Negativity toward epidural in UK?

[wispaxmas]

Hello, ding a search, I found a discussion on this from 2010, though there might have been others more recently. I'm from Canada, it's much much much more common to have an epidural there, and in fact I only know one person who didn't have one in childbirth, and there was no difference between the labours - I don't know anyone who needed assistance like ventouse or forceps, either.

I understand that statistically there is an increase in the need for assisted delivery, but I'm not convinced it's entirely causally related - a more difficult labour is more likely to cause both the mother to request an epidural and also to cause the need for assistance, and the other risks to mom are so small especially with mobile epidurals, that I can't understand the extreme negativity towards epidurals in this country.

I'm only just shy of 15 weeks, so obviously thinking a ahead at the moment, but I've been thinking about my booking in appt recently, as I have my next appointment next week. After going through all the notes and labelling my as low risk, the midwife asked where I would preliminarily like to give birth. I said a definite no to home birth and no to the midwife led unit, as I wanted to have the option of an epidural if I wanted one.

Her response was to write down that I was told to go with the midwife led unit, with no mention whatsoever that I wanted a hospital birth. She told me also that women who wanted the option of epidurals more often than not got them. Uhh, no shit Sherlock. I've done a fair amount of research into it, I feel quite confident that I'm aware of the risks, and at this point I'm comfortable with them and would be happy to have an epidural in labour, and quite frankly, I'm upset that I've been told I shouldn't have one without being given the data to support the advice. I'm being treated like a child when I am in fact a very well educated and independent woman able to make informed decisions about my care (this pertains to almost all advice given to us while pregnant).

Argh, sorry for long post. I guess my point in posting is to know if anyone else has experienced the same, or what your views are.

[Bue]

I'm Canadian too. Yes it is much less common here in the UK to have an epidural (overall rate is about 35% I think, but over 50% of first time mothers have one). Obviously this particular midwife has a preference for natural birth, but you won't find any negativity in the hospital about having one. (She may also be under pressure to push the MLU.) You may want to look up the 2011 Birthplace study - basically it showed that for women having a second or subsequent baby, a consultant-led unit is no safer for the baby and less safe for the mother in terms of morbidity, so statistically it is actually the worst place for a low risk mother to give birth. So although she probably didn't do it in a very good way, the midwife perhaps felt she was recommending the best option overall. However, your desire for pain relief should be respected!

I do know an awful lot of women in Canada who have had natural births though. It may depend on what province you're in.

[GeppaGip]

Yes, there is a culture here of 'doing it naturally'. Having spoken to many people about it over recent years, in general, pro-natural birth supporters think that you can't feel your body urging you to push with an epidural, and this slows down labour and increases complications.

Within the NHS, I believe there is the core issue of funding. Dissuading women from having an epidural (whether convincing them it is better to go without or pretending that it is either too early or too late) saves money and allows them to dedicate minimum resources to it. Those who choose an epidural have to have one on one care and increased monitoring, whereas resources are so scarce that this is a huge pressure for each hospital to spread midwife care thinly.

When I had my first child I had to wait a long time for the epidural because the one available anaesthetist was busy. In fact, I believe I only got one eventually because I refused to let it drop despite their best efforts and they eventually gave in. It was better for them if I just suffered and I think that is why natural birth is pushed so much in the UK. It is cheaper, even if it is significantly more unpleasant and painful than it has to be, and that matters more to the NHS.

[mercibucket]

this is about resources really. hopefully you will get what you want.

[Rowboat]

It is partly about resources, yes, but I think from what I've been told an epidural slows the labour down. This is what increases the chances of further intervention such as forces. The baby is more likely to get into distress because of the length of time its taking to be born. It is, of course, up to you. I didn't have an epidural last time and its only a last resort this time because the idea of an enormous needle in my spine terrifies me more than labour pain. Also, I feel that why should I take more drugs than I need to? Why increases that risk to the baby unnecessarily? Yes, I know all childbirth is inherently risky. But this is just my opinion and I only include it for the bigger picture. If you want one, I hope you get one. The mw should've put your request down. Make sure you write it in your birth plan, but be aware that you might not get it if resources are limited. Good luck.

[TondelayoSchwarzkopf]

I don't think there is an anti-epidural culture in this country* - I think you just have a midwife who won't listen or hasn't explained that it's best to consider all options and facts before making a final decision. Or you may be surrounded by peers who are more pro-'natural' birth than others. I know maybe 2 people who requested epidural but didn't get them because their births happened so quickly. No-one else I know has had a problem with getting an epidural. I had quite a quick labour and had one.

Is your MW led unit attached to a hospital with a labour ward? If so, I really wouldn't worry. FWIW I am currently scheduled to give birth in our MLU but it really is hugely unlikely as I will be 40+, likely to be induced and have a complicated labour history. But as I am low risk for now, that's where I'm listed for now. (I'm 22 weeks)

You should also be aware that once you are in labour to request an epidural asap - so the anaesthetist has time to get there - some women leave it too late.

*That said, when the government did a recent consultation on labour options, the NCT was asked to contribute and the Royal College of Anaesthetists wasn't!

[SuiGeneris]

Hi OP, I had the same impression as you when I first looked at things in the UK, and two babies later I can confirm the impression was correct: epidurals seen v negatively by many midwives and NCT instructors, who are the main people low risk women come across.

I knew well before becoming pregnant that I would want an epidural and got one. I was high risk and under a consultant from the start and none of the actual doctors were even mildly against it. The majority of the midwives were-except for the senior ones, who were supportive of my choices (being high risk I saw moltitudes of people). My take was that the midwives were against because (1) it gave them less control (by making dr involvement necessary; (2) they did not understand the science around it (aside from the consultant midwives, who were excellent but far too few, many of the others were appallingly ignorant- I had to pick up mistakes more than I would have liked); (3) they tended to have a romantic idea of birth, with pain being not all that bad and just in the mother's mind (or in any event bearable if you weren't a wimp).
Are you going NHS or private? If NHS insist on seeing a consultant and make your wishes well known- write it in your notes yourself if need be.

[TondelayoSchwarzkopf]

There are also benefits to epidural - eg it may protect against prolapse and bladder problems in women.

[lljkk]

Sorry if MW isn't listening, you should get other opportunities to make clear your true intentions; your pregnancy may turn higher risk anyway, so no need to wage that battle after all.

I think what usually happens in UK is that most people decide to see how it goes without something like a needle in the spine & by the time they are desperate enough to insist on EPI they are nearly finished & there's no time for it to be done & take effect, anyway.

I would have thought just put what you want in your birth plan & make sure you go to hospital early. They may send you home if they think it's too early, but do insist on Epi once you're in. No one is going to turn you away from a hospital if you turn up in active labour, regardless of drivel written about birthing place in your notes.

[Shenanagins]

I think it is just the midwife you had. In both my pregnancies all the midwives i saw were very much of the opinion of seeing what worked for me and if that meant drugs that was fine as the most important thing was the safe delivery of the baby.

I would recommend that you look into all options, go with an open mind rather than automatically think you will want an epidural as you will be amazed at what your body can do and I say this as someone who had one.

[Bue]

This 'resource issue' is a complete myth IMO. Most consultant units have 24 hour epidural service. They may not have 4 anaesthetists sitting around just waiting, but there should be someone to do it within a decent period of time (people might be interested to know that the Obstetric Anaesthetists' guideline is to come and see a woman within 30 minutes of a request, unless there is an emergency elsewhere). Also no midwife or doctor in the hospital setting is thinking of the cost of a bloody epidural. There might be a push to encourage low intervention birth higher up the policy chain, because of resources, but that concern doesn't exist at ground level.

lljkk is right that a lot of women in the UK have a wait and see approach (as opposed to, say, the American approach of having an early epi) and often this leads to not having one at all. This is very common with multigravidas, who often want one when either the birth is imminent or when they are no longer able to sit still to have it sited.

Most midwives I know, esp. with a first baby, advocate the see-how-you-go-and-keep-an-open-mind approach. No one knows how they are going to cope in labour.

[wispaxmas]

Ahh, glad to hear it's not entirely negative. I'll try to make sure I let them know how I feel.. I might have to get H up to seed on all this so he can be my advocate.

The statistics say that on average epidurals prolong pushing by 15 minutes only, and although the numbing can inhibit the need to push, most women are still able to push effectively. The weakening of contractions can easily be dealt with by administering syntocinon, which poses no threat to either mom or baby. In fact, the only possible bad side effect of epidural for baby is that it may require unnecessary antibiotics. All other side effects are myths with absolutely no evidence to back them up.

My point about the causal link is that the longer and harder a labour is in the first place, the more likely you are to request an epidural, and in a long labour you're more likely to require forceps or ventouse, so how much of an increase in risk is there really. In North America, where a much larger percentage of women choose epidurals from the start there is no correlating raise in number of assisted deliveries. So if in the UK most women only choose an epidural if the worst case, they're already at risk of needing an assisted delivery.

Rowboat, I guess I just have the opposite view to you. If modern medicine can make childbirth a less traumatic experience for me, why wouldn't I make use of my options? Obviously if my labour is extremely quick I won't have one, but first time labours tend to be long.

[babynelly2010]

Yes its about the funding and also NHS tent to not invest into treatment for prevention. I would of benefited greatly from epidural in my last labour as my organs started prolapsing before the labour and my baby was huge for my body frame and labour was very violent and that is when everything pretty much ripped apart. But because I had people looking at me in my pregnancy that simply did not care about what will happen to me in the future and did not listen to my concerns I will probably will be affected to the rest of my life because of a prolapse I acquired and the severely separated muscles. I will probably die sooner now as well because I can't exercise properly and there is going to be no funding from NHS to "fix" me properly I am sure either way. I plan to see specialist in the states once I return but it will probably cost me a pretty buck now and will require me to undergo number of surgeries...
It is a shame really, I work hard and pay plenty of taxes portion of which go to NHS but yet when I go for treatment there every one treats me like I am just a number and very quick to remind me that this is pretty good for free care. I work my butt off so NHS can be around so to me it is not free at all.

[Rhianna1980]

When you say midwife led unit , where is it? I have always assumed MLU was in a hospital and it is normally attached to consultant led unit just in case the lady needs to be wheeled off to theatre and / or intervention . Am I wrong assuming that? So your MLU is not in thr hospital? Where is they then?! and how far from hospital is it ?

[ZingSweetPea]

I love epidurals.

had it with four of ours (DS1, DS2, DS5 & DD)
only DS1 was a forceps delivery - but not related to epidural as his head was stuck at an awkward angle.

DS3 came far too quickly so no pain relief with him and DS4 was ELSC (footling breach)

#7 is due in July and if I can avoid another ELSC I'm definitely going for epidural again.
It's stength is easily controlled and the effect typically wears off by the time you are ready to push - which means I had no pain relief at all for the pushing phase with DS5 and DD (6th) - that helped me to stay in control as I could feel what I was doing.

I recommend epidurals to everyone, I don't see why go through the agony of contractions while the cervix is dilating - especially if the birth is induced (as it was for me with my first two).

hth

[wispaxmas]

Rhianna, it's at the hospital, but I've been informed that if there are no beds on the ward I wouldn't be able to be transferred unless it's an emergency and the baby is in distress, and also it would delay access to stronger pain relief, even if there are beds available. I'm going in the with open mind that I will see how it goes, and obviously not going to ask for an epidural right away (for all I know, I could be one of the lucky ones with a baby in my arms after only a couple hours!).

But then there's the fact that 40% of first time moms giving birth in birthing centres are transferred to the ward anyways, and is that disruption really necessary?

I'm just trying to weigh the pros and cons - What I'd be interested to see is the actual numbers. I know the overall rate of assisted delivery in the UK is 13% of all vaginal births. I would like to know the rate for just women who have the epidural and just for those who don't. I want to see how BIG the difference is. If the difference is small (say.. 10% vs 15%), I don't see the increase as too significant, but if the difference is large (5% vs 40%?), that would obviously effect decision-making.

Too often we are just told that such and such 'increases risk of' something or other. We aren't told what the increase IS.

Without easy access to these numbers, it's still helpful to look at overall numbers from these countries
UK rate of epidurals in VB is 25%.
USA rate of epi in VB is about 60%.
Canada rate of epi in VB is 55-60%.

UK rate of assisted delivery (forceps and ventouse) is 13%.
USA rate 5%.
Canada rate 13.1%

UK rate of caesarean sections 24%.
USA rate of caesarean sections 30% (could potentially explain the low rate of assisted delivery).
Canada rate of caesarian sections 26%.

Just looking at these numbers, which are for all births (the numbers don't differentiate between planned or emergency c-sections, for example), I can't imagine that the increased risk of assisted delivery is that big. Canada's rate of epidural use is more than twice that of the UK, but only have 0.1% higher rate of assisted delivery. The slightly more telling statistic is the caesarean section rate, which is 2% higher overall, though it would be helpful to know if this was due to more planned caesarean sections of more emergencies. I am happy to concede that there is an apparent increased risk in having a caesarean section if you have an epidural.

But then, also looking at numbers, if you have constant monitoring (epidural or not), you have an increased risk of c-section, as doctors and midwives often overreact and jump to the conclusion of foetal distress when a 'wait and see' response or even intermittent monitoring would then show that baby is in fact perfectly fine. If you have an epidural, you are more likely to have constant monitoring, and therefore more likely to end up with an EMCS due to the monitoring even without taking the epidural into account.

[NoComet]

I can't think of anything I'd have liked less, than a large needle near my spinal cord.

I'm fine with injections if I can watch, but I didn't find the idea of an epidural at all appealing.

But then I had DD2 at home so l'm probably the wrong person to ask.

[mrsmugoo]

"But then there's the fact that 40% of first time moms giving birth in birthing centres are transferred to the ward anyways, and is that disruption really necessary? " - Does anyone have a source for this stat?

I'm a FTM currently trying to decide between MLU attached to a hospital and a standalone birthing centre.

[wispaxmas]

For the stats on first time moms transferring to maternity wards from MLU:

NCCWCH. 2007. Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Centre for Women's and Children's Health. Clinical guideline. London: RCOG Press. www.nice.org.uk, pg 60.

(As cited on www.babycentre.co.uk/a548986/all-about-birth-centres#ixzz2myuiDkqh)

[brettgirl2]

The evidence doesn't appear to be that strong does it?

I think we have a rather strange culture where people like to compete about things. Birthing is unfortunately one of them, plus a belief (rather than knowledge) that natural is best.
For me personally natural was best, the thought of not being able to feel my legs scares the living daylights out of me, but that's me. I nearly had an epidural with dd1 though but then I was further on than they thought. My second labour only hurt for 40 minutes anyway (and at that point of my homebirth I asked for an epidural )

I'm with you though on the mindless promotion of what they see is right. I don't understand why they can't just sensibly give women the facts and then let them make up their own mind.

[wispaxmas]

Actually reading it, the stat is 38.6% for first time moms and 12.8% for others. This stat was from a 1995-6 study that found the average transfer rate was 26%.

In London in 2003 a study showed the average transfer rate increased to 30%; however, this study did not differentiate between first time and other mothers.

[Bue]

That statistic about transfers is correct, it comes from the Birthplace study. I think it's worth remembering however that a transfer from an in-hospital MLU to labour ward is nothing but a change of rooms, however. You just walk or have the bed wheeled down the corridor. It's not a big 'to do' like a transfer from home.

[wispaxmas]

brettgirl2, not being able to feel your legs is not an issue with low dose (mobile) epidurals, though, but unless you go looking for the information yourself you might not be told by your midwife.

[brettgirl2]

Why is transfer a big deal?

[brettgirl2]

And I doubt they were available......

[NomDeClavier]

I think there is a significant argument that MWs in the UK are not as good as managing labours with epidural as in other countries with higher rates. France has a hysterically high rate of epidural compared to the UK, although a lot are sited with a very low dose and known as a walking epidural. In the UK it's a numb legs and on the bed scenario more often than not and MWs focus on encouraging movement and managing an active labour which if your legs are numbed is more difficult. Once an epidural is sited it seems there's much less support for optimal positioning etc, and an inactive labour increases risk of needing assistance.