrane review has research from 2008- and was updated in 2010. By looking at SEVERAL reviews it eschews bias from one author - its no good stating one piece of research - anyone can find one giving them the answer that they want to hear.
This is from the cochrane website:
"The reviews are updated regularly, ensuring that treatment decisions can be based on the most up-to-date and reliable evidence"
"Without Cochrane Reviews, people making decisions are unlikely to be able to access and make full use of existing healthcare research"
This is the UK, not the USA - there is a different ethos in this country, Math seems to think several very odd things - such as its ok its only a 1:1000 risk, we dont need to know about it, the other 999 will be fine. And that antibiotics are the way forward.
I'm fascinated with the view that the lack of universal availability of epidural analgesia might be a feminist empowerment issue.
One of the social aspects of childbirth that interested me as a childbearing woman and a midwife is that the promotion of epidural analgesia is a feminist issue - that women are being oppressed and coerced by a male dominated medical profession into believing that they cannot carry and birth their own babies without help. The concept of women as weak and ineffectual, ill-equipped to undergo pregnancy and childbirth without medical assistance, is not a new one. And it seems to have become so entrenched that anyone who defends womens' ability to give birth without medical intervention is accused of being somehow anti feminist.
I have always supported womens' informed decision making, whether that is to have an unassisted birth or to have a c/s for breech. My 4 year degree gave me the opportunity to study the science and the facts: this is something that most of my clients don't have the opportunity to do. It is the midwife's responsibility to provide the evidence, where it is available, as to the risks and benefits of any intervention. But if that same client group is going to call midwives' integrity into question, or simply refuse to believe what they're saying, then there's no point in us even practicing. Being 'with woman' goes deeper than just saying, "yes, you must have that intervention because you want it, and of course you must have it right now because you stamped your foot, no of course it won't cause you any harm." Being 'with woman' involves telling the truth about interventions then supporting their informed choice.
JellyBellies, I would ask to see a supervisor
of midwives, go through my notes with her, then make an appointment with a consultant and discuss my plan of care for the delivery.
NICE does state that all women who request an epidural should be able to have one, even in the early stage of labour. Discuss with the SoM and consultant when would be the best time to go in during labour. You can quote the NICE guidelines for your epidural to be administered in early labour. They should point out the pros and cons of having an epidural too soon.
It's all about having all the facts and then making an informed choice. This is what should happen.
Cleo - we are not talking about doctors forcing women to have epidurals they don't want.
We are talking about women who request it (like the OP and many others) who have it denied.
You obviously have strong feelings about natural birth and that's fine - when you have a baby go for it. Other women, however, who don't share your ideas, have a right to have their views respected.
"women are being oppressed and coerced by a male dominated medical profession into believing that they cannot carry and birth their own babies without help."
But they aren't 'helped' are they? Women are pretty much left to their own devices without medical or emotional support till they have reached the magic 5cm dilated.
Then they are often left to labour alone for prolonged periods of time due to understaffing.
Then in post-natal wards, they are often left alone while they try to establish breastfeeding and look after newborns. Not much help going on there, medical or otherwise.
And absolutely nobody at any stage tried to persuade me that I COULDN'T manage without pain relief, in fact quite the opposite.
Ushy this whole thread is riddled with examples of how the thought of childbirth without epidural is viewed as a ridiculous idea by medical professionals and women alike! Nobody needs to force anyone, the product has been sold very successfully already.
MistyValley yes, this is true. I have experience of maternity services in the UK and abroad, and I am considering returning to the UK to practice. My biggest misgiving about this is the fact that I will most likely be unable to provide one to one care for women in labour.
And I'm pleased that you were encouraged to manage without pain relief - with the caveat that I'm sorry if this represented an unsatisfactory experience for you. But my assertion that the Medical Model of childbirth promotes intervention and only views it as safe in retrospect stands.
It boils down to your concept of what constitutes 'normality', and I believe that this has been skewed by an omnipotent medical profession. I have huge respect for obstetricians, by the way, when their expertise is being used appropriately. Just in case anyone thinks I'm dissing the docs.
Almat The Cochrane review has noted the new studies but not update the conclsuions yet. It says so itself.
"The 31 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed."
Arsebiskits - that's a huge part of the problem in the UK though, isn't it? Being midwife-led, the culture is one of avoiding anything 'medical' as far as possible.
But there aren't the resources to support this, in terms of midwife numbers and space and facilities for women at every stage of labour.
So many labouring women are falling painfully between the two stools of 'supported midwife care and natural birth as far as possible' and 'medicalised birth with freely available pain relief'. (Maybe those two terms aren't strictly accurate but I hope you will get what I mean.) It's actually very cruel.
But I do think that women should be free to make their own choices about pain relief without having to fight for it, or be made to feel that they are failing in some way if they want it.
arsebis I can't help feeling the voices of ordinary posters like me are being drowned out by a chorus of professionals.
No-one is saying childbirth without epidural is ridiculous. No-one
We are saying wehn we ask for an epidural we should get one.
Arsebis how could you say this: "women are being oppressed and coerced by a male dominated medical profession into believing that they cannot carry and birth their own babies without help"
What are you talking about?* You're saying we all have our silly little girly minds operated by men? GRRRRRR
Oh come on!
Thanks elbow grease!
I have met my consultant after my scan do discuss if unwanted a c section. I didn't and she was happy with that. But I did say thAt I was worried about tearing again and she wrote in my notes that there was to be a very low threshold for giving me an epsiotomy(sp).
So should I book an appt with her and say that i would like an epidural this time to avoid issues? I just want to make sure that I get one if I need it as another tear would really mess up my pelvi floor!!
"So many labouring women are falling painfully between the two stools of 'supported midwife care and natural birth as far as possible' and 'medicalised birth with freely available pain relief'.
I agree with you Ushy!
We are setting women up for horrible experiences if we prime them to want a natural birth and then subject them to a system of care that in every way militates against this happening.
(Which, on a personal note, is why I remortgaged my house to pay for an IM for my second and third births, and stayed the fuck AWAY from hospital until it became a medical necessity for me to go in!).
whoops - sorry, that comment was directed to MistyValley.
"Being midwife-led, the culture is one of avoiding anything 'medical' as far as possible".
Not sure about this - as far as I can see being admitted to hospital in labour, labouring and giving birth on an obstetric bed, and having people stick their hands into your body at regular intervals to see how far your cervix has dilated are all part of a medical model of childbirth! And that's about 90% of all births in the UK at present at the moment
ushy I'm saying that the medical professionals have historically viewed women as being weak and incapable in every aspect. There is plenty of evidence to support this. Midwives were also, historically, denigrated by the medical professions because of the threat that they posed to a very lucrative business, the 'business of being born'. This threat came in the form of recognising and promoting the fact that women can, by and large, give birth quite successfully without intervention. One central tenet of midwifery philosophy is the faith in womens' intelligence and innate ability to be women.
There's no point in trying to put words in my mouth or twist my words into other meanings. It is self evident from this thread that pain free childbirth is viewed by some as more than desirable, it is viewed as their right as a woman. I'm not denying that right, I'm merely commenting on the social circumstances that have brought that thinking about.
But don't forget, the epidural might buy a a pain free experience (although this is not guaranteed either), and it might have prevented some of the distressing experiences reported on this thread, but it doesn't eliminate the chance of a woman feeling traumatised by her experience.
It's a shame that there is such a lot of politics and ideology involved - 'medical model' vs 'non-medical' for example.
And this concept that physiological pain is fine and just something that you have to suffer if you're a woman. Period pains are normal and physiological, so is it ideologically wrong to take a paracetamol?
fwiw I bought into the whole 'natural' thing when pregnant, and I am squeamish about needles so wasn't at ALL keen on the idea of epidural. So I'm not coming from some sort of 'medical model' background.
I just don't think you can blame women for being a bit bitter and cynical about having been sold some sort of hippy dream about water births and breathing your way through pain (while the midwife mops your brow) when the reality turns out to be very different for so many.
"Cleo - we are not talking about doctors forcing women to have epidurals they don't want".
No - I'm talking about doctors being instrumental in creating systems of maternity care which make labour unbearable for women. For me it's the elephant in the room in any discussion about pain relief in labour, whatever it is. You can't talk sensibly about epidurals without acknowledging the social context in which women are giving birth and how it impacts on their ability to cope with labour pain.
"We are talking about women who request it (like the OP and many others) who have it denied".
I assumed we were all in agreement that if women request an epidural, it's available, and it's safe to site it, then she ought to have it!
Anyone NOT agree with this?
"You obviously have strong feelings about natural birth and that's fine - when you have a baby go for it. Other women, however, who don't share your ideas, have a right to have their views respected".
Had my three births and have done with all that now (thankfully). Would have to say though, my experience is that most women who want epidurals get one. On the other hand, the women like myself who want to give birth without pain relief and want one to one care, freedom of movement, the chance to use water in labour, or the chance to have their baby at home, face huge obstacles when it comes to realising their birth choices. I had to pay out my own pocket because my choices (to be looked after by a midwife I knew and to have my baby at home) were simply not available to me on the NHS, despite the fact that both these things were clinically and emotionally instrumental in me having a safe and satisfying birth.
On the other hand, had I wanted an epidural (and even in my case a planned c/s given my g/d and enormous baby)I assume I would have been given one without too much of a struggle.
"I just don't think you can blame women for being a bit bitter and cynical about having been sold some sort of hippy dream about water births and breathing your way through pain (while the midwife mops your brow) when the reality turns out to be very different for so many"
Problem is when your choices for labour are completely at odds with the care that you're actually given, and the environment in which you give birth. It's like trying to run a Weight Watchers club in a fish and chip shop. S'not going to work for most people!
I broke my leg, had surgery to insert metal plates etc.
Needed mothing more than a paracetamol, I have no idea why it just did not hurt.
Offered morphine, tramadol and all sorts of pain relief every 2 hours which I did not need.
I was even offered gas and air for stitch removal!
Why should childbirth be some sort of endurance test? If there is money for that there should be money for adequate pain relief in labour!
The conflicting ideologies are, unfortunately, central to the provision of maternity care. It's a battle that's been raging since time immemorial. They used to burn midwives as witches you know. Thankfully all that has changed(oh yeah, I am being sarcastic).
And you're right, it does detract from the ideal of placing the individual at the centre of care.
But when you say that women are sold a hippy dream about birth, don't you think they're sold a dream about childbirth and parenthood in so many other ways? Couldn't you equally say that parenthood is going to involve shitty nappies, vomit, smells, grazed knees, lack of sleep? Parenthood isn't a sanitised process, why are we trying to sanitise childbirth to such an extent? I'm honestly not promoting one above another, I'm really not, but I'm wondering what reality is acceptable and what reality isn't?
"Why should childbirth be some sort of endurance test?"
It's not an endurance test and nobody has suggested it is or it should be.
But you need to acknowledge that many women don't want pain relief because they weigh up the pros and cons and feel both them and their babies will be better off without it.
Those women have just as much right to have their wishes catered for as women who want to be drugged up to the eyeballs.
At the moment you are vastly more likely to get pain relief in labour than you are to get one to one care, the one thing which makes NEEDING pain relief less likely.
Which is why I think that all the breast-beating about the availability (or otherwise) of epidurals is a bit annoying. Most women don't want epidurals. They just want optimal care in labour and the chance of a normal birth. And at the moment many of them not getting either!
Many of the women demand epidurals for their second or late babies because of the memory of the experience of the first. Some even want caesarens. They are not 'talked' into it.
Childbirth can be horrific even if you have a nice midwife and nice surroundings. Nature is actually a bit of a mysogynist - babies are getting bigger, women are having them in their mid/ late thirties and birth is getting more painful. It is no use saying birth is natural when western lifestyle isn't natural.
There seems to be a midwifery belief that birth is a wonderful thing and as long as no one interferes women will be 'empowered' by the experience. Some of us do not buy into that belief.
Those of us that don't - based not on male mind bending but on our own experiences or those of friends - have a right to get pain relief when we as for it.
I say a right because there is no other area of medicine where people are routinely left in a sound proof room - the delivery room where their screaming will not upset other women, experiencing one of the severest measurable levels of pain and are not provided with effective pain relief when they are for it.
Would men tolerate this? No then why hsould we?
The point is that women ARE sold the hippy dream at antenatal appointments, and via the whole 'natural childbirth' culture.
If they were given a more truthful appreciation of what their birth experience might entail - and why - then maybe there wouldn't be so much shock and anger when things don't go smoothly?
"Childbirth can be horrific even if you have a nice midwife and nice surroundings."
Speaking as someone who had one forceps delivery following 24 hours in active labour, one shoulder dystocia with an 11 lbs baby and a third labour where I took 20 hours to go from 8cm to fully dilated, I would agree that childbirth is very, very hard, it hurts A LOT and it's not something you'd ever consider doing if there wasn't a baby at the end of it.
But I know that with the right sort of care, birth actually CAN be 'empowering' and 'wonderful' - even when it involves excruciating pain and exhaustion. Not saying it always will be or that it should be, but it CAN be. And I know plenty of other women who have had similar experiences to mine.
"I say a right because there is no other area of medicine where people are routinely left in a sound proof room"
No - because in no other area of medicine are health professionals involved in the care of people who are generally completely well. Pain in itself is not pathological in childbirth. And many women are accepting of fairly extreme levels of pain - they're happy to go without pain relief because they want to work with it to get their baby out as quickly and as efficiently as possible.
Can't think that's true of many ill people - that they see pain as having any sort of purpose at all, and in fact is a sign of the healthy functioning of their body.
"Midwives spend 3 years studying, pregnancy, childbirth and the postnatal period in its entirety. 3 years on one subject. No doctor in the world gets that." - What a load of twaddle, I am sure that my old uni chum back home that is an ob/gyn specialist who trained for 14 years - yes 14 years of training not a measley 3 years would have something to say about that!!! Doctors in North American at least have to do 2 years pre-med, 4 years med, and 4-8 years of specialistion. Sure makes a midwives 3 years look....
I agree the midwives commenting on this thread (on the whole) have certainly given backbone to the arguments given.
If women are so well informed about the risks and benefits of epidurals, how come I've had the following conversation on many many occasions:
Woman in labour: "I've had enough, I'd like an epidural now,"
Arsebiscuit RM: "No problem, I'll ring the anaesthetist, he/she will come straight away if they're not in theatre/in another room. They will also run through the risks of the epidural with you. (it goes without saying that this is not the ideal time for a woman to be hearing about this for the first time, but it's the way it seems to be)
The epidural is effective for most women, but not all. It is associated with a slow second stage, and to an increased risk of instrumental delivery (vacuum or forceps). Having an epidural doesn't mean you will have a complicated or instrumental birth, not having an epidural doesn't guarantee that you won't, it just alters the risks.
You will need to sit in one position for about 20 minutes while the epidural is sited, and remain completely still for a few of those minutes. You will be on the CTG for the rest of the labour. I will have to put a needle in your hand to give you fluids because your blood pressure might go very low, and you will have a tube inserted into your bladder because you won't be able to pass urine. (^woman's eyes widen - this is news to her^). You will be able to move around the bed to some extent, but you will not be able to get out of bed. You will remain immobile for 4 hours, your urinary catheter will remain in situ for this time.
For all those women who wanted an epidural and not got one, yes I am saddened.Genuinely. I've also seen how women can have excellent birth experiences with epidurals. But I've also seen how many womens' experience of epiduralised birth constituted a massive reality rebate. Some were very upset to be catheterised, some hadn't realised how helpless they would become, some were distraught at their inability to push effectively and, when the fetal heart rate indicated problems, were completely terrified at their powerlessness to do anything. I've never seen anything so vulnerable - and women in childbirth are already a vulnerable group. It wasn't the empowering experience that they were expecting, and that clash between expectations and reality breaks my heart.
Cleo "Most women don't want epidurals. They just want optimal care in labour and the chance of a normal birth. And at the moment many of them not getting either!"
Cleo - that's the belief and I know what you mean but it is NOT always true. I had had one child with a nice midwife and it was a horrific experience. I've got two friends who have had similar experiences and say exactly the same.
I WANTED an epidural. If I had a choice between a midwife and an epidural I'd have picked the epidural!
What really griped me was after the perfect epidural birth number two, postnatal midwife said did I have any regrets about 'needing' pain relief because there was a 'Birth Reflections' service!!! I said no, I could probably cope with the terrible guilt and feeling of failure ...teehee
The difference is BecauseItolYouSo, that doctors spend almost all their time focused on DISEASE and INJURY.
Most babies birth themselves. Why would doctors waste their time on developing expertise in an area in which they simply have no useful purpose?
no wonder i didn't get one if you cant even get one if you beg.
i had ptsd from my first birth and kept telling myself well you are the one who wanted a natural labour.
I wondered why my shit midwife (who i made a formal complaint about) didn't suggest one, or suggest ANYTHING to help me.
she was a total bitch, but i can also see that from reading here she couldn't prob be arsed.
2nd degree tear,pushed for 2 hours but baby flew out, no guidance from her on panting or anything. 27 hr labour, grazes, cuts and all that on top of spd.
She wouldn't even let me get off the bed as she had a 'bad back'.
fucking fucking bitch.
No Ushy - I did make a point of saying that it's not always true that women don't want epidurals.
But I'd suggest it's MOSTLY true, and that the figures would bear me out.
your name says it all.
A junior reg will have studied 5 years as an undergraduate and may have had only a few weeks of postgraduate medical obstetrics and gynaecology experience.
My neighbour's daughter has had 8 weeks obs AND gynae experience and is now walking round the wards with a prescription pad.
The difference is BecauseItolYouSo, that doctors spend almost all their time focused on DISEASE and INJURY. - I am afraid that you are INCORRECT it depends on what area you specialise in.
Perhaps you should be clear on the definition of an Obstetrician - A doctor who specializes in pregnancy, labor and delivery.
My old uni chum focuses on women and babies and ensuring they have the best pregnancy and birth experience possible.
arsebiskits - Mine name says it all?? I can see that the name calling shows you up as a mature and intelligent woman!
Cleo Yes, but are women told the real truth about epidurals or the scaremongering version? (See Mathanxiety posts]
They are often told they increase caesareans, you'll need an instrumental delivery. My friend told me her midwife talked of 'paralysis' risk!!!! No quantification about just how infinitessimally small this risk was.
Nor are they told that epidurals work best if administered before 7cm. They are told to 'hang on' to see if they can 'manage'. They are not told that actually this will reduce the chance of the epi working if they do need it and increase the risks because they won't be able to keep as still.
"A doctor who specializes in pregnancy, labor and delivery".
In the UK obstetricians would not be involved in a normal labour or birth in any capacity.
So they are only called in to deal with disease or dysfunction.
They have more or less no involvement in normal birth.
"My old uni chum focuses on women and babies and ensuring they have the best pregnancy and birth experience possible"
How luvverly. At the moment the evidence suggests that low risk mothers cared for by obstetricians in pregnancy and birth have much higher rates of intervention in labour, without any improvement in maternal or neonatal outcomes compared to midwife led care. But I'm sure your friend is very good
Arsebiskits - your point about women not realising what happens during an epidural is interesting, and I can see your point.
But it does beg the question of WHY the realities of epidural comes as such a shock to many? There is no earthly reason why they can't be given a leaflet and diagram beforehand which explains the pros and cons.
ushy you said "Many of the women demand epidurals for their second or late babies because of the memory of the experience of the first"
But equally, many women actively avoid a second epidural for subsequent births, such is their dissatisfaction with epiduralised childbirth. That door swings both ways. At this point, I've been with hundreds of labouring women, and there are many more who are disillusioned with epiduralised birth than there are those who would be utterly traumatised if they didn't get one. Not saying that we should dismiss those who are traumatised, mind. Just that the perspective is being skewed.
mistyvalley because we don't actually have a proper birth discussion with them at 32 weeks, as we are supposed to do. I think antenatal information is lacking. Reasons I've heard for wanting an epidural include,"My sister/cousin/friend said I had to have one," - in the absence of factual, objective information, women rely on other people's subjective experiences.
And, re the question of why so many women aren't aware of the mechanics of epidurals, it's probably for the same reason that so many are utterly shocked by having to have an emergency CS.
It's because of the culture of letting women go into childbirth with blinkers on, believing that their bodies are perfectly designed for childbirth and that things are SO unlikely to go wrong that it's not even worth worrying your little head about.
"in the absence of factual, objective information, women rely on other people's subjective experiences."
Yes, I'd agree with that.
arsebis "I've been with hundreds of labouring women, and there are many more who are disillusioned with epiduralised birth than there are those who would be utterly traumatised if they didn't get one"
That's interesting because the latest stats say 91% of women who have epidural would have one again. The main cause of epidural dissatisfaction is it not working. Inexperienced anaesthetists, leaving the epidural late inlabour are two factors that could reduce failure but there is a lack of will to do anything about it.
Women's pain in childbirth is a low priority - so much for equality.
Ushy - would agree that women need accurate information about epidurals.
However, for many women I know it's not the possible risks of epidurals that are the issue. Certainly not for me personally either. It was the indignity of labouring with a catheter in situ, the unpleasantness of having a venflon stuck into the back of my hand, and not wanting to deliver in in stirrups (as many, many women do with an epidural, even though it's not usually necessary), plus feeling disabled and immobile throughout an event I see as an essentially physical and active, that was profoundly off-putting.
I also had the increased motivation for not having an epidural of having enormous babies - it's no fun trying to shove out a 10 pounder sitting upright on a bed partially paralysed and unable to feel much from the waist down - epidural or no epidural. And I'm amazed the doctors don't warm those of us who make huge babies of the increased risk of s/d that come with having an epidural (which is likely to become more and more of a problem because of the increasing incidence of g/d among pregnant women).
"That's interesting because the latest stats say 91% of women who have epidural would have one again"
Women are pretty loyal to their birth choices generally - if their choices are realised.
Women who've opted for homebirths being a case in point.
"Women's pain in childbirth is a low priority"
Well - it'll always be a lower priority than theirs and their baby's physical safety won't it?
"It's because of the culture of letting women go into childbirth with blinkers on, believing that their bodies are perfectly designed for childbirth and that things are SO unlikely to go wrong that it's not even worth worrying your little head about".
Aren't MOST women aware of the fact that nearly 1 in 3 births in the UK is done by c/s now? The majority emergency c/s?
You kind of have to wonder how any woman can get through 9 months of pregnancy with no knowledge of the fact that most first time mums giving birth in hospital will have some sort of intervention in labour.
"You kind of have to wonder how any woman can get through 9 months of pregnancy with no knowledge of the fact that most first time mums giving birth in hospital will have some sort of intervention in labour."
Which makes it all the more surprising that the subject is swiftly swept under the carpet when you bring it up in antenatal appointments. At least that was my experience.
"Which makes it all the more surprising that the subject is swiftly swept under the carpet when you bring it up in antenatal appointments. At least that was my experience"
The community midwives in my area are working flat out just PROCESSING mothers through their routine antenatal care. It's absolutely shite. They really have no time or energy to have any sort of meaningful conversations about anything other than medical issues. It's very bad.
Well I could not agree more that one to one care and encouragement would lead to less women feeling like they need an epidural.
Its not happening though is it?
However, to see these women begging for an epidural on OBEM is highly distressing.
For what its worth, had a a home birth with my first, it was ok, very lovely indie midwives, all the trimmings
I had the 2nd at the hopital with an epidural i was not traumatised by natural childbirth but I did not want to be stitched again on gas on air
Twas much better
ushy you said, "That's interesting because the latest stats say 91% of women who have epidural would have one again. The main cause of epidural dissatisfaction is it not working. Inexperienced anaesthetists, leaving the epidural late inlabour are two factors that could reduce failure but there is a lack of will to do anything about it."
That's interesting - can you post a reference to those statistics?
mistyvalley I'm not sure I get the link between lack of birth preparation - emergency c/s - womens' bodies being poorly equipped for childbirth. The c/s rate isn't a reflection of womens' inability to give birth vaginally, it's a reflection of the medicalisation of childbirth.
arsebis That's interesting - can you post a reference to those statistics?
Sure I can't actually find the original one I referred to but I found another similar one which gave even higher recommendation figures (95-98%):
Retrospective assessment of epidural analgesia
Ginekol Pol. 2005 Apr;76(4):277-83
"Women's pain in childbirth is a low priority - so much for equality."
I don't think equality has anything to do with it. Actually, most medical professionals will try to get people to deal with their pain with as little medication as possible regardless of the cause. I know people, of both sexes, who've been in exrteme chronic pain for years who are prescribed exercise, physiotherapy, and/or 'relaxing a bit more'.
Most do it as it's safer and has far less side effects (and as someone who had one of those unlikely horrible, life threatening side effect to something I was told was "completely safe", it was extremely distressing to find out that they knew this could happen and didn't bother to tell me and my husband) and pain medications tend to be tolerated after time and the more powerful ones have worse side effects.
There are some medical prats who think people should just get on with it, especially if they think the person did it to themselves (my husband, who has been in extreme chronic pain since 19, has been told to his face by multiple medical professionals that he originally wasn't going to get XYZ because they thought his injuries were due to motorcycle accident and/or sporting injuries).
It has nothing to do with equality, it has to do with some medical professionals being rightfully cautious and some being prats. We need to boot the latter and find better ways of communicating with the former to get both parties to a place where they feel their concerns are being heard.
Labour pain is one of the severest pains measured.
Where in medicine are people left in that level of acute pain for such a long time and not being offered pain relief without any hestitation.
Could you be specific and tell me exactly what other specialism does this?
"I'm not sure I get the link between lack of birth preparation - emergency c/s - womens' bodies being poorly equipped for childbirth. The c/s rate isn't a reflection of womens' inability to give birth vaginally, it's a reflection of the medicalisation of childbirth."
I wasn't relating lack of birth preparation to emergency CS rates. It was more a comment on the lack of information on what will happen if you have to have an emergency CS. It's barely even acknowledged that it's likely to happen in the first place.
This means that when it does, it often comes as even more of a shock to women (and their partners) than it otherwise would have done. This must contribute to stress and difficulties with coming to terms with it both during and after the procedure.
I realise my last point is a bit off topic, it was a continuation of my point that women are led blinkered into childbirth by this idea that nothing will go wrong because their bodies are designed to cope.
Mistyvalley You are so right. People are just not given full information.
Arsebis The c/s rate isn't a reflection of womens' inability to give birth vaginally, it's a reflection of the medicalisation of childbirth."
That's interesting. Is there a study comparing morbidity and mortality outocomes of a group of women who are not allowed caesareans versus a group of women who are not? Could you let me have a reference?
OOps! I meant who are allowed and who are not
But womens' bodies are designed to cope! Although having said that, there is an argument that it got a lot harder for homo sapiens when we started walking upright. And this whole thread has meandered in and out of many topics!
usha thanks for the link. Firstly, it's a very small, localised study. It's not very recent. The fact that 87% of the participants were primigravidae seems to support my original observation that many multiparous women aren't that fussed about getting an epidural. Do you have any sturdier evidence than this? A systematic review would be more reliable.
Jellybellies: "So should I book an appt with her and say that i would like an epidural this time to avoid issues? I just want to make sure that I get one if I need it as another tear would really mess up my pelvi floor!!"
I think it would be a good idea to keep communication channels open. From what I have been reading here over the last couple of days, it seems that the main concern that women have is that they weren't listened to.Communication is the key as people are aware of what you want for you. Maternity services are women's services. It is only right that you should have your needs addressed. If you talk to your consultant and a SoM,they will be able to discuss all options and the pros and cons of each choice. Then you can take the info away and have a good think about what you want. When you have made your decision, share it with them. They can help you to come up with an individual birth plan that's suits you. Anything that is discussed should be written in your notes, so that everyone is aware that the discussion has taken place and everyone is aware of your choice.Hope that helps ; )
The NICE guidelines are very clear about the risks associated with elective caesarean section.
However, when you say women who are 'allowed' c/s versus those who are not 'allowed' them, do you mean those who request elective c/s without clinical indication?
Women's bodies aren't designed to "cope". From a strictly physiological and historical standpoint, it's the infants' bodies who are designed to be as fully developed as possible, with the largest head size that can possibly pass through a female pelvis whilst killing off no more than a third of us.
And if effective pain relief is available to mitigate this practical joke evolution has pulled, I damn well want it.
The point about communication is very valid. I donlt have a link but wasn't there a study that showed that if you knew, understood and could see what was happening to you,you felt less pain?
"But womens' bodies are designed to cope!"
Well, firstly, people aren't 'designed', they are the result of random combinations of genes. Some gene expressions are anatomically and physiologically 'good' for the physical rigours of childbirth, and some not so much.
So you can't apply the 'well designed' thing to all women. In the same way as you can't say that all people are well designed to be pole vaulters or whatever.
And yes, I get the argument that some women don't really get a good shot at finding out whether they are well designed are not, because of bad preparation and care. But they are NOT all well-designed in the first place.
And actually, sometimes it just isn't relevant how 'well-designed' the mother is - for example if there are problems with the baby, placenta, or umbilical cord. Which strictly speaking aren't actually part of the woman's body at all.
'Although having said that, there is an argument that it got a lot harder for homo sapiens when we started walking upright.'
It's not an argument, it's an anthropological fact. Because of bipedal locomotion, the human female gives birth to a far more immature, defenseless infant than her closest relative, the chimp. Bipedal locomotion means a shorter pelvis, a shorter gestation time, a more immature infact and, left entirely to nature, a far higher maternal mortality rate compared to other great apes.
The advantage, however, was enough that evolution kept moving in that direction, minus a percentage of females dying in childbirth and a significant percentage of infants as well.
That's interesting. Is there a study comparing morbidity and mortality outocomes of a group of women who are not allowed caesareans versus a group of women who are not? Could you let me have a reference?
I take it Ushy that you mean elective over emergency? I would think that the overall risks are the same. However, an emergency is just that isn't it? So, obviously there will be additional risk factors added,such as the additional risks that led to an emergency c-section.
You can get the mortality figures from CEMACH.
The physical aspects of childbirth are not an evolutionary pinnacle as far as the mother's body is concerned. It's enough that the infants produced survive. Darwin doesn't give a toss that you might spend 48 hours in agonising pain as long as that all-important fetal head circumference ensures a babe that lives to reproductive age.
"The point about communication is very valid. I donlt have a link but wasn't there a study that showed that if you knew, understood and could see what was happening to you,you felt less pain?"
I am not sure, but it would make sense Susie :D
"with the largest head size that can possibly pass through a female pelvis whilst killing off no more than a third of us"
Where did you get the idea from that one third of women would die in childbirth without surgical intervention?
In the 1960s the c/s rate in the UK was 5%. The maternal death rate at that time was about 30 in 100 000 births.
Meant to add - apparently a maternal death rate of 1 in 100 is the highest historical rate recorded in the UK, and that was in the early 1800's.
OK, so in place of antibiotics what would you suggest, Alimat? Spitting on infection sites? Rubbing some mud in? 200 babies died in the UK from GBS; would their parents have preferred routine ABs or your cautious approach? ABs do far more good than harm. They are not bad things to be shunned.
And one 'chance' you mentioned was not a 1 in 1000 'chance', it was 1 in 15,000. I personally would take that chance.
My objection to most of the alleged 'risks' being waved about here is that those crying wolf are not stating what the real risk is. 1 in 1,000 is a long, long way from 1 in 15,000.
As for the claim that US maternity care has a different ethos from the UK -- not so. Same slop, different bucket. Practices in US hospitals do not vary all that much from the UK, though they vary greatly from hospital to hospital and even from doctor to doctor, or MW to MW. If anything, there's an even greater pressure to 'perform' in the US, women there have low bfing rates and have to return to work much earlier. And afterwards there's no HV to come round.
'Math - ages ago you asked how often we give out tinzaparin as you didnt believe it was a big problem for postnatal women dying of DVT.
In my unit I would think that 1:4 women go home on 7 days of tinz and around 1:15 go home with 6 weeks supply.'
I don't know how you managed to misread me so thoroughly. I didn't believe the cost should be touted as a big problem. I didn't believe increased monitoring after an epidural was causing DVT/ VTE problems or deaths.
Again, read what I posted about the causes of DVT. They are not labour/ epidural/ monitoring related, which was the context of my remarks. DVT is a byproduct of pregnancy, beginning at 16 weeks, with risk increasing to term. You tried to suggest it was the increased need for monitoring with epidurals, and women lying in bed during labour instead of moving about, that caused it. You were misinformed.
Here's a RCOG information publication (pdf) about DVT. Heparin is used to prevent clots during pregnancy and is continued after birth for those who have used it up to birth -- maybe these patients account for some of your 1 in 15? You can bfeed with heparin and it does not cross the placenta. Apparently the only problem with heparin is that an epidural cannot be given until 12 hours after the last injection of heparin, if a woman has been using it during pregnancy. And get this -- "You will have the option of alternative pain relief" -- Not in some hospitals you won't. Here the RCOG apparently sees no problem with heparin, states that it is used to control conditions related to pregnancy itself, not to lying in bed during labour, and also seems to say that pain relief raises no eyebrows.
You also told us how much a 6 week course of tinzaparin costs for that 1 in 15 woman -- £995 -- as if that should be a consideration when deciding if a woman should get an epidural. If cost is going to be factored in then women should just squat where they are when pushing time comes and avoid hospitals and prenatal care altogether. I marvel at your priorities.
Monitoring = bad
Effective pain relief = risk of death for mum and baby
Antibiotics = the work of the devil, and not the way forward
Costs associated with childbirth in hospital = unconscionable
Real statistics to back up scaremongering = to be avoided
Tell all that to my mum's cousin, the now retired district midwife, and she would laugh in your face.
From RCOG statement on NICE Clinical Guideline 55, Intrapartum Care: Note that the requesting of epidurals and the prevention of unnecessary pain are seen as an advantage of having women labour in freestanding birth units as opposed to delivering at home (the context of the paragraph). 'Co-located unit ... also provides women with the option to request an epidural for pain relief. It avoids long waiting times and a possible rough ride in an ambulance when mothers are already in pain or in the second stage of labour.'
Cleo -- wrt VEs. Yes, VEs are intrusive and yes they are done despite that, because they are one very useful way of assessing progress in labour. You can check whether the cervix is ripe or open and how far labour is advanced when a woman first turns up at the hospital. You can check progress of cervical opening, and effacement, and how far the baby has descended, plus whether baby's head or some other part is engaging, and whether the head is facing front or back. They are not the only way, but one way. To say an epidural cannot be administered until a VE is done and then refuse to perform one and end up with a patient who does not therefore receive effective pain relief is just cruel. If VEs are to be avoided, then other signs can surely be used in order to provide clues about timing for the purposes of an epidural?
And furthermore, it is a huge contradiction to express concern for the how women feel about VEs, concern about their intrusiveness and the feeling that someone has poked their fingers up to your tonsils, yet argue against epidurals. I suspect that most women given a choice between having a VE or going without an epidural would choose that VE, intrusiveness be damned.
OBs in private practice in the UK see 'normal' patients. Same in Ireland, where there's a dual state/ private system and proportionately more private patients. They train far longer than midwives do and have a basic general medical and pharmacological education that is far superior to midvives' education before specialising. Outline of training here from RCOG. They specialise in pregnancy, labour and delivery and their training encompasses both normal and unusual situations.
Arsebiskits, you really don't like The Man, do you? 'It is the midwife's responsibility to provide the evidence, where it is available, as to the risks and benefits of any intervention. But if that same client group is going to call midwives' integrity into question, or simply refuse to believe what they're saying, then there's no point in us even practicing. Being 'with woman' goes deeper than just saying, "yes, you must have that intervention because you want it, and of course you must have it right now because you stamped your foot, no of course it won't cause you any harm." Being 'with woman' involves telling the truth about interventions then supporting their informed choice.' That statement is one of the most arrogant and contempt-filled I have seen about any group of patients and about any medical professional's mission. Everyone involved in L&D is out of step except you apparently. The integrity of midwives is called into question when they fudge facts and present risk as likelihood, and omit pertinent information like actual figures -- 1 in 15,000 for instance.
WRT CS rates -- the foremost factor contributing to CS rates is maternal obesity.
Poppyella -- 'facts as they happen in real life' are not statistics. They are anecdotes. If you feed your patients anecdotes you are not telling them facts, you are not telling them what the real risks are. You are recounting your own experience and they are not the same things at all.
And as to assuming I went back 5 times so it couldn't have been that bad for me -- my own experiences (one epidural, four non-epidural, three inductions, two spontaneous labours -- need a venn diagram here -- one lazy, horrible, mendacious nurse and all the rest fab) have nothing at all to do with my thoughts on the way other women are treated. My arguments here are based on facts and not my own personal experience masquerading as the ultimate truth (in contrast to what many of the MWs here seem to be doing); the idea that if I got on ok why should I be bothered by the experiences of others is a cold one indeed.
Elbow grease* "Is there a study comparing morbidity and mortality outocomes of a group of women who are not allowed caesareans versus a group of women who are not? Could you let me have a reference?
I take it Ushy that you mean elective over emergency? I would think that the overall risks are the same. However, an emergency is just that isn't it? So, obviously there will be additional risk factors added,such as the additional risks that led to an emergency c-section. "
Emergency caesarean carries over five times the risk of mortality for the mother than planned elective - look on page 13 and use hospital data to get the denominator.(CEMACH)
A midwife poster said "The c/s rate isn't a reflection of womens' inability to give birth vaginally, it's a reflection of the medicalisation of childbirth."
Therefore if you don't have any "medicalistion" you shouldn't have any caesareans. Of course not - you'll have alot of death and brain damage.
It was a bit of a tongue in cheek question
Well why bother with midwives at all then? If docs are the holy grail of obstetric practice?
"OBs in private practice in the UK see 'normal' patients"
There are only a tiny, tiny number of low risk women having private obstetric care in the UK.
"They train far longer than midwives do and have a basic general medical and pharmacological education that is far superior to midvives' education before specialising"
So why are the outcomes for low risk mothers who give birth under obstetric care poorer than for mothers delivered by midwives?
"Monitoring = bad"
If continuous monitoring for low risk mothers doesn't reduce neonatal mortality and morbidity and does increase c/s rates than how can it be a good thing?
"Effective pain relief = risk of death for mum and baby"
Have I missed someone saying or implying that epidurals are highly dangerous?
"Antibiotics = the work of the devil, and not the way forward"
Are there no counter arguments for a regime of blanket screening and prophylactic a/b's for GBS? You seem to be saying that not supporting screening and widespread antibiotic use is completely irrational and fanatical. My understanding is that there are serious arguments on both sides of the debate.
"Costs associated with childbirth in hospital = unconscionable"
While we don't have enough midwives to make childbirth in the UK as safe as it needs to be for women at the moment it's hard to argue for an increase in the availability of expensive medical technology for the relief of pain. I'd be all for hugely increasing the spend on maternity care - but it's hard o justify increasing money spent on things which don't appear to improve clinical outcomes for mothers or babies.
Cleo "So why are the outcomes for low risk mothers who give birth under obstetric care poorer than for mothers delivered by midwives?"
There's a good reason for that. Bad outcomes are considered to be interventions including epidurals. What happens is that women self select. Those wanting pain relief and who are open to earlier intervention rather than hanging on for a protracted vaginal birth tend to opt for consultant unit. They do have more 'intervention' but there is a very good study showing that is actually want they want.
Women more motivated to go for natural birth tend to go for midwifery led and they end up with less intervention - mainly of the pain relief type.
So why are the outcomes for low risk mothers who give birth under obstetric care poorer than for mothers delivered by midwives? - The outcomes may be worse in the UK where Ob/Gyn's mainly deal with high risk patients rather than 'normal' pregnancies and as you said a very small percentage of women in private care.
This is not however the case in other countries where Ob/Gyn's are the primary carer for women. Canada is a very good example. As per WHO figures given in a one of my earlier posts I gave the figures in Canada are in fact better than the UK for many maternity issues and OB/Gyn's have handled care of pregnant women for a very long time. Midwives were illegal in Canada for a very long time, In fact midwives are still not allowed to practice at many, many hospitals.
I gave birth in the UK so have first hand experience of the UK system. I initially met with midwives at my local NHS hospital which actually led to a very serious complaint being lodged with the Head of Midwives and Head of Nursing of the hospital. This was then further escalated to the Chairman of the hospital and the local PCT. I was moved from that hospital to another hospital where I sought the services of an OB/Gyn privately. The care that I received was far superior. I then carried on to see the same OB/Gyn that I paid for privately as an NHS patient in and NHS hospital. So yes OB/Gyn's do deal with women here on the NHS, I experienced it first hand.