Negativity toward epidural in UK?

(80 Posts)
wispaxmas Sun 08-Dec-13 17:59:31

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.

Umlauf Wed 11-Dec-13 08:28:45

I haven't read the whole thread, but I recently had my pfb in Spain where I was told 90% of women have epidurals! more of the other 10% is through circumstance rather than choice. They thought it was really strange and barbaric when I told them it wasn't so common in the uk.

I had one and it was bloody brilliant.

minifingers Wed 11-Dec-13 09:25:34

Chunderella - maternity services are very stretched, and many women are getting a raw deal at the moment, not just women who want quick access to epidurals but also those who want one to one care, case loading care, and access to waterbirth services.

You are right that it is very hard to unpick the causal relationship between epidural and birth complications. The majority of challenging births involve an epidural. Perhaps you can argue that midwives and mothers don't know any other way of dealing with very long and dysfunctional labours any more. That's why I find the place of birth study findings so interesting. The reduction in serious interventions experienced by healthy women who opt to labour in settings where epidurals are unavailable is SO striking. It really does warrant further analysis.

All of my friends in Canada had natural births with midwives, two were at home. The 'culture' seemed very similar to the UK in terms of birth options. I think it probably depends where you live and your own attitudes.

I had an epidural with my first labour because it was prolonged and needed augmentation with syntocinon. By that point I believed I was too exhausted to deal with the heightened, strong contractions. My second was at home with a birth pool and gas and air. Although the contractions were much much stronger than with my first it was over in 2 hours and I had an incredible high afterwards. That alone is a reason not to have an epidural in my opinion. If I had my first labour to do over again I would have said no to the epidural even with augmentation because I think it slowed everything down. Also, although I couldn't feel the pain of the contractions, I had a very bad ache in my back and legs throughout the epidural and not being able to move made me very uncomfortable and unhappy. They tried resiting it but it made no difference. So epidural does not necessarily equal no discomfort.

Chunderella Wed 11-Dec-13 13:42:58

Yes it is true that maternity services are really stretched minifingers. That's why in some ways, I'm glad we're not actually sure what the cheapest way to give birth is overall, or even if there is one (I know the estimate the NHS uses, but there are some question marks over that one). Because you know that if we could prove it beyond a doubt, that's what we'd all end up having to do. I'm also far from convinced that scrimping now is cheaper in the long run. If you deny women access to things they need to birth safely like adequate pain relief, one to one and continuity of care, ELCS etc, you have to expect a cost later. The can gets kicked down the road, though. I'd be happy to see further work on the difference you mention, as long as it acknowledged both the difficulty and importance of trying to control for pain threshold and maternal attitudes to labour. It actually doesn't surprise me at all that women who are likely to have higher pain thresholds and/or particular beliefs about the desirability of drug free birth, naturalness of a long labour etc cope better with more difficult births than average. Particularly as there's often one to one care in the type of environment you mention.

'Barbaric' is a good description for what happens to some of us umlauf.

katieks Wed 11-Dec-13 14:24:20

With my first birth, I wanted a water birth. Therefore didn't want epidural. I didn't get the water birth as it was too late and I was pushing before pool filled (I was only at hospital for about 30min and they had me waiting in maternity ward kitchen whilst they 'got the room ready')?! At one point I was begging for an epidural but I believed them when they said it was too late, since it probably was.

With second birth, I wanted an epidural. Told it was too early. Asked again and again, eventually told it's now too late. I was soooo angry at that point because I just felt they had lied to me. Also, I specifically asked about a mobile epidural with midwife at last check up and she said they don't do them. Latter was at Swindon.

I think there is a epidural avoidance culture overall. Saying that, I did a week on labour ward as part of my degree course. That's 7x 12 hour shifts. EVERY epidural lady had intervention! Ventouse, Forceps, whatever. That's why I didn't want it with first birth. With second however, I really wanted one as I knew the pain was horrendous. We'll see what happens with next baby. I'm going to be asking for that epidural before I even arrive so that anaesthetist is there waiting and ready!

minifingers Wed 11-Dec-13 14:36:59

Also one to one care for women with epidurals Chunderella!

Can I just say, most women I know who opted for a homebirth don't feel they have particularly high pain thresholds. In fact the opposite is sometimes true. Certainly it was in my case. I knew I was likely to have a difficult labour and stayed away from the labour ward because I felt my pain would be unmanageable in that environment.

Chunderella Wed 11-Dec-13 14:37:23

I wanted a water birth with DD too. Wasn't very impressed when I found out I couldn't go in the pool because my waters had been broken over 24 hours, either! But wrt the women you mention katieks you'd also have to know what happened to the women who'd asked for epidural but didn't get it, in order to ascertain whether it was the epidural or the fact that a woman has got to the stage where she asks for one that caused the issue. Or maybe there were no women who asked for epidural and didn't get it, in which case tell me the name of the hospital right now!

minifingers Wed 11-Dec-13 14:40:54

Chunderella - in my opinion both birth and death are barbaric. One day we may find a way to avoid both of them, but at the moment it's part and parcel of being a human being. For me the only comfort is to be treated with compassion and kindness during these events, and to treat them as an opportunity for spiritual growth (until the day we can sanitise them out of existence - roll on Brave New World: babies growing in bottles and a branch of Dignitas on ever high street).

Chunderella Wed 11-Dec-13 14:43:46

Minifingers it's not so much that women who have homebirths etc have high pain thresholds. Just that if you know you can't cope with pain, you're more likely to want to be somewhere with drugs. That's not to say that women who choose homebirth must have higher pain thresholds than average, just that you have a powerful reason not to want a drug free birth if you're the sort of person who needs a paracetamol for every headache. Equally, if you know that pain relief doesn't agree with you, you're more likely to want to be somewhere that it isn't an option. There are MNers who've posted about choosing freestanding birth centres and homebirth for this very reason. That's what I mean by attitudes and pain thresholds.

I don't mean that to sound negative about people with low pain thresholds by the way, I'm a ponce myself or so I'm told by everyone who knows me!

Chunderella Wed 11-Dec-13 14:46:51

And to clarify, I strongly disagree that birth itself is barbaric though emphasise that you have every right to characterise it as you wish. Deliberate denial of pain relief to a human being in agony who has asked for it though, that fucking is.

blu3sky Wed 11-Dec-13 16:02:33

I've not read the full thread but wanted to mention as someone said there were no complications from epidurals. I never got a epi-avoidance vibe and the midwife suggested an epidural with my first when I wasn't coping with the syntocin (it really really ramps up the pain/contractions and I was in and out of conciousness. I was doing perfectly well without it but they needed the labour to speed up as they needed the bed sad ). It was meant to be a mobile epidural but the anaesthetist accidently went in too far and gave me a spinal block (used for c/s). That may have been to do with the double shift he was on and his obvious tiredness that the midwife commented on at the time. There's a migraine problem that happens in 1/200 for epis but 1/3 for spinals. You leak fluid from the injection site which lowers brain pressure causing pain when not horizontal. This happened to me. You have two options then - ten days entirely flat to naturally heal or a second spinal/blood patch which means more time in hospital. The other problem is infection. They were paranoid about it from having two spinals in two days. I'm still glad I had the epi with the syntocin because I was going into shock and it would have ended with a crash section otherwise which has a much longer recovery time.

TarkaTheOtter Wed 11-Dec-13 16:11:09

katieks my epidural was Swindon and whilst they never called it a mobile epidural it was patient-controlled and light enough that I could feel lots of pressure to push (just no pain). I don't know if I could have been mobile as I was on my back for other reasons - had drips in each arm and monitoring so moving around was v complicated - but I was definitely up and about very quickly afterwards. Ie before I left the delivery suite post birth.

TarkaTheOtter Wed 11-Dec-13 16:14:22

I agree Chunderella even if you are only looking at data where women have a choice over birth location the sample is still self-selecting. There is no "true" control group/random sample.

minifingers Wed 11-Dec-13 16:22:50

I think birth is pretty barbaric. The pain is absolutely unspeakable. Then there's the blood, the shit, the tears.

Chunderella Wed 11-Dec-13 16:36:23

Ah, well you see I didn't poo when giving birth so perhaps that's why we differ...

TarkaTheOtter Wed 11-Dec-13 17:08:55

I was given an epidural when I asked for one (once I felt that I wasn't coping with the pain) and I didn't find birth barbaric at all. It was very calm and I felt very clear-headed and in control.

minifingers Wed 11-Dec-13 17:23:29

Ah well Chunderella - it's not all about you. ;-)

Most women produce a stool during labour.

Chunderella Wed 11-Dec-13 17:43:18

I genuinely wonder if anyone has ever actually bothered to research that...

But yes from what I've heard most people do. I think the reason I didn't is because I'd done a big, bowel emptying poo just after my waters went. It was like my body wanted to eject everything simultaneously, so there wasn't anything else left in there when it came to pushing. It would definitely have come out if there had been!

janey68 Wed 11-Dec-13 18:13:36

I think the points about place of birth are really significant. Out of 8 of us first time mums in my NCT class, I was the only one opting for a MLU birth. 6 of the others could have chosen MLU (one was deemed high risk pregnancy so didn't have the option) That woman had a very medicalised birth but given the complicated pregnancy that was probably unavoidable. Of the other 6 women, 5 ended up with epidurals, and most had ventouse or forceps, episiotomy etc. Given that we were all low risk pregancies, we all had the option of MLU delivery and all of the group were keen to have as natural a birth as possible (hence attending NCT sessions which focused heavily on non invasive pain relief) it does seem that place of birth is very significant.

Chunderella Wed 11-Dec-13 20:44:39

Or being the type of person who will choose MLU, of course.

Chunderella Wed 11-Dec-13 20:46:44

Sorry, cut off there. Because people who are particularly keen on natural birth, as opposed to liking the idea, are going to be more likely to choose an environment they consider more likely to facilitate it.

londonkiwi Thu 12-Dec-13 09:32:00

For me, an epidural for DC1 was wonderful! I went into labour hoping for drug free but open to an epidural if it seemed the best option.

After 14 hours of active labour in which I was drug free and active (walking/bouncing on birth ball) I had remained 5cm dilated for at least 8 hours.

I then went on a syntocinon drip to intensify the contractions, so at this point decided to have an epidural as well.

Whilst lying flat on my back and pain-free I dilated to 10cm over a number of hours and was able to push my baby out as by that point the epidural had mostly worn off.

DC2 came only a few hours of active labour and gas and air were sufficient, but I have no regrets about an epidural for DC1!

minifingers Thu 12-Dec-13 10:07:37

"Or being the type of person who will choose MLU"

Chunderella - you can't categorise a person according to what sort of birth environment they choose. Many women choose to go to a MLU because they feel they will be safer there, because they know that their local labour ward is ridiculously busy or understaffed, or because they're frightened of needles and think they might be less likely to have to be poked with one in labour if they go to the birth centre. This doesn't mean that they think they're tough, or have massive confidence in their ability to cope in labour. Or that they are massively confident in their body's ability to labour well. Most go to an MLU thinking they will see how things go. Nobody knows how they will cope in labour, including those people who generally believe they have a low pain threshold. I can't tell you how many women I've met who start their birth story saying 'I'm an absolute wimp and terrified of pain, but I coped in labour and I don't know how'.

And lots of women choose homebirths because they've had hideous and traumatic births in hospital, on the labour ward. And I say that as someone who has worked as a volunteer homebirth support person for the NCT for 10 years. I have met and spoken to many, many women about their reasons for choosing to have their baby at home.

As for being 'keen on a natural birth' - are there actually people out there who WANT an emergency c/s or forceps delivery? As far as I can see ALL women who are not having a planned c/s would prefer to get their baby out vaginally and without the use of instruments (ie 'naturally'), if it can be done safely.

Chunderella Thu 12-Dec-13 14:45:44

Minifingers you're actually describing the sort of people who might choose MLU birth, and the reasons they might have. You make mine and Tarka's point: even when comparing low risk women in the different settings, the control groups are very different and this is because of maternal attitudes and experiences. That is why they need to also be considered in any research about the different outcomes in various settings.

Regarding being keen on a natural birth, presumably we are all aware that some women want epidurals and have no interest in attempting to see whether they can manage without one? It sounds like you're defining it as widely as possible, ie all women who deliver vaginally without augmentation or instruments, regardless of whether they have anaesthesia or not. In which case sure, every woman wants a natural birth apart from all the ones who don't (ELCS). But women who want a natural birth that involves an epidural and lots of opiates form a rather different control group to those who want a natural birth that involves staying well away from hospital and avoiding anaesthesia entirely, even where their medical histories are otherwise identical. And if we define natural birth in the more usual way, which means excluding epidurals, there are lots of women who have no interest in having one. Clearly these women are going to form a different control group again to those who want an MLU.

minifingers Thu 12-Dec-13 15:01:45

mrsmugoo - you need to ask for this information from the units you are choosing between - they will have it. National statistics are a bit pointless, as some units transfer vastly more mothers than others.

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