OBEM - why are they so anti-epidural?(151 Posts)
Just watching OBEM and I've been wondering every time I watch it, why are the midwives so anti epidurals? Is it the same all over England? There was another episode recently where a girl was practically begging for one and they talked her out of it (at 3cm) & I just don't know why. I know there are risks but they are minimal and thousands of women give birth every day with epidurals but watching that show would make you think they're a last resort.
I'm just curious really. I'm from Ireland where it's more normal for first time mums to have an epidural than not and it's almost presumed you will. Having had two kids I am a big fan of epidurals and secretly think giving birth without one is a bit mental!
(ps don't want to start a big debate, just wondering!)
I think it's because there is more chance of intervention when a woman is not mobile and there is very much a feeling of see if you can manage without.
An epidural was my worst fear as I'm needle phobic!
epidurals often slow labour down
I noticed the midwifes catsbumface too, wondered why it was a problem
An epidural brought my labour to a standstill.
However at the point that I
demanded asked for one, I was in so much pain that if they'd have handed me a gun I would happily have shot myself.
I haven't watched OBEM, but when I was 38 weeks pregnant with my first dc I was at a dinner party with an obs/gyn from Portugal who was really surprised to hear that epidurals are "opt-in" in the UK. In Portugal it is assumed that everyone will have an epidural (or at least this was the case in 2001) unless they specifically request not.
Cost. Time. Availability of anaesthetic team. Medieval midwives.
I waited a whole day to get an epidural with dd.
I decided to have an elective c section with ds so at least I was guaranteed pain relief. I got one on the nhs on birth trauma grounds.
It makes me so mad they try and talk women out of pain relief.
Having said that I had a major problem during my section and had three anaesthetists and a head consultant with me. If a woman wanted an epidural during that time she would have had a very very long wait.
I think cost is a major reason. And staff which is part of costs.
Yeah I know it can slow things down but that wouldn't bother me (would rather a few more hours with the pain relief!)
And as for intervention, the few who do get it on OBEM seem to give birth in varying positions do presumably they get light epidurals/ let it wear off which would reduce intervention. I do feel mad on behalf of the wOmen who are asking for one & bring offered a bath instead!!!
DrGoogle, me too, me too.
I don't get it either. Its one thing to point out that it could slow labour and there are risks involved in the epidural itself, but I really don't get why they try to talk women out of it. Your body, your pain, your choice.
The single best moment of my life, after 36 hours of contractions, was the moment the anesthetist walked in to my room
Personally I get very angry that sometimes to push/pressure to have a pain relief free birth comes from the medical profession itself. I don't think it helps. Just be open about any potential side-effects or risks that come with every form of pain relief, and then let the actual person in pain make the decisions.
Cascade of intervention - there's more chance of other intervention being required - they're talking about it now!
I needed to be able to move around and I didn't want monitoring, and I wanted a water birth (which didn't happen for other reasons). I was lucky and had a fast and fairly easy birth where the contractions were compulsive and forceful but not painful per se - so I turned down all forms of pain relief and was glad of it.
Yeah but I'm talking about women who do want an epidural and from what I can see on the show, the midwives try everything to put them off. Like it's a bad thing. I think it's an amazing invention!
The midwife said to one woman earlier, oh you could do it without an epidural and she was almost disappointed when the woman made it clear she wanted one. It just makes no sense to me.
I am pregnant and am currently attending NHS ante-natal classes.
The MW who is taking our classes says it is now NHS policy to try to encourage women to try to have a birth which is as natural as possible and to fully understand their options and possible consequences so they can make a fully informed decision.
The MW's should support whatever they decide though and not pull a face like they've just sucked piss off a nettle like that one did on OBEM.
See I don't even agree with their being a policy to encourage as natural birth as possible. I think before labour women are informed of pain relief options, risks etc and once they come in the midwives should just ask what they want and give it to them. By all means support them if they want a natural birth but butt out of the decision.
I was with my sister when she had her DD. My sister was struggling and in so much pain, we both begged the midwife for an epidural. The midwife just smirked and said my sister could manage without and would "feel like a real woman" if she gave birth without one. My sister scream and shouted and made a huge fuss but the midwife just ignored us and refused to help.
My poor sister suffered with severe PND and I'm sure it had everything to due with the traumatic birth. I can't watch OBEM, the way some of the midwives treat the women is just too upsetting.
Oddly enough the consultant I saw at the hospital pretty much insisted I had an epidural. I had been left on the ward all night and I have a recollection of the doctor leaning over me and saying "why is this woman still here, she's clearly in distress. Get her into a delivery room and get her an epidural NOW". Despite this even as I was being taken to the delivery room there were at least 3 midwives flapping around me all insisting that I shouldn't have one!
I was appalled by all tonight's midwives comments about the epidural. One said "it's a shame, without it she'd have given birth quicker and had a six hour discharge." So bloody what? I'd prefer a slow pain free labour to a fast and furious few hours if agony before being thrown out if my bed with hours.
I've had two epidurals and they saved my sanity. I have huge babies and needed stitching both times, how dare anyone judge me for not wanting to feel my vagina rip apart and then be slowly patched back together. I am seriously furious that women who choose to work as midwives would judge a woman for their pain relief choices.
I hope you got your epidural Ruth - what is their problem with them?
Shame for who though? A six hour discharge not ideal for everyone, but ideal for a hospital wanting to make space for the next patient. I was surprised at these comments too.
Actually I'm more surprised it is assumed you need one in Ireland. I didn't need it my first time, never asked for it. I am definitely not mental either.
Oh yes, I got it, and it was wonderful! The relief when the pain stopped was immense.
I do feel rather ashamed at my reaction to the nice lady who came in to offer us a coffee whilst I was waiting for the anaesthetist - "I don't want a fucking coffee, I want a fucking epidural!!!!"
I don't think it's 'mental' to give birth without an epidural - you couldn't pay me enough to have a needle in my back, the idea gives me the heebie jeebies and I was actually quite relieved when I had to have GA for my c-section with DD1 rather than a spinal or epidural - I had DD2 at home with gas & air and found it very manageable.
I do however think that if a woman wants an epidural and asks for one, she should get one and should not be left for hours in agony or treated like a child who is unable to make a (perfectly valid) choice for that type of pain relief. My birth plan both times clearly stated that I wanted to be offered an epidural if I had to be induced.
I had lunch with a friend who is an anaesthetist last week and interestingly, she said she didn't fancy the idea of an epidural as the risk of permanent nerve damage puts her off.
Nobody, but nobody, short of a life-threatening situation, is coming that near my spinal cord with a fucking big needle; oh, and cascade of intervention, slowing down labour, lack of mobility etc etc... I'm with the midwives on this.
I had a 40 hour labour, had very slow progression. At one point when I asked for pain relief the midwife said I couldn't have any but to get in the bath, where I screamed in agony for an hour. When they realised I wasn't progressing and in fact that my contractions had slowed down after they examined me I was offered an epidural and hormone drip. This was 30 hours into labour.
Before the intervention I did 1cm in 4 hours, in the 4 hours after the intervention I got to 10cm and the epidural was still working (although at one point it only worked down one side so I had contractions down my left side and not my right which was very strange!)
In the end I needed forceps as DSs heart rate was too variable. At no point did the midwife try to discourage me from having an epidural. Maybe I was very lucky.
Surely it should be the woman's decision, only she knows if she can cope with the pain
it's just this patronising tone that irks me.
I'm all for informed decision but his was all a bit one sided (the bits that were shown at least).
It is just so patronising not to let women choose. I have had 3 epidural births, two successful epidurals and one that just numbed my legs. All were inductions and the failed epidural was back to back baby, tearing and a nine pounder. Would not wish that on my worst enemy and I am no wimp! Epidurals rock!
I gave birth in Leeds with one of the midwives that features on the show
we had a discussion about epidural, she was very matter of fact, explained the risks but was happy to support my decision to have an epidural with dd1 -but then she could see I was exhausted (3 day induction anyone?) I certainly didn't feel any pressure not to have one
I think they get annoyed with the women who don't give it a go so to speak, asking for epidural very early on, won't try moving around etc
IMO if you can talk through a contraction you don't need an epidural
This is why I don't like OBEM - I think it fetishises the idea of childbirth being inevitably painful. I get very upset when I see or read about women being denied pain relief. It feels like we're going backwards - it's like the Victorian resistance to anaesthetics in childbirth because women "ought" to suffer in labour.
I think I'll delete this episode from sky plus as I kind of quite like watching it but it makes me really angry sometimes there are a couple of midwives I switch off when they are on duty.
Anyway back to the point the obsession with natural childbirth is ridiculous. It should be patient centred (like best practice in the rest of the NHS). Why are women considered incapable of choosing?
See, now I was watching OBEM when a woman had an epidural, and she was not feeling her contractions, so I believe she was pain free. Looked good, until she came to pushing the baby out and was doing his for an hour with no joy.
My two came out with a couple pushes like rockets. Don't know if that's what they mean though???? But also they were both quick labour s 7 and 3 hours from first contraction. Didn't really want an epidural, but towards the end of dd1s birth I wanted one.
I was throwing myself out of the birthing room to get home with dd2. Glad I didn't have one tbh. Who wants to be sat in a hospital, when home is where you'd be better settled with baby. And ewww to the needle in the back <shudders>
It's all about personal choice, and not everyone deals with pain effectively as others. We all have different thresholds.
I was denied pain relief in labour for 6 hideous hours during which i wanted to die, once I got it I dilated a lot faster. I had other complications but the withholding of pain relief was a huge factor in the severe PND and PTSD I suffered from. I am pregnant with DC2 and have been been diagnosed with secondary tokophobia as a result of my first experience so will most likely be having an ELCS. I really believe that if the midwives had been more humane and sympathetic I would not have suffered so badly mentally.
If it's a cost issue that is insane as I have cost the NHS a fortune since the birth, although on the mental health side.
I'm Irish as well and really envy my sisters managed birth experiences where pain relief was offered before she even asked.
When I say it's the norm, not everyone has one and they don't have them ready & waiting when you come in or anything. But if you ask for one and you're in active labour, it's not a huge deal.
For those saying they didn't have one/didn't want one etc, that's great for you but do you not agree that women who do want one should be respected and given one without making them feel it's a negative thing?
I was talked into an epidural at 3cm and I have very mixed feelings about it tbh. I had been having contractions for 2 days to very little avail and it actually speeded things up - I was fully dilated within the hour. But then the birth stalled and I ended up with a syntocin drip (!), ventouse and episiotomy. I found it disorientating to lose the pain and almost even the sensation of the contractions, although it was a blessed relief to have a break from that unproductive pain. I think I would have preferred to be helped, at that stage, to help progress the birth by being active - I walked around a lot when I went into labour the second time and turned up at the hospital at 9cm.
Oh I got a right catsbum mouth when I insisted on an epidural with DS - the midwife actually said to me "you can't just come in and ask for an epidural" (I'd stayed at home for a while and then it was snowing so it took longer than planned to get to the hosptial, so I'd only been there about an hour at this point) I replied with what DH calls my "death stare" and "I think you'll find I just did, get someone in here to sort it now." I think she got that it wasn't going to be something she could talk me out of - but she was a right moody cow for the rest of her shift. Was very glad that I got someone else a few hours later who actually was rather cheery.
Our NHS trust won't offer any other pain relief apart from paracetamol or tens until you are 5cm, then you can have entinox/epidural/diamorphine. So I'm always amazed when watching OBEM that they get entinox at such early stages or other pain relief.
I think they are because:
They know that women often manage birth best when they feel empowered to do it naturally ie not made to feel the pain is unmanageable or that you have to have pain relief to cope.
I gave birth to DS at 9 lbs plus with only g and a for the first stage and nothing at all for the last 3 hours which were augmented on the drip. I am so glad I didn't have an epidural!
I think if I was a mw i think as a first step I'd be saying you can do it yourself to try to empower the woman giving birth.
BUT only the labouring woman knows how much pain she is in. If she is adamant she wants one even with the best support then every labouring woman should get one immediately.
At the unit where I gave birth the average time from requesting an epidural to getting one is v short. However, their rate of epidurals is much much lower than the national average because they offer almost 100% one to one support in labour, so women cope much better with the pain.
I think you know if you want one, and we shouldn't be treated like children asking for biscuits before dinner.
I wasn't happy about the whole needle thing, but when a shot of morphine hadn't touched it, I hadn't slept in 3 days, and the syntocin was all the way up I changed my mind - the amazing relief from the continuous, unproductive pain actually had me giggling (or perhaps that was the morphine still hanging around)
This time around I shall be asking my consultant about what all these chances are so I can factor it all into my choice of VBAC or ELCS
For those saying they didn't want an epidural I totally respect that but it should all be about informed choice. Some of you made informed decisions not to have an epi, you got supported in that choice, why can't women who make the opposite choice be equally supported? I'm fed up with the idea that women panic and want an epidural and its not a rational decision, for many it is very rational.
Before my first epidural I'd been in labour 36 hours and was in so much pain and so tense that I could not wee. The fullness of my bladder prevented the baby descending and without the head coming further down I wasn't dilating. The epidural sorted all that, I relaxed and everything speeded up. It was a sensible decision. Thank God I made that decision as it later turned out that my 10lbs baby was the wrong way round with her head titled and I needed forceps, if I hadn't had an epidural in place already I'd have probably ended up with a general anaesthetic and a CS.
With both my epidurals I chose to let them wear off at 9cm so I could feel to push. It's that sort of tip the midwives should be giving rather than just disapproving. As a result of the informed choice to let the epi run down I could feel to push. Epidurals can be managed sensibly.
I am now 7 months with DC3. This time I will ask for an epi as soon as I am 4cm and labour is established. Knowing my past history I will probably have been in pre-labour for over 24 hours by this stage. The epi will allow me to stay calm and regain by strength. At 9cm I shall ask for it to be turned off and I will push with sensation. If I give birth to my third baby that has a 99% head and weighs over 10lbs then I know I will tear again and I will be thankful the epi is still in place and can be cranked up again for stitching. These are my choices and the midwives should support me in them. Is that too much to ask??
All this disapproval, judgyness and one-up-man ship is so bloody English and so bloody female. I hate it.
I haven't read all through this thread, but in my case, I had a nasty long labour, needed epi, everything slowed down completely and I stalled, and then needed intervention in the form of forceps.
This caused me to tear right through my back passage and now 2 years later I still bleed when doing a bowl movement, sex is painful, and I sometimes can't contain my "gas" in public, utter embarrassment. I'm so worried I've done permanent damage and incontinence is a permanent issue.
How I wished I had just coped with a few more hours of pain to have stayed mobile, and possibly not have torn and have these issues now. This is my own experience and opinion though.
Babyblabber - can I ask whether you/your friends went public/private/semi-private in Ireland? Because as far as I am aware, there is a huge difference on availability of epidural depending on that, and depending on what hospital you attend (particularly in Dublin).
The plural of anecdote isn't data - but I certainly know of people refused/talked out of epidurals in Ireland. (I was kind of talked out of one - by the time I asked for one I was told it was too late) I certainly wouldn't hold Irish maternity practices up as hugely enviable to be honest.
viola I didn't want to say it, but the treatment of the Indian dentist was particularly distressing. IMHO way worse than the push for natural birth here.
I got a midwife trying to talk me out of a dose of codeine post section! I think some of them have it ingrained to treat us like naughty children.
I only saw the bit where she said she wouldn't go in the water because she wanted an epidural and the mw said 'you can do it without an epidural' and the american woman said 'no way, i am the sort of person who takes drugs at the first sign of a headache, i want an epidural' and the mw said 'ok then'.
What happened after that? was she refused one? I think that exchange was fair enough tbh and not patronising.
I want to try to avoid an epidural as i want the pool and walking around as much as possible, but if i end up immobile for any reason (spd, monitoring, whatever) then i will want an epidural.
OLTT - I genuinely hadn't even thought about that and to be honest think that's a whole different issue than the general treatment of women in labour - but there's certainly a lot of interesting attitudes among midwives in Ireland too
(Saying that, all the midwives I had were incredible - with the exception of one who was just too "nice" and sickly sweet. So I'm not sure I'm qualified to speak directly about the failings, although they are well known and I've heard some very hard stories from friends)
Viola no I don't think Irish hospital are in any way enviable but just compared to watching OBEM I think they seem more open to epidurals. Most of my friends have been private or semi private but the consultant would be no where near them at the time of the epidural. Most in Dublin hospitals. The only person I know who was talked out of one had said she didn't want one all along, then the pain got so bad she asked for one but she was 8cm so they told her the baby would be born within 2 hours and did she think she could go without and she agreed. Another friend was told to get it before they started a syntocin drip as her contractions would be so intense so the midwives almost pushed it on her but she had planned on having one all along.
I gave birth in France where it was an epidural or nothing when it came to pain relief. They laughed their heads off when I mentioned gas and air - "Like your Queen Victoria". I had one - though felt slightly wary in view of having read lots of English books on childbirth - I had a 7 hour labour from start to finish, pain free, pushed my dd out with about six pushes. LOVED IT!!!! Ds was even quicker and just as enjoyable. I also stayed in for five days in my own room (standard in the public hospital in Paris where I gave birth) - bliss. I think the reason we are so anti-epidural in the UK is cost pure and simple. More epidurals means more anaesthetists and I think as someone mentioned down thread there is an expectation that women should suffer. There is no such expectation in France - giving birth without an epidural is not referred to as natural childbirth it is referred to as giving birth without an epidural and quite frankly why would you.
I went the natural route for both my DC and was quite adamant I didn't want an epidural. And I am not mental!! But I totally understand that every woman is different, deals with pain differently and is entitled to decide how they want their childbirth to go. I would never treat someone in a negative way because they want to choose the epidural route.
I do however think that there is a problem with some woman getting so worked up about what a horrendous experience childbirth it as they only hear the horror stories and so they go into the hospital dead set on epidurals. Its all very well the NHS wanting to promote natural childbirth but they also need to change the way the childbirth is talked about generally. I found my antenatal classes quite vague in discussing pain and I think it would be useful to have mothers talking about their positive birth stories alongside the pain relief options.
I was offered a water bath and also (later) an epidural, but in the event had neither due to lack of time. I'm glad I didn't have an epidural as the catheter and potential problems were much more frightening to me than a bit of pain. I think I have a high pain threshold and low fear threshold
As for the midwive's attitude, the younger midwife at my labour was bl**dy awful, and the older lady had a very enlightened flexible approach and was very supportive and reassuring. As with any job there are good employees and bad ones. I'm glad I had one good one, and she was senior, as the other midwife insisted I mustn't push as I was only 4cm dilated. I was actually 10cm, needed to push and using all my energy to fight against the contractions was not a good idea.
I think it's an in and out thing as well as slowing it down, it also stops an active labour. I had one btw so I'm not anti at all!
The midwifes at leeds seem amazing very encouraging and involved I had none of that. So I wonder if they 'know' you can do it with a bit of encouragement, which has been proven when you watch the show.
Do they actually slow things down? How can anyone know? Even just looking anecdotely on here you can see that some people who didn't have an epidural had long labours and some who did (such as myself) had short ones and of course the reverse is true. Surely the longer your labour the more you need an epidural (so you can have a bit of a snooze through the contractions and save your strength for the pushing). We are told in the UK that having an epidural increases the likelihood of intervention, but some women will need intervention anyway. If you've been in labour for over 24 hours (without an epidural) it's not surprising that you are too knackered by the end to make much of a fist of the actual birth.
lillian - they have the statistics. there are over 800,000 births in a year in the uk and for every single one they know if the woman had an epidural or not. So it is possible to know if women who have them generally have longer labours, it then takes more detailed studies to try to work out if the epidural causes the labour to lengthen or the long labour causes an epidural to be requested... but that's what researchers do, they study these questions carefully and try to allow for all compounding factors and variables. Same goes for studies of interventions.... lots and lots of researchers working to try to answer these questions... because it's important to try to understand and that's what medical researchers do.
I think it slows it down as you end up stuck in a rubbish position. But I do agree I'm not sure how statistics can prove it
I CAN have a tooth drilled with no anaesthetic but people would consider me either well hard or bonkers.
As it is I don't get any pain relief in birth, I don't dilate until right at the end but do the awful pain bit to no apparent effect so I'm not allowed more than paracetamol, never mind epidurals! Again, the whole nauggty schoolgirl language of being allowed stuff and not being able to be trusted that you can judge your own pain or progress of labour- even if you have a proven history of rapid deliveries... and don't get me started on how they talk to you like you've had a lobotomy instead of a baby on post natal wards either.
Seems to still be accepted to infantalize women and know what's best for them far far too much in birth.
Disclaimer- currently a prisoner on a post natal ward so my being treated like an idiot hackles are up anyway on the subject!
It's not always simply about the pain, though, and that's what frustrates me. Like other women on this thread I had a ridiculously long early labour, active contractions, very regular, very painful but it still took a day and a half to get to 4cm and be considered for any pain relief or to be allowed near a pool or bath. A day and a half of standing up, walking around, not being able to sit or lie because it was too painful, not eating, not really drinking - I wasn't in a position to carry on.
I remember being aware that the pain, while very bad, wasn't screamingly hideous, and maybe if it had only taken a few hours to get to that stage I would have carried on with G&A or maybe pethidine to get through the next few hours of dilation. But I was beyond exhausted, so I asked for an epidural because I knew I needed some rest before coping with birth itself (though in the end I had a emcs because my baby was ill). I honestly think that if I didn't have an epidural and had progressed on to vb, there would have been more intervention because I wouldn't have had any reserves to draw on to actively push.
There is a need for guidelines and for the majority of women, 4/5cm dilation before being eligible for serious pain relief is probably ok. But I really believe that the length of time women have been in pain for should be taken in to consideration as well.
I asked this a while ago, ds3 is 11 weeks old. I had a quick labour and was desperate for an epidural when I got to the hospital, I was 6cm or so - kept being fobbed off, Oh I just have to fill in this form, Oh I've got to do this, Oh your baby will be here very soon, etc etc
FINALLY I got one about 20 minutes before he was born
I had to beg, literally
At one point she even gave me a bloody sweep which I hadn't wanted and told me afterwards
I presume to speed things up, when all I wanted was to slow them down and get some pain relief.
I have no idea why they didn't want me to have one. I gave birth 6 years ago with nothing and I didn't get a medal that time. I had nothing to prove to her or to myself.
oh yes I had the 'you can do it without' implied over and over...yes I know I can, I've done it before without any pain relief. That's how I know I want one!!!
rooneymara my even classier NHS hospital refused to examine me even. They told me they were too busy so they can't escalate my case. I was left in the antenatal ward with my DH, no midwife for 2.5 days in labour. Because I wasn't in 'active' labour, all I got was codeine, my tens machine and a birth ball.
So no guideline is going to help just because it says women after 4/5 cm dilated are to get x&y pain relief. All they have to do is not put you into the system by not examining you.
I was finally attended to at fully dilated after 2.5 days. That's when I was moved to the delivery room to push for an hour.
Thank god I have a high pain threshold. All through those 2 days I can hear the cries of the women in the rooms next to me. They sounded really really awful.
I saw the dinner ladies more than midwives during my stay. They were lovely getting my meals to my room, and popping in to refill my tea etc. I can't help but think they felt sorry for us.
I dont think midwives can win. They're damned if they do and damned if they dont. They are in a very difficult position. Every decision they make directly affects the womans experience, and could well come back to bite themon the arse. How many women would regret an epidural? How many women would have serious intervention because they had an epidural?
There are arguments for and against epidurals, I ended up asking for one when in labour, but in hindsight Im glad I didnt.
I'll seriously try to avoid any kind of pain relief next time. Even Entonox makes me lose long periods of time, Pethedine put me completely out of my skull for hours. I missed the entire birth. Next time, I want to be mobile and hopefully be in a position other than on my back.
I watched OBEM last night and IMO the midwife said what she did about the epidural because the parents had a small child hanging around, and not having one would have meant a quicker discharge and less childcare issues. I dont think she was being funny at all. It was just her opinion.
Yes, the midwife who tried to put me off having codeine after my section had an opinion too. But it was not her call to make. It was mine. As it should be. I am not five and she's not my mum!
But whether they 'know' you can do it or not is irrelevant. Of course I could give birth without an epidural as millions of women have before me but I don't ever want to. Each to their own & brill if you want to do it without but if you want one I think you should get it as soon as you ask (so long as you're in labour!)
I also disagree with the use of the term natural birth, now that I think about it. If we went with nature we'd still have a life expectancy of 50, women would frequently die in childbirth and we wouldn't use contraception. An epidural, like chemotherapy, heart stents, the pill etc is something that we've developed to improve our lives so I just don't get why those midwives see it as a bad thing.
I also HATE the term 'natural labour'. And 'failure to
Just explain to the person who is actually suffering from the pain what the pros and cons of each type of pain relief is, and let them make the decision.
It does seem to be a cultural thing. That's how we do it in the UK - there is an entire industry in the form of the NCT to brainwash us into believing that this is the best way. I realised that I had been slightly brainwashed when attending ante natal classes in France and I was the only one asking "What if you don't want an epidural". The other women in the class couldn't think why you wouldn't want one. The default position in France seems to be that you can have one - it's not obligatory, but it is a perfectly normal and acceptable request. The midwife's line was that the length and progress of your labour was pretty much genetically predetermined and an epidural wouldn't make any difference - no doubt they have their own statistics to back this up.
but that midwife was just filmed voicing her opinion. She didnt inflict it on the mother.
Dont forget OBEM is edited. Its not an impartial view.
Each to their own & brill if you want to do it without but if you want one I think you should get it as soon as you ask (so long as you're in labour!)
And what about when there just arent the resources in the NHS? Or you book yourself into a birthing unit that doesn't offer epidurals, but you change your mind half way through?
I also think it is interesting that the woman insisting on an epidural, not being swayed by any guff about waiting to see what happened, was not British. Her birth looked pretty straightforward to me - the only downside (as far as the midwife was concerned) was that they couldn't boot her out after six hours.
"An epidural, like chemotherapy, heart stents, the pill etc is something that we've developed to improve our lives so I just don't get why those midwives see it as a bad thing."
Childbirth isn't an illness or disease. You cannot compare the use of pain relief in labour to chemotherapy. Taking the pill is for convenience, just like driving rather than walking everywhere, but that doesn't neccessarily mean it's good for you.
The reasoning behind not giving an epidural on the basis that it can slow labour down isn't just because the hospitals want to get rid of your as quickly as possible, it's because a baby is more likely to become distressed if labour is slowed down.
I absolutely agree that women should be given the pain relief they need but it's so important to remember that the NHS aren't the enemy and maybe the reasoning behind the stance taken in respect of pain relief is more sound than some seem to realise.
Interesting LillianGish. I've just given birth in France too except all your positives are my negatives: I hated the expectation I would have an epi and that I would have an extended break in hospital. In fact, I did neither . Having argued here about my distaste in general for epidurals, I do also accept OP's issue with UK MWs. I think pain sensation and reaction to pain is so individual that it's patronising of anyone to think they can gauge someone else's suffering. Epis have upsides too - less tearing as the push reflex is reduced/absent so the final stage is more controlled, more relaxed perineum etc. Who could possibly stand by watching an extented labour and not want to relieve someone's pain so they can rest a little ?
I had, fortunately, a quick labour but if, at its most painful point, I didn't progress and I had to feel that pain for an hour or more, I would've been crying out for that bloody epi for sure!
Ive just watched it again. I still dont think the midwife was after an empty bed. She said "If she hadn't have had the epidural, she would have probably delivered, and got a six hour discharge" Given that at the time the epidural was put in the father was at home minding the toddler, the midwife didnt say "we could have sent her home on a six hour discharge" or the like, and you only heard one sentence of what could have been an extensive conversation, IMO she wasnt being at all 'off' or insensitive.
I feel that I was treated well in labour with regard to pain relief, but I did spend a lot of time in hospital with gallstones during one pregnancy, which were every bit as painful as labour, if not moreso. In my experience, midwives were very anti pain relief. I was being prescribed pain relief by the consultant, who had talked to me about pros and cons, and about side effects, and about how they wouldn't suggest pain relief if they didn't believe it to be safe. Then he wrote it in my notes, disappeared, and the midwives gave me paracetamol instead, supposedly on the grounds that I would need to learn to tolerate more pain in anticipation of the upcoming birth .
My experience in hospitals at every stage was that doctors were much much more compassionate than the midwives, although I'm not of the opinion that all midwives are nasty and sadistic, just that their training seems to somehow make them immune to other people's pain.
I think midwives have a vested interest in protecting their own professional turf, and that is why so many of them seem to be resistant to medical management of pain. Women should be trusted to make their own decisions.
My experience was the opposite, they mws kept pushing me to have an epidural (back to back baby) and I kept refusing. I didn't want one, I don't want one this time either, and not I'm not "mental"
Then you got what you wanted MyNameIsAnAnagram. Imagine if they'd just ignored you and forced one on you anyway - that's what it's like for women who really want one, but can't have one. Surely it's a question of choice - and women should be allowed to make up their own minds.
Sorry, I must have missed the bit in my post where I said I didn't think women should be allowed them if they asked for one.
My point was that not all mws are anti epidural.
secretly think giving birth without one is a bit mental!
I had an epidural with dd2, and spent the next 2 hours slipping in and out of conciousness, bloody terrifying!
I also have a friend who ended up with permanent damage following a bodged epidural, leading to leaking of spinal fluid, and a chronic headache which lasted a year!
Comparing it to chemo is daft, chemo is a poison with awful side effects, honestly not something you would choose to have, unless the consuequences of not having it, weren't pretty dire.
Sorry Anagram - point taken.
I was 3 weeks overdue and was in to be induced. Before hooking the IV up they offered me an epidural straight away as apparently it is more painful than a natural labor. I managed 3 hours before saying "you were right! Gimme that beautiful epidural!" And she went running off to organise! So my midwife was very pro epidural in my case!
Each to their own & brill if you want to do it without but if you want one I think you should get it as soon as you ask (so long as you're in labour!)
And what about when there just arent the resources in the NHS? Or you book yourself into a birthing unit that doesn't offer epidurals, but you change your mind half way through?
Fwiw I am far scareder of the needle in the spine than the labour pain
CatPussinacrownofthorns, obviously that's not what I'm talking about. My post is about midwives discouraging epidurals, nothing to do with resources (although it seems a good few people think resources are the reason for the attitude)
Every woman deals with labour differently, many women can handle labour with no pain relief. I think a lot of women ask for an epidural early because they are scared of the pain later, midwives want you to wait until you see how you are handling it. Although, maybe if you felt that you would be given the epidural as soon as you asked for it you would be more willing to wait and see!
And minimising interventions is better for the baby and makes recovery easier (in general)
But how do you know its not about the resources? Surely "you can do this" or "Its too late" or "come on now, you can cope" is more acceptable than "You cant have one because theres no anaesthetist" or "we cant afford to give you one"? Or even "you cant have one because we dont have enough midwives to give you one to one care"
And there are lots of MLU and delivery wards that just dont offer them. IT's not feasible to just get one because you decide you want one.
Does a midwife have to stay with the mother once the epidural is in?
I didnt get an epidural because the anaesthetist was dealing with an emergency.
I was under the impression that once you get an epidural they have to stay with you.
possibly regional or just wrong
I thought you had to have one to one care on gas and air as well, though?
I don't know it's not all about the resources! That was the point, I was curious as to why they seem so anti them. If resources is the reason then that's my answer!
I agree with skibunny it seems some people ask really early instead of trying to cope a bit longer, and maybe surprising themselves. Of course women who've been labouring for hours/ days should get epidural. No questions asked.
The problem with epidurals is increased interventions, therefore more complications for mum and baby. It's not purely about money but also outcomes and it therefore makes sense for midwives to encourage women to try to continue without (within reason)
I don't think everyone should be offered one as a matter of course, nor do I think you're mental if you don't want one.
My labour was painful (I wanted to die), but I really really didn't want an epidural as I knew it could mean a cascade of intervention, forceps? EEK!
However - if you want one, you should be able to have one, no questions asked. If you were in an horrific road accident and having your leg amputated, they wouldn't think twice about giving you pain relief. Childbirth should be no different.
I was given an epidural with my DS2, almost as soon as I asked for it, despite not really needing one and being so far progressed with a quick labour, that it made almost no difference at all. I was fed up because I couldn't go in the birth centre and thought as he was my last baby, I'd 'treat' myself to the epidural, despite a previous quick birth on G & A. I still wish I hadn't had one, two years later. The needle was horrible, I was terrified that I couldn't stay still long enough for them to stick the needle in my back because my contractions were coming in waves and he was born 30 minutes later. I felt everything and just ended up with a backache for 2 days after he was born. I think at the time, midwives were under mounting criticism from people re epidurals, so they just gave them out. I don't think that just handing out epidurals without question is the right way to go, just because thats the way it's done in other countries.
MWs don't like epidurals because the woman has to be kept under closer observation- more work basically
I never wanted one, then I had to be induced and was hooked up to some kind of drip to help my contractions along. The midwives tried talking me into it, saying the contractions were much more painful with the drip. I said no.
I don't know how long exactly I lasted, but I still remember the pain now. I could cope with gas and air for a bit, but they just didn't go away. I had no let up between each contraction. It was just the worse thing ever.
Then I had an epidural, the relief was immense. However, babies heart beat started dropping and they rushed me off for a EMCS.
Its so difficult. I don't think people have any idea what it may be like. The option should be there for everyone, regardless of circumstance. However, I don't think its the best thing to just ask for one straight away, you should see how it progresses.
WRT The midwife on OBEM I saw her comment as being about being able to go home to her family. The mother was on her own because the father was looking after their toddler, instead of being able to go home and rest in comfort she'd have had a night on the postnatal word (or hell on earth as I like to think of it).
I know doctors who say they can often tell how well a patient is likely to cope with pain (not just childbirth, any pain) and MWs encouraging people to see how it goes is part of that, plus of course people often ask for pain relief as they go into transition so it makes sense to check it's not just that. Obviously they won't always get it wrong, and our personal perception of pain varies so much anyway. I quite enjoy natural labour (got 3DC) but hated my root canal treatment! So a doc might think 'oh, she'll be a stoic one' (based on how I am in labour) and then I'll stub my toe and scream the building down.
I must watch the wrong OBEM episodes - practically every one I see has the mum labouring flat on her back and ending up with an epidural.
MrsJLS85 Sorry to hear about your tear but there is no evidence that epidurals do increase the chance of tearing overall. Epidurals may slightly increase instrumental deliveries (by about 1 in 20) but they also reduce the risk of tears caused by uncontrollable pushing. Tears can be horrible but despite what some midwives say, epidurals do not increase their incidence.
It isn't just the issue of putting women off epidurals, it is also that many midwives will blame everything that goes wrong in childbirth on the epidural.
I really do believe giving birth is more painful for some women than it is for others. With DD1 I was contracting and when I got to hospital (after waters went), I was 3cm and it was a doddle. However, fearing the pain, I asked for an epidural and got one. I progressed very quickly (3-10 in 5 hours) but did require forceps, although I'm not entirely convinced that's because of the epidural.
With DD2 I was induced (never doing that avian!) and the consultant said I should have one as he wanted to break my waters and he knew I wanted one. I was 4cm when my waters were broken and Ive had period pains worse than those contractions. She was also born via forceps, though came out much faster than DD1.
I would still opt to have an epidural. I think my body doesn't register the pain until after my waters have broken. It doesn't slow my labour down at all and makes things much more bearable for me.
I do think its extremely barbaric to give a woman syntocin without an epidural. In the US you are given an epidural before syntocin but not here which I really don't understand!
I had an epidural and the midwife did not stop with me the whole time
which was just as well as she was a right moody cow although I had DH there, perhaps if you are labouring without a birth partner htey have to stay with you once it's in...
The reason they tried to encourage her to go without was because they believed that she would labour faster and be able to go home to her husband and little girl. I agreed with them actually and felt really sad for her being by herself as clearly they didn't have anyone to watch their daughter. I think they were being really caring. And there is nothing wrong with trying to encourage women to give an epidural free birth a go. Jeez, some of you need to wind your necks in.
Midwives' whole ethos is to promote normal birth. Epidurals do disrupt the normal physiology of birth and necessitate syntocinon augmentation, and often catheterisation, continuous monitoring, higher rates of episiotomy. Mothers who have one have a radically different postnatal hormonal profile in the hours after birth from women who've had an unmedicated labour. I appreciate that most people don't think that's important, but midwives study the minutae of birth - the finer points of mother and baby interaction in the hours after labour and how these are subtly influenced by hormonal physiology, hence many of them seeing epidurals as a complex intervention.
"Epidurals may slightly increase instrumental deliveries (by about 1 in 20) but they also reduce the risk of tears caused by uncontrollable pushing.@
As for the view that epidurals are not linked with higher rates of c/s, instrumental births etc (except slightly, for first time mothers), which is the advice given in the NICE guidelines, this is based on a meta-analysis of studies almost all of which compare women who are giving birth with epidurals with women who have been sedated with pethidine or other opioids. There are only a TINY number of studies that compare women labouring with epidurals with women having unmedicated labours.
In other words you are comparing outcomes for women having epidurals, with women who are having supine labours, who have been given a drug which is KNOWN to be associated with non-reassuring fetal heart rate traces in labour, and with a group where the majority of women will be having their labours monitored with CTG, something also associated with higher rates of emergency c/s in low risk mothers.
I personally think the evidence from the Place of Birth study is very interesting - that it shows low risk, healthy mums who opt to labour in a setting where epidurals are generally the most accessible (consultant led units) have double the rates of emergency c/s than women who have opted to labour in settings (home or midwife led unit) where an epidural requires transfer and is therefore less accessible.
FWIW I haven't seen the episode of OBEM from the other night. Will watch it this weekend. IMO the conditions women are subjected to in in big, busy consultant led units like the one in the programme generally necessitate epidurals except in the situation where the mothers labour is completely straightforward and quick. Labour is hard enough for most people without syntocinon/being expected to lie on your back/continuous monitoring.
This is an interesting article.
I think the cost gets taken from their wages.
I think the comparisons, like the one you quote shag, are very interesting but there are always a lot of factors involved that are probably very hard to include in such studies. For example, I don't know how other areas are set up, but in my area the MLU and the CLU are in the same building; women are automatically assessed in the MLU, and then can move up to the CLU if they request an epidural or need closer monitoring. So the choice about where to labour is made during labour, not before.
Thus is an area like this, the option of an epidural is available to women wherever they labour. It's an easy transfer from one unit to the other, and I know plenty of women who did it. The MLU, however, is set up like a traditional, separate MLU, all very nice, calming, less medicalised, baths and pools and balls etc, so I imagine it would be the same for a mum labouring in it as it would be if they were in a standalone MLU.
Situations like that skew the figures a little, I imagine, though I appreciate it is very difficult to measure this. It would be interesting to see the rates of epidural, intervention and emcs in this set-up, though.
I think a woman should be informed of all the options and then given the choice - period. These stories of women waiting literally hours and hours for pain relief is appalling. Cascade of intervention be damned - if a woman is made fully away of the possible consequences and still wants one she should be given one as soon as a qualified member of staff is available to give her one - not to be told to wait and see.
I would love to see the actual evidence for a cascade of intervention with epidurals.
They have done a number of studies where they looked at interventions in births in hospitals before an 'on request' epidural service was introduced and then after.
These so called 'impact studies' found no difference and they are the best evidence that the 'cascade of intervention' is a myth.
What they did discover was that women who requested epidurals were in more pain because they were the ones experiencing the more difficult labours. Those women who strolled into hospital and popped the baby in five minutes with no complications obviously didn't ask for epidurals.
That's a good point, ushy, and what I've wanted to say. No two women's labours or pain are comparable. A lot of women will be in more pain, or suffering more (however you want to put it) because there is naturally something going on with their body and their labour that is causing that. There's a high chance that reason would have caused an intervention anyway. There's no real way of knowing, that's not something that I imagine can be scientifically measured.
There is absolutely nothing wrong with encouraging a woman to have an epidural free labour. There is nothing wrong with offering pain relief on a slow and sliding scale and seeing how the woman manages in water, then with G&A etc.
But it's the push back - the "oh, really, are you sure? But you can manage it, it would be so disappointing if you did have an epidural" - that is frankly insulting to a woman in pain.
Ushey - from an anectodal POV - I can tell you that my epidural given to me after being at 3cm for around 12 hours and still at that stage 2 hours after ARM did indeed not lead to a cascade of interventions. I went from 3 - 10 in less than 15 minutes and DS was out shortly after.
Epidurals are not all bad. As you found trustissues75, they can enable women to relax and dilate. As Thurlow says, women feel these things differently and every labour a women experiences will be felt differently - dependant on stress, baby's positioning etc. What I object to is too much pushing an agenda - whether that be pro-epi or anti-epi. Stick to the facts. Give women a real choice. My experience (abroad) is a pro-epi culture. Perhaps the UK MWs have swung too much to the opposite extreme?
I have always been anti epidural, partly because I have a massive needle phobia. My 3 DC's were all born with G+A and pethidin. I had drips with DC1 and DC3.
However, DD was born 11 weeks ago. After being in labour for 24 hours - 6 of them in the labour suite, DD got stuck, and the contractions slowed down. I then BEGGED for an epidural, the pain was unbearable, I was literally losing my mind with the pain. I was transferred to the high dependency unit and lucky the consultant who saw me said that I needed an epidural.
I ended up with forceps and being cut and stitched up and didnt feel a thing. I was so grateful for the epidural as I couldnt cope with the pain. The relief was immense.
I have no idea if the midwifes did cats bum mouths as I delirious with the pain.
Thurlow - the research I referred to allocated the low risk mother s to each arm of the trial BEFORE the start of labour, and then excluded those who presented at hospital with any risk issues.
This would minimise the likelihood that women in the CLU arm were there because their labours were more challenging to start with.
Ushy - the problem with the study you mention is that there would have been no 'control group' of women having long and challenging labours who didn't have an epidural. I think when a baby is presenting in an optimal position the epidural probably doesn't make much of a difference to the outcome. It's when the baby is presenting poorly, which would lead to a longer and often much more painful labour, that being fully mobile might make a difference to a spontaneous birth or one involving forceps or c/s. However - the common response in uk hospitals to long and challenging labours is to offer epidural.
In fact in midwifery circles midwives discuss this issue - that they are losing their skills in caring for mothers having challenging unmedicated labours because women who opt for this are as rare as hens teeth these days.
As an aside - I think there is a huge danger in using 'normal' or 'natural' birth to just mean 'do it without pain relief.'
For a lot (most?) of women, there is very little that is 'natural' about their birth anyway. From being in a hospital environment, having to go through early labour on a brightly lit ward surrounded by other women, to being moved to a 'delivery suite' to repeated vaginal examinations to a whole host of interventions from ARM to sweeps to induction....
But no - what gets focused on, obsessively, as a barrier to 'normal' or 'natural' birth is epidural anaesthesia.
Btw, I come at this as someone who has/is having planned CS's by choice. But even I, from the 'outside' can see the damage in reducing the whole debate about natural birth to the availability of epidurals. I think there are often other agendas at work which people aren't open about - whether it is women having to bear children in pain and sorrow etc or a kind of 'if I had to go through awful pain to have my baby then you should too' attitude.
All that aside, I totally agree with the previous poster who suggests there is nothing wrong with offering a 'sliding scale' of pain relief, and helping women to make informed choices etc (both of which involve more than a simple 'ok' when a woman asks for an epidural) -
But face pulling and an 'oh gosh, how very DISAPPOINTING you are' attitude are wholly out of place in a care giver dealing with a vulnerable woman. Any MWs dealing out that sort of attitude should be ashamed of themselves.
rain good point but the sliding scale idea has a downside.
Epidurals are more effective when administered early - it is the late epidurals that are more associated with instrumental deliveries and failure to work. Also, working through gas and air, the pool, pethidine and everything else leaves you totally spaced out, sick and out of it.
It is perfectly reasonable for a rational woman to say no, I don't want anything else - just an epidural. You are vulnerable in labour and it isn't fair to expect women to have a pain relief debate or 'prove' they know the risks and benefits of epidurals before they have one. NICE says if a women requests an epidural she should get one.
I say here here to that
I have heard people mention but I am not o fey with this - that there are a few different types of epidurals you can get which mean you can be mobile, not as mobile as without one but certainly some sort of movement.
op i didnt watch that particular episode, I have noticed though some women in such pain, writhing round, get an epidural and suddenly they are sat up, back to normal its amazing to see.
I've had syntocin 4 times, and never had an epidural. After the syntocin drip was started I managed with G&A (Autocorrect wanted to change that to G&T, probably the best thing for labouring mums... ), and pethidine.
I went longer without syntocin in my fourth labour, (was induced with first 3, but went into labour naturally with DS3, but labour stalled) and found it such a breeze compared to having the syntocin straight away, so I can see how some people could think that labour without an epidural when syntocin is used might be 'cruel', but I found that to be 'normal' labour for me, and the first 20 hours with DS3 were actually really mild.
Yet most people can have a colposcopy and LLETZ under local anaesthetic, and I had to be knocked out under GA or I might have kicked the Consultants teeth out from writhing round in pain...
I did find that I was treated as something of a rarity in my local hospital - 24 hour induced labour with a back to back baby as a 16yo who refused an epidural (though by the end I was begging for a C-section).
72 hour induced labour (contractions every 2 minutes or closer for the entirety) refusing epidural with a back to back baby.
I found DS2's 8 hour induced labour a breeze by comparison!
DS3 I had a 24 hour labour.
But all the MW were incredulous that I was turning down an epidural.
I think the woman should have an informed choice. Interestingly in my local hospital this time round they said I could have an epidural whenever because new research had shown it didn't slow labours down at all. Anecdotally, it sped up my first labour considerably, I'd been at 2-3cm for 2 days and went from 3 to 10 in 4 hours, apparently I was fighting the pain and once I relaxed things went faster. I did need a ventouse, due to an unusual presentation, but I think I would have needed one anyway as he was well and truly stuck. Second time around I needed no help and got her out in 2 pushes with no tearing, That was with a perfect
Epidural and I literally didn't feel a thing. Third time I tore as I was on the drip and the epi didn't work so i was still in agony and couldn't control my pushing at all. It was still only one or two pushes but the result was a lot different in terms of recovery and pain afterwards.
Couthy - I transferred in from a homebirth with my third for syntocinon and didn't have an epidural. Honestly it was hard but it was doable because I had my independent midwife with me who was outstanding and gave me such amazing support.
I think the problem is that a woman having an unmedicated labour which is anything other than straightforward needs VERY skilled, intensive and intimate support from a midwife she has a strong relationship of trust with. I think it's very difficult to get this on the NHS in most obstetric settings because of the way midwives have to work, and the institutional pressures they are subject to. And given this - epidurals are the answer to lack of really outstanding midwifery care.
"I think there is a huge danger in using 'normal' or 'natural' birth to just mean 'do it without pain relief."
If the form of pain relief you use disrupts the normal hormonal physiology of birth to the point that you need synthetic hormones to be administered through a drip throughout the labour in order to achieve delivery of your baby then it means you are not having a 'natural' or 'normal' birth. Doesn't mean that your labour isn't enjoyable, safe or what you want. And it's important to draw attention to the fact that there is no moral weight attached to whether you have a 'normal' or 'natural' labour or not.
Is anyone here in agreement that when women are informed (antenatally) about pain relief it ought to be made clear that the meta analysis of epidurals on which NHS recommendations regarding pain relief are made doesn't compare outcomes of unmedicated with medicated births, but the outcomes of epidurals with opioids (usually pethidine)? Because I think most women are in no way aware of this and IMO it's a MASSIVE oversight.
Certainly typical attitude at LGI. . My last baby- , i was basically told to shut up and get on with it. I had no birth partner and my wishes were ignored. Could have punched the bitch to be honest, but am over it now
And it's important to draw attention to the fact that there is no moral weight attached to whether you have a 'normal' or 'natural' labour or not.
I think its worth pointing out the number of women who report comments made by midwives to the contrary on a regular basis on MN. Or report comments made by friends and family that judge them in a negative way, if they don't have a normal or natural labour.
Do you remember the thread with the link to the midwife forum that was publicly viewable - until MN picked up on all the horrendous moralising and judgements that practising midwives were posting - which then suddenly became member viewing only.
I think you need to start changing the attitudes of the medical establishment on that one, before you post comments like that, which bare no resemblance to what women seem to experiencing and can see with their own eyes.
And thats before you deal with the press view on this subject, which helps to shape public perceptions to a huge degree.
Oh, there is a LOT of moral judgement attached to the idea of 'normal' or 'natural' birth! On these boards and elsewhere (god, I remember that HORRIBLE midwives board thread....I would be terrified of being in the care of one of those bullying people).
Time and again you see pain relief, or lack of of, being held up as the biggest marker of natural or normal birth. To the extent that a long augmented labour ending in a vaginal birth with a baby hauled out with forceps is not seen as 'abnormal" - but having pain relief is.
It's all very anti-woman in my view. And Ushy, yes - respecting a woman's request when she asks for pain relief has to be the default setting in any humane society.
Shag, I'm with you about the studies. I'm also personally a bit surprised that women routinely say they've had natural birth to mean a non-epidural birth with opiate pain relief. It's now of no shock to me that France have banned opiates during labour. And yet these zealous UK MWs are sticking in needles freely at the same time as frowning on epidurals. Need some joined up thinking me thinks.
I agree re opiates. They have a much greater (negative) effect on newborns than epidurals, where the anaesthesia doesn't cross the placenta in any case - sleepy/dopey babies are more likely to have trouble breastfeeding, of course. Or feeding at all.
I do find it interesting that while epidurals/spinals are literally just painkillers, both opiates and gas result in an altered state of consciousness. You can read many accounts of women who used either/both talking about how it didn't exactly kill the pain, it just made them not care, or feel 'off their heads'.
I don't see why a lot of natural birth advocates talk about hormones and interrupting the natural flow while ignoring the fact that women are basically being drugged into artifical 'highs' to enable them to endure labour. From a mental health pov, not to mention the effect on newborns of opiates, I find that a bit disturbing.
"To the extent that a long augmented labour ending in a vaginal birth with a baby hauled out with forceps is not seen as 'abnormal""
I think you'll find most people don't categorise a forceps delivery involving syntocinon as a 'normal' birth. Midwives certainly don't.
"yes - respecting a woman's request when she asks for pain relief has to be the default setting in any humane society".
As someone who is an advocate for natural birth of many years standing, who mixes with A LOT of midwives, I have never heard anyone support the view that women should not be listened to and that they should be routinely denied pain relief if it is available and safe to administer.
"And yet these zealous UK MWs are sticking in needles freely at the same time as frowning on epidurals"
Most midwives don't 'frown' on epidurals. All the midwives I know see them as a valuable and important tool for childbirth. They do worry about epidural use becoming routine in childbirth, as it has done in other countries which have obstetric led maternity care. Most midwives have concerns about the use of opioids in labour. I know a good number of midwives who see pethidine as a useless drug, who are happy to communicate this view to their clients. Some hospitals (for example St Thomas's) have stopped offering it to labouring mothers.
"I don't see why a lot of natural birth advocates talk about hormones and interrupting the natural flow while ignoring the fact that women are basically being drugged into artifical 'highs' "
I think you'll find they don't ignore this. They are also VERY concerned about the widespread use of opioids in labour.
"From a mental health pov, not to mention the effect on newborns of opiates, I find that a bit disturbing."
I'm not aware that there is any research flagging up concerns about women's mental health following a childbirth involving sedation with opioids, which you'd expect there to be if there was anything to worry about in relation to this given that they've been used in birth for centuries. All 'natural birth' advocates I know worry about the impact of pethidine on newborns.
Point being made: it is false to assume that midwives are generally 'anti epidural' and 'pro pethidine'. They value epidurals for women who can't cope with labour pain, and for complicated labours; most midwives do have concerns about the use of pethidine.
It seems very very odd to me that there is no research into the effect on women's mental health relating to the use of opioids during labour. And that because there is no research, that must mean everything's fine!
For a start, Twilight Sleep had a pretty serious effect on a lot of women. And there have been plenty of posts here from women who took pethidine and loathed it, feeling alienated and dissociated from the whole process of birth.
How strange none of that is a concern, but epidurals are. I guess it comes
down to money. Or a lack of concern about mental and emotional well being.
Actually, this is interesting (10 seconds on Google threw this up) -
Just info from a hospital in the US about childbirth anaesthesia. It points out that opiods sedate both mother and baby - and "higher doses are accompanied by the dulling of all senses, leading to altered consciousness, and a reduced urge to breath. In worst cases these drugs can dangerously impair breathing in the mother and, more commonly, in her newborn."
I'll take the epidural/spinal, thanks. If anyone thinks that giving birth in a state of drug induced altered consciousness ain't a problem - well, that's their choice, I guess.
banana87 I've been induced twice and didn't have an epidural and didn't feel the need for one, even with my first where I had a very long second stage. Interestingly when I spoke to the MW who had been with me early in labour after the birth she said 'oh, maybe you should have had an epidural' whereas although it took forevre I'd say I felt exhausted rather than in insufferable pain. So I certainly wasn't discouraged from having one by the MWs. In comparison my third was a classic short sharp induced birth and although it was intense and I only had about two puffs of G&A due to how quickly it ramped up I never felt like I couldn't cope with the pain. I work in the pharm industry and don't have any issues with using pain relief but personally I didn't need it. I would have had a worse experience if I had been forced to have an epidural, choice works both ways and it is as bad to insist on one as it is to refuse one.
FWIW the cascade of intervention is bullshit as well, a moments thought shows that if mothers are offered a series of interventions then obvious all the ones who would have ended up up having a CS will have had all of the others. It does not follow that the intervening interventions caused the CS. I for one avoided a CS thanks to the lesser interventions I had with DS.
"It seems very very odd to me that there is no research into the effect on women's mental health relating to the use of opioids during labour"
Or indeed of the effect on women's mental health of the use of epidurals in labour, as these profoundly impact on the normal hormonal physiology of both labour and the immediate postnatal period.
As for there being a lack of concern about the emotional wellbeing of mothers and babies among health professionals - all I can say rain is that you should go and have a look at the main stream midwifery journals in the UK, Practising Midwife, British Journal of Midwifery - as these have articles and research papers about these subjects in every single issue. Midwives do care about these things.
"I'll take the epidural/spinal, thanks"
That's fair enough, but can I just point out that epidurals contain opioids too? Fentanyl usually, which is a very, very strong opioid. That's why some women experience pruritis after the administration of an epidural.
"If anyone thinks that giving birth in a state of drug induced altered consciousness ain't a problem"
But if you have an epidural you are also in a drug induced state of altered consciousness, compared to what you would experience if you weren't taking a powerful drug! Without an epidural you'd have extremely high levels of endorphin and oxytocin in your body, which have a profound impact on feelings and sensations.
You have a lot to learn about epidural anaesthesia. A good place to start might be mumsnet's own webchat with David Bogod, here - www.mumsnet.com/onlinechats/david-bogod
Among many other things.... "... epidural doses of fentanyl over 100mcg do have an effect on the baby. In practice, doses of this level aren't often used. Even if they are, the effects of pethidine or diamorphine in sedating the baby are many times greater and last considerably longer."
And "oxytocin levels aren't affected by epidurals." (this specifically in response to a question: 'Could you tell me anything about the effects of of epidural anaesthesia on the birth hormone oxytocin and any implications this may have for the baby or mother post-birth?')
This webchat with an obstetric anaesthetist would actually be really useful for a lot of women on this thread. It is science based myth busting, and concerned with actual evidence rather than woo. Very useful.
It's not true to say that midwives don't like epidurals as it means more work for them.
Generally the opposite is true. If the woman I'm looking after has an epidural then I can't be given anyone else to look after no matter how busy the ward gets. If I already have two women I'm looking after then someone else will have to take my second woman so I can stay with the one having an epidural.
So from my point of view a woman having an epidural is a good thing as far as my work load is concerned. It's easier to look after one person with an epidural rather than two women without epidurals and a postnatal woman!
To be honest there's an argument that care of a woman with an epidural is easier full stop, there may be more obs to do and another chart to fill out but there is generally less encouragement, etc needed as the pain is gone.
I don't watch obem but where I work its unlikely anyone would get an epidural at 3cm.......women are meant to be in established labour so 4cm. At 3cm its possible that labour stops and doesn't start again for a few days. If there's an epidural on board then you'd either need to stop it in such a case and send the woman home. Or more likely the dr would decide to induce as "we're now committed" and break the waters.
I wonder if my epi slowed down my first birth, but tbh, the pain was so bad I was out of my skull. She was face up, with her right hand up cupping her head above the ear. I was in agony for hours, all night, begging. She wound up an H-F forceps delivery and I have no regrets. Cons got in and first thing she said was, 'Oh, little one, your wee handie shouldn't be up there!' and then, 'Oh, wee one is looking at the stars!' The pain was so bad before the epi I truly wanted to die.
I def should have had epi first time, the pain was too much, I was strangly calm going into labour after years of fear of CB, irrationally thinking about it too much, I felt strangly calm and safe, I had a nice easy build up of two days of contractions before establised labour.
I got terrific support but I asked for an epidural when i felt I could not cope anymore, I had done my research into it all, and yet I was steered towards pethadine, as someone said up thread, you feel the pain but you care a bit less.
Pain is pain though.
i just cant see dentists advising people to breath through a tooth absess, my mother used to say that tooth ache - and child birth were on a par, she had four DC in the 60's/70's. Including an emergency cs.
The thing is - mother hood is a life long thing, and when your at the starting gate you can loose site of that and you get all caught up in how you have to have a natural birth and shouldnt need pain relief because the body can do it, and you shouldnt give in, but if you do need pain relief - you have " given in", and then the BF and its all a big package all along with companies flogging first timers huge travel systems they spend 600 quid plus on, they want to start so well , be soo good.
its hard to be soo good two years down the line when your toddler is pushing every single boundary and you have been up all night with them, and have them alone all day, they wont eat, they are too thin, etcetc or your ten year old is playing up and wont play ball and your so scared about them and how to handle them or your teenager seems to be falling in with the wrong crowd or seems to be getting too fat or too thin... etc etc etc.
Can you still apply this purity and severity and strictness then,this total selflessness all for the baby.
Are these people still carrying through I would love to know.
Was all for a natural birth pre DD1, like so many. The books had me well convinced, a needle in my back was unthinkable, hypnobirthing all the way etc. But you just can't legislate for everything in labour, can you? My waters broke and labour was just so explosive from the start. I was trying to communicate to my midwife that I really felt DC was coming NOW but because I 'looked' quite calm and because my birth plan was all 'don't give me loads of VEs', she suggested, at the very point where I felt I just couldn't go on, that she 'check me again in 4 hours'. I broke and got DP to organise the epi. Midwife (this was in Ireland) was a bit are you sure? (trying to be supportive of my birth plan, I think) but organised it straight away. It was the worst pain ever sitting up on that bed getting the needle in my back. BUT it was so wonderful to get a relief from the pain and I dilated fully within minutes and went on to have a great birth.
Still would really like to try to avoid epi if there's ever a DC2, just because of the risks and because at least I know now what is happening during labour. But I've totally given up on this fetishing of natural birth stuff. I really see the big picture now.
Great post elizaregina <relurks>
Interesting hearing opinions from MWs - reading a lot on MN about birth it's easy to assume MWs are using pethidine a lot. Certainly was the case for my sisters....but no idea how widespread this is.
Interesting reading about workload too. When I gave birth first time around there were three women (including me) giving birth at the same time - one MW on duty. She was able to do this because we all had the epidural and all hooked up to the monitor so she could do 'remote' monitoring of our progress. With my second birth I was advised by the OB to hire a private MW as I didn't want an epi or continual monitoring and thus would need a MW with me at all times and the OB couldn't guarantee I would have access to this.
But I've totally given up on this fetishing of natural birth stuff. Good for you. I feel we should be viewing births and birth pain as just 'normal' birth. No fetishising. Acceptance that pain is part and parcel of the birth process, intricately linked to the release of hormones etc. I would like less fear to be associated with birthing - there is a common perception of overwhelming pain associated with childbirth which isn't (always) true. When we get rid of the fetishisation, we (as a group of women) will also be happier with the epidural - accepting it if required.
Eliza - labour is over for most people in 24 hours (or 36 in my case) no matter how painful it is. Struggling as I am now with an autistic child and an aggressive and unhappy teenager I look back on my very long, painful and unmedicated labours as a breeze - at least those are two things I managed to do in the way I wanted and the sense of achievement I felt at the time is still with me.
If I came on to this thread and rubbished and trivialised women's reasons for wanting an epidural, characterised them as 'weakness' or 'cowardice' I'd quite rightly draw a huge amount of flak.
So why is it acceptable to characterise the motives of women wanting a drug free labour as pointless perfectionism or competitiveness? Can people not accept that some women feel very strongly that having an unmedicated labour is important to them, and that its disrespectful to trivialise their beliefs and feelings as silly and without value?
Also wanted to add that the view that it's unrealistic and perfectionist to want or expect to labour without an epidural - according to the POB study only one healthy woman in ten needed to transfer to hospital for an epidural from out of hospital birth settings. If you excluded first time mothers from that sample it would go down to 2 in a 100.
"there is a common perception of overwhelming pain associated with childbirth which isn't (always) true."
And more to the point, overwhelming pain in labour isn't necessarily intrinsically pathological, traumatizing or impossible to get through without an epidural.
It's an absolute myth that the only women who cope well without epidurals are women who have straightforward, short or 'easy' labours.
Acceptance that pain is part and parcel of the birth process, intricately linked to the release of hormones etc
Yeah. I agree. Because I had been led to believe by all of the natural birth hypno stuff (and I read LOADS of it) that if you weren't afraid, labour would progress smoothly and that the pain would be minimal/manageable. I wasn't afraid when I went into labour. I was pissed off (because DP woke up when my waters broke) and wanted to be alone in a dark cave. The pain was huge, unreal, but as long as I felt it was going somewhere it was just about manageable. I went into hospital when my contractions were 3 mins apart and still wasn't afraid, was psyched, ready to do it. But fuck me, don't tell me that it didn't hurt. I got afraid when I thought that my own feelings (that the birth would be happening SOON and I could start pushing SOON) were apparently at odds with what was happening down below (only at 4-5cm, midwife saying she'd see how I was getting on in ^4 hours^). That scared me beyond belief, when I thought I had got it so wrong.
And the mobile/'light' epi sorted me right out: when the pain went the fear went and I jumped to 10cm in minutes, pushed out my baby with no tearing or episiostomy, was flooded with amazement and delight to see her, breastfed within minutes. So...I am all for a frank acknowledgement that intense pain is part and parcel of MANY if not MOST labours. Have only had one so cannot compare. My mother has had 5 labours and a couple were straightforward, quick and 'easy'. Her first and her last were intensely painful and traumatic.
So why is it acceptable to characterise the motives of women wanting a drug free labour as pointless perfectionism or competitiveness? Can people not accept that some women feel very strongly that having an unmedicated labour is important to them, and that its disrespectful to trivialise their beliefs and feelings as silly and without value?
It isn't. I accept that. I'd absolutely love to have an unmedicated labour. I'd never trivialise that wish, because I share it. Can absolutely understand why your births represent moments in your life you return to and cherish at difficult times. However, I am personally very wary of adopting absolute attitudes - either NO DRUGS EVER or ALWAYS DRUGS HIDEOUS PAIN - about any of this stuff. I feel that there are always shades of grey.
"This webchat with an obstetric anaesthetist would actually be really useful for a lot of women on this thread. It is science based myth busting, and concerned with actual evidence rather than woo. Very useful."
Also useful to look at the information on the website of the Society of Obstetric Anaesthetists, here and the Cochrane Index reviews, [[ http://www.thecochranelibrary.com/details/browseReviews/579369/Pharmacological-methods.html here]] which rain I think you'll agree are not 'woo'. Especially the latter which are systematic reviews of a very wide range of evidence.
From the patient information leaflet on the Obstetric Anaesthetists' website:
- With an epidural, the chance of the obstetrician having
to use a ventouse or forceps to deliver your baby is 14%.
Without an epidural it is 7%.
- With an epidural, the second stage of labour (when your cervix is fully dilated) is longer and you are more likely to need medication (oxytocin) to make contractions stronger.
- You may develop a fever, which may be associated with
distress to your baby.
- If you have higher doses of opioid through an epidural,
your newborn baby may be more likely to need help with breathing (see reference 12 on page 15) and you may have less chance of breastfeeding successfully (see reference 13 on page 15).
But you know, I made no comment about babies being affected by the opioids in epidurals, only acknowledged that fentanyl is usually used in epidurals.
Re: oxytocin and syntocinon - I find it interesting that an obstetric anaesthetist talks about these two things as though they are identical. Syntocinon is NOT oxytocin. It's a synthetic version of it and they don't necessarily work on the human brain in the same way. In any case, it's utterly bizarre to suggest that oxytocin levels aren't affected by epidurals. If this was the case then why on earth would they have to give most women with epidurals syntocinon? If they still had optimal oxytocin levels after the administration of the epidural they wouldn't need it!
"However, I am personally very wary of adopting absolute attitudes - either NO DRUGS EVER or ALWAYS DRUGS HIDEOUS PAIN - about any of this stuff. I feel that there are always shades of grey."
You know - I don't think ANYONE on this thread or anywhere else has said or implied 'no drugs ever' or 'always drugs'. I don't know any midwives or natural birth advocates who don't believe that epidural has an important role to play in modern obstetrics. I think it's not helpful to suggest that this sort of absolutist thinking is common.
I think the reason why some women have very strong feelings about pain relief and whether they don't want to have it, or feel that they did something 'wrong' by having is comes down to the attitude of some people and tutors - "if you weren't afraid, labour would progress smoothly and that the pain would be minimal/manageable" (not picking on you, curtsey, I completely agree with your post, it was just as well written phrase).
I fully believe that every woman should aim for and hopefully be facilitated to have the birth experience that they want. So if they want a home birth, or a water birth, or a pain relief birth, they should be encouraged to do that. Equally if they are of the mindset that they would like an epidural as early as possible, that should be allowed (workloads allowing etc).
However when women embrace the concept that accepting the pain and embracing the process will result in a relatively pain-free, or manageable labour, and then they find the pain overwhelming, or their labour lasts a long time and they are exhausted, and they then opt for pain relief - that is when some women struggle afterwards and feel that they failed somehow. People who are then militant that it was their own acceptable of labour pain allowed them to have a pain-free birth don't help the situation. Sometimes labours just are slow, or the baby is back-to-back, or other reasons which are completely out of the woman's control in terms of managing their pain and exhaustion.
I really do wish that some women wouldn't knock others for taking pain relief early, and others wouldn't mock a desire for a natural birth.
Oh - and for those of you who are interested, this is what the Cochrane review of 38 trials (of which all but 5 compared epidurals with opioids) involving 9658 women overall found:
"Epidurals relieved labour pain better than other types of pain medication but led to more use of instruments to assist with the birth. Caesarean delivery rates did not differ overall and nor were there effects of the epidural on the baby soon after birth; fewer babies needed a drug (naloxone) to counter opiate use by the mother for pain relief. The risk of caesarean section for fetal distress was increased. Women who used epidurals were more likely to have a longer delivery (second stage of labour), needed their labour contractions stimulated with oxytocin, experienced very low blood pressure, were unable to move for a period of time after the birth (motor blockage), had problems passing urine (fluid retention) and suffered fever. Long-term backache was no different. Further research on reducing the adverse outcomes with epidurals would be helpful."
"I really do wish that some women wouldn't knock others for taking pain relief early"
Yes, me too.
However, I have rarely heard anyone doing this on mumsnet or in r/.
Big needle near my spinal cord didn't appeal.
No one suggested it and I would have said no if they had.
Pethidine sent me to sleep for a few minutes, otherwise pretty useless.
Best pain killer by far was DH rubbing the top of my legs because DD1 had squashed my sciatic nerve. Contractions were a minor annoyance compared with the pain in my legs.
DD2 was born at home so I could keep walking about and wandering up and down stairs thus preventing her wedging herself on said nerve.
I get way more frighteningly painful constipation than either of themselves contractions.
The knocking or the taking pain relief early?
The only person I know of who had an 'issue' free birth was, weirdly, an American (but over here in the UK) who had an epi at 4cm and actually had an easy birth, no tearing etc. Not saying that as anything like proof epidurals are fine, just thought it was interesting.
I do pick up a bit of militancy sometimes on the MN boards about embracing the pain and there's a sense of looking down on women who don't 'embrace the pain'. And very weirdly I had a night out with my NCT group when our babies with about a year old and one of them rehashed our births and was basically working through everyone's reasons for having and epidural or an emcs! It was very odd. Two of the group had emcs's because their baby was pretty much stuck; she seemed to judge that as them failing! I had one because my baby was found to be ill, she deemed that an acceptable reason Though she seemed disappointed in me for only getting to 4cm in 36 hours!
I was induced for both my DCs. I had an epi with my first and it was the best thing since sliced bread! Had my second 3 years later with just G&A. All pregnancies and births are different. I don't regret my epi but found my second birth easier to deal with so didn't need one. There are no medals on offer for a drug free birth!
First off; I think every woman, once made aware of the risks, should be able to request and have one.
That said, I can see the midwives point. Fear can drive you rather than the actual pain. The assurance that it can be done or (in my case) the absnece of the option can push you through.
I had done hypnobirth training and laboured on a packed commuter train before getting home to do the 45 min drive. When we got through the doors I asked for an epi, the fear of it getting worse drove me. In hindsight I was in transition. Midwife wasn't convinced I was in labour, waters went 5 minutes later and I was ready to go, DD was born 90 mins later. I got off of the bed within 1/2 hour of having 3 little stitches. There was no way I needed it. BUT had I of been at home, I would have gone in earlier and got one, I do think this would have slowed down the birth and if nothing else led to a less enjoyable, bed bound experience for me.
However when women embrace the concept that accepting the pain and embracing the process will result in a relatively pain-free, or manageable labour, and then they find the pain overwhelming, or their labour lasts a long time and they are exhausted, and they then opt for pain relief - that is when some women struggle afterwards and feel that they failed somehow.
Yep, exactly, Thurlow. I'm a bit of a people-pleaser and interested in health generally and I like doing things according to how the experts say it should ideally be done. I think I did want a medal, actually - and I felt so annoyed with about myself for not having been 'tough' enough. Even though the actual pushing part and bonding experience with the baby went really well.
I've witnessed lots of absolutist thinking re. childbirth, I think it is fairly common! Perhaps more so in RL and on other forums than here on MN. Both the kind of person who deconstructs your birth to see where you went wrong, and also the kind of person who will tell anyone who's listening to 'never make a birth plan, as soon as you go into hospital it goes out the window, take every drug on offer'.
But ultimately, even though I had a great experience with the epi, I do not want to have another one if I ever have another dc. If it works out that way so be it, but the risks are undoubtedly there.
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