Negativity toward epidural in UK?

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

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

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

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

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

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

Bue Sun 08-Dec-13 19:30:16

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

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

GeppaGip Sun 08-Dec-13 19:47:16

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

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

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

mercibucket Sun 08-Dec-13 19:51:34

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

Rowboat Sun 08-Dec-13 20:09:00

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

TondelayoSchwarzkopf Sun 08-Dec-13 20:18:23

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

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

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

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

SuiGeneris Sun 08-Dec-13 20:21:05

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

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

TondelayoSchwarzkopf Sun 08-Dec-13 20:21:47

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

lljkk Sun 08-Dec-13 20:30:07

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

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

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

Shenanagins Sun 08-Dec-13 20:40:40

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

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

Bue Sun 08-Dec-13 20:45:49

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

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

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

wispaxmas Sun 08-Dec-13 21:23:42

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

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

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

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

babynelly2010 Sun 08-Dec-13 21:37:06

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

Rhianna1980 Mon 09-Dec-13 00:10:52

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

ZingSweetPea Mon 09-Dec-13 04:19:51

I love epidurals.

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

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

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

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

hth

wispaxmas Mon 09-Dec-13 12:08:50

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

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

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

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

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

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

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

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

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

NoComet Mon 09-Dec-13 12:16:11

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

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

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

mrsmugoo Mon 09-Dec-13 12:41:41

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

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

wispaxmas Mon 09-Dec-13 12:50:05

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

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

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

brettgirl2 Mon 09-Dec-13 12:54:18

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

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

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

wispaxmas Mon 09-Dec-13 12:56:12

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

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

Bue Mon 09-Dec-13 12:56:59

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

wispaxmas Mon 09-Dec-13 12:58:42

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

brettgirl2 Mon 09-Dec-13 12:59:50

Why is transfer a big deal?

brettgirl2 Mon 09-Dec-13 13:00:36

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

NomDeClavier Mon 09-Dec-13 13:07:10

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

wispaxmas Mon 09-Dec-13 13:35:28

A walking epidural is the same as mobile or low-dose, which is available in the UK, and in fact there shouldn't be reason for using the single drug high dose bupivacaine epidural anymore. The epidural will be sited by the anaethetist, but then maintained by the midwife, so there shouldn't be any reason that it isn't used in the UK.

In 1999 24% of maternity wards in the UK offered mobile epidurals (http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.1999.00894.x/full), and in 2001 a study suggested that the continued use of traditional epidurals was no longer justified (http://www.ncbi.nlm.nih.gov/pubmed/11454372). Although I haven't yet been able to find the percentage of UK mat wards offering mobile epidurals today, I can't imagine that it hasn't gone up dramatically in the last 15 years, especially considering the number of studies done in the UK on the difference between the two. I did, however, find that 20% of UK hospitals not only administer mobile epidurals, they administer patient-controlled mobile epidurals, meaning the mother has control over when she gets more pain relief, and how much she gets.

I suppose the only way to know for sure what's available to you is to talk to your midwife; however, she may not know, and a conversation with the obstetric anesthetist may be needed to ascertain what exact methods of epidural are offered, whether the traditional full dose epidural, low-dose combined or low-dose infusion. Many hospitals will refuse to call the latter two 'mobile' or 'walking' epidurals, but they are the same thing.

brettgirl2 Mon 09-Dec-13 13:59:58

You are starting to seem quite pro-epidural as opposed to pro-choice. If the walling epidural had worked as it should (which they don't always) with my first labour I would have been better off having one. With my second labour though I was better off without. My second labour was an amazing experience, honestly and the contractions were part of it. If you want an epidural you should get one, as should any woman but it doesn't make not having one wrong either.

brettgirl2 Mon 09-Dec-13 14:00:20

walking epidural grin

wispaxmas Mon 09-Dec-13 15:35:10

Yes, I'm pro epidural personally, but still pro choice. More important than that I'm pro educated choice, and I find that the attitude I've seen here in the uk leads health professionals to not fully explain the risks and benefits of anything in pregnancy, not just this. I think that's why I'm try I to find as many statistics as possible. Maybe some midwives are better at fully explaining options than others, definitely possible.

I can easily see why a woman similar to me - first time mother, low risk pregnancy, etc - would look at these same statistics and choose to not have one. The postdural headache risk, for one, is a great reason to turn one down. Or the threat of constant monitoring (which may happen, but not always). What doesn't make sense is the pervasive belief that epidurals are harmful to baby, prevent good bonding, delay lactation, cause paralysis in mom, and mean you have to labour and give birth flat on your back. Some of these were never true, some of them are no longer true but they are still bandied about as reasons to not get an epidural.

It's the misinformation and lack of communication from health professionals I can't abide.

NomDeClavier Mon 09-Dec-13 15:37:26

Just because it's available doesn't mean the uptake is high, though, and just because it's available doesn't mean MWs are any better at managing the dosage to enable active labour because the birth culture is very different. People in the UK don't ask for epidurals as a matter of course. They are generally encouraged to go up the scale of pain relief and epidural comes last before a GA! Therefore when an epidural is administered the intention is to block the pain out and it is the numb legs scenario, unlike other countries where an epidural in itself is seen as a gradually progressive form of pain relief in it's own right. IME it's just another cultural difference. Also a consultation with an obstetric anaesthetist isn't routine, unlike countries with a higher epidural rate where the choices are described in quite some detail. Personally I'm quite pro that consultation having benefited from it in my first pregnancy in France and finding out my spine is pretty unsuitable for any kind of epidural or spinal so I get to skip from pethidine to a GA, but I'd have been pissed to discover in the UK on D-Day that it wasn't an option once I'd asked for one.

snoozysleeper Mon 09-Dec-13 16:51:58

wispa I found two studies you may find interesting. They are recent too. The second one references comparative statistics that you were asking for (ie. relative risk etc), the detail of which are in the results section. I hope it helps. Ultimately your choice, of course!

Pain management for women in labour: an overview of systematic reviews:

www.ncbi.nlm.nih.gov/m/pubmed/22419342/?i=21&from=epidural%20assisted%20delivery

Epidural versus non-epidural or no analgesia in labour.

www.ncbi.nlm.nih.gov/m/pubmed/22161362/?i=28&from=epidural%20assisted%20delivery

Bue Mon 09-Dec-13 17:02:37

wisp but you seem to basing this assumption (that the UK is a thoroughly anti-epidural nation) on your interaction with ONE health care professional. That's like meeting a midwife who says the opposite and deciding that the UK must be completely anti-natural birth! I repeat, over 50% of first time mothers have an epidural. If the entire NHS were systematically trying to prevent women from accessing pain relief in labour, that simply wouldn't be the case.

Nom I think you are right that a lot of midwives do a bad job of managing epidural births, however we do usually use low dose and some movement is possible unless it has been topped up for hours and hours. I had one mentor who was very skilled at facilitating an active pushing stage, so I love a kneeling birth with an epidural if the woman has the strength in her legs. That doesn't happen with most midwives! However, in other countries with much higher rates, there would be no choice at all, it would be legs up in lithotomy, so I don't think they do a better job of managing labour in other countries, necessarily. My friend in France was genuinely surprised when I mentioned something about a woman choosing what position to push in. She didn't know there were options! sad

Sirzy Mon 09-Dec-13 17:07:43

Personally I wouldn't have wanted to have any sort of intervention unless needed and I include epidural in that. I certainly wouldn't have planned to have had one before seeing how the labour progressed.

Given the way DS got stuck (and what I was told by the staff afterwards) I think an epidural would have massively increased my chances of needing a C-Section anyway.

Everyone will make the choice of which pain relief they feel is best for them. I dont think epidurals not being the first choice for most people is a bad thing

Sirzy Mon 09-Dec-13 17:09:47

and I find that the attitude I've seen here in the uk leads health professionals to not fully explain the risks and benefits of anything in pregnancy,

When I went to be induced an anesthetist spent a good 20-30 minutes talking to me about epidurals, he was very matter of fact giving the pros and cons, discussing the benefits and the possible issues. That was what made me decide even more that it wasn't for me unless I really felt it was needed.

wispaxmas Mon 09-Dec-13 17:33:10

Fair enough, I'm probably more annoyed at that midwife than anythingblush though I also found my sonographer equally uncommunicative, and I was annoyed to find out on my own time that I didn't really need to have cut down on coffee or cut wine out entirely, so it's more than just advice about labour. I'm sure elsewhere in the world it's no better. Is it wrong to think it should be better, though?

TarkaTheOtter Mon 09-Dec-13 18:04:07

I was induced and found the midwives looking after me were actually quite pro-epidural. As it happened I decided to wait and see and did eventually have a "patient-controlled" epidural which was great. I could still feel to push and was up and about almost immediately after giving birth. Despite it only being a few hours since the epidural was sited.

I do know several people who have given
birth in the same hospital who were told that the anaesthetist was unavailable/they couldn't transfer from MLU as "too busy" on delivery suite.

NomDeClavier Mon 09-Dec-13 18:32:23

bue really?! Both hospitals I've been at in France have given out leaflets about labouring positions and birthing positions that specifically avoided litho, and been quite happy to facilitate that in practice. Lying on your side and kneeling supported on the bed for the birth were also specifically mentioned as possible with an epidural in my antenatal classes. Unfortunately a lot of French women insist on an OB being present though heaven knows why and then it can all go downhill because they like that position. But if a woman is badly positioned during the first stage of labour it increases the chances of malpresentation for the second stage, and even if you end up in litho during the second stage as long as the first has been managed well you have better chances of avoiding needing assistance. Good MW management can make all the difference and this is anecdotal rather than evidence based but it seems UK MWs are fab at managing non-epidural labours but less good with. French MWs OTOH are pretty crap at helping with non-epidural labours despite the fact that the same techniques can be applied. It also very much depends on the hospital/clinic. With DS I went further afield because the nearest clinic had a 97% epidural rate and the chain of events was very much 'you arrive, we put in a drip and epidural, you lie down, we monitor you continuously, you dilate at 1cm per hour and we examine you every hour, you push, if baby doesn't come out we go and get it'. I didn't hang around long enough to find out whether they were giving out the nice little leaflet but I imagine they had to at least pay lip service to it.

Squatting gets funny looks, tis true....

Ultimately it's down to expectation. People expect an epidural to take the feeling away rather than take the edge off and if they get the MW to turn it up to that level then there isn't a lot you can do.

I was completely against epidurals before ds because I am against intervention the reason being that I feel ANY unnecessary intervention has risks which I would not like to take.

I tried for a home birth with ds but after a 40 hour labour I ended up with an epidural, ventouse, episiotomy, the works.

When you get an epidural they read out all the risks to you which sound pretty horrific.

I ended up with dangerously low blood pressure because of it and baby was affected too.

I also let the epidural wear off for pushing stage because not feeling where to push is not nice and makes things harder. This is where I disagree with your point about causation. ..not being able to feel where to push and having to be laid down because of the epidural is more likely the cause of the cascade of intervention rather tgan a long or hard initial labour IME.

janey68 Tue 10-Dec-13 07:17:15

I think a healthy amount of information is useful, but honestly you can tie yourself in knots trying to analyse every piece of research, much of which will be conflicting, or will have been carried out on groups of women which may not be directly relevant to you anyway. Statistics don't tell the whole story!

I think it's a lot simpler than that: many women simply choose a non medicalised approach. That's not making a moral or medical judgement; it's simply a preference. I had my babies in a midwife unit where there was no epidural available. My first labour was particularly long and tough, but I had made a choice that the benefits of the MLU environment outweighed other factors. I didn't spend weeks reading up all the research: I looked at the more basic facts and decided that I really wanted to try to have my babies naturally, I wasnt keen on any drugs I might not need and I didn't want to be continuously monitored. For other women, a hospital birth or home birth might be their preferred choice

I think there's a danger of over thinking it. Opt for a hospital if you're more comfortable, and epidural if you wish. But the culture in the UK is different from some other parts of the world and there is a strong desire for low tech births as well as hospital ones, some women prefer to labour with just a midwife and not an anaesthetist in sight, and that's equally valid to a medicalised birth

Bue Tue 10-Dec-13 14:19:00

Nom that's really interesting! I know my friend had a private OB so perhaps that is the issue. She has had all three of her babies there and genuinely didn't know you could give birth in a position other than on your back! OTOH I have worked with a French midwife over here who was fabulous at facilitating active birth. I am pleased to know the picture there is rosier than I thought!

wispaxmas I think unfortunately you've just hit on the fact that midwife appointments are not long enough to give information on all the topics required sad MWs tend to give out a lot of leaflets and expect you to get info from those. I am not convinced you'd find it all that different in Canada - part from my friends who have had midwives there (as they have long appts and talk about everything) prenatal visits with a doctor tend to be very short. It seems to be a fairly universal problem and it's a shame.

MyDarlingClementine Tue 10-Dec-13 20:04:39

not read the thread I do not think they are against it - just can they provide it, the cost, the one anethetist who may or may not be busy,. the no of women on the ward and the more waiting in the wings wanting a bed, kwoing an epi may slow you down!

MyDarlingClementine Tue 10-Dec-13 20:09:36

wispa don't forget you are looking at an NHS in massive crisis, midwives pleading for more numbers and help, massive un precented birth rates, on an already fatally dangerous system...

With the greatest respect, make sure your hospital isn't known for turning away women in labour like mine were. getting into ours in the first place was an issue, let alone getting an epi.

rednellie Tue 10-Dec-13 20:22:35

bue - totally right. Having had dd in the UK and the dtwins in Canada I can confirm the UK midwife and Canadian ob appointments were perfunctory and short. My mw appointments in Canada though, ah they were amazing...I could sit for hours boring them about all my pregnancy woes. And I knew plenty of people who didn't have epidurals, I didn't.

Chunderella Tue 10-Dec-13 21:03:16

Very good post Geppa. The phenomenon you describe isn't universal, but it certainly exists. I encountered it myself. It is a horrifying truth that about 10% of the roughly 750,000 women giving birth in the UK annually are unhappy with the pain relief received. We are often brushed under the carpet, and we are not well researched. Given that women who have epidurals are often able to get some rest, i would like to know whether those of us who were refused are more likely to end up with instrumental deliveries, tearing etc. I suspect my experience in this respect was not unrepresentative...

OP, it is very true that a lot of people discussing the subject in Britain are unaware of the distinction between causation and correlation. Although having seen some US literature and forums, I don't think that's limited to us! It is true though that it is impossible to ascertain how much of the slightly lengthier average labour time is down to women who request epidural being more tired and in more pain than those who don't. As for your own birth plan, it is really poor that you said you didn't want to go to the MLU and the midwife wrote that down anyway, totally aside from the question of pain relief. I'd complain, and of course insist on it being changed.

minifingers Tue 10-Dec-13 22:17:10

Almost all the research into epidurals around the world uses as the control group, women who have had pethidine or another strong opioids. And yes - compared to heavily sedated women having mostly supine labours (ie, women who have had pethidine), epidurals don't look so bad.

However, the Place of Birth study 2011 flagged up that healthy, low risk women who opt to try to give birth in setting where opting for an epidural requires a transfer to a different setting (ie birth centres and home births) appear to have rates of emergency c-section half of that of identical women who opt to labour in settings where epidurals are readily available. I think this is very telling. I haven't met a midwife who doesn't feel that epidurals sometimes create a situation in labour which can only be resolved with surgery. It's because of the link between epidurals and higher rates of fetal distress, which the latest Cochrane review found clear evidence for. Opioids are also associated with higher rates of fetal distress.

I'm not anti epidural btw. Think they can be very useful. But I think we've got the balance right in the UK mostly.

minifingers Tue 10-Dec-13 22:21:45

Chunderella - 1 in 8 epidurals doesn't work at all, or gives incomplete pain relief. I'm sure women who experience epidural failure are unsatisfied with their pain relief. Ditto the 40% of women who find pethidine useless. It's not always about pain relief being denied. Sometimes it's about pain relief simply not working very well. Not all pain is controllable, even with the wonders of modern pharmacology!

Alanna1 Tue 10-Dec-13 22:25:19

I had my babies at UCH in London. I don't know anyone who had their babies there, requested an epidural, and didn't get it if they still wanted it. The anaesthetist told me their rate was c.95% within 15 mins of request (although i forget the exact figures).

I thought I wanted one with my first and went to the labour ward for that reason. They examined me and said I was too late. I said "but you always say that" based on what the NCT etc had told me. The midwife said she'd call the anaesthetist. To cut a short story short my baby was born about 2 minutes later. The anaesthetist came a few minutes after that and apologised for not having come sooner - the midwife said to him "you'd have been too late even if you'd been here immediately."

annielosthergun Wed 11-Dec-13 05:53:33

Wispa - I am not sure that the availability of mobile epidural has increased massively in the UK actually? I was due to give birth at one of the big London teaching hospitals and they weren't available there (a year ago). In the event I moved before the birth and got one privately - it worked well for me, I could shuffle around with DH holding my hand and felt the urge to push etc (though it had mostly worn off then!)

I think like a lot of things NHS related availability of the mobile version is still a bit of a location lottery...

Chunderella Wed 11-Dec-13 08:19:52

None of what you have posted amounts to actual evidence that the slightly lengthier labours are caused by epidurals rather than associated with them minifingers. We all know about the links between the two. Unfortunately, there seems to be much less research on eg rates of foetal distress in women who were denied epidural (which happened to me). We would need a lot more of this before we could say with any confidence that it was the epidural rather than the circumstances leading it to be requested that were the problem.

And yes, of course they don't always work and I suspect women who have had failed epidurals might well have worse outcomes than average. Could be wrong but it sounds plausible doesn't it? Although an incomplete epidural will frequently leave a woman with much more relief of pain than any of the other, less efficient but cheaper options that we are too often forced unwillingly to settle for. So those two outcomes really need to be considered separately. As for mostly having got the balance right in the UK, matter of opinion of course, but while there are 75,000 of us annually who remain dissatisfied with our pain relief, I find that at best a too-positive slant on things. It should really require more than the number of women who have the confidence to say they are dissatisfied being a minority.

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

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

I had one and it was bloody brilliant.

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

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

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

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

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

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

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

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

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

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

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

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

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

Also one to one care for women with epidurals Chunderella!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Most women produce a stool during labour.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

minifingers Thu 12-Dec-13 15:03:57

"It sounds like you're defining it as widely as possible, ie all women who deliver vaginally without augmentation or instruments, regardless of whether they have anaesthesia or not."

Yes - because other ways of describing it aren't actually all that useful or meaningful.

Juliet123456 Thu 12-Dec-13 15:17:44

Chund... there is a photograph of me at the moment of giving birth with the poo emerging (home birth) - there your evidence. Didn't bother me at all. Perfectly natural. Better than than those awful enemas they used to give women or being hungry with no energy giving birth.

Chunderella Thu 12-Dec-13 15:20:30

Well, that's a matter of opinion. I don't really care, tbh, but the idea that 'natural birth' is one that doesn't involve epidural is pretty common (and even espoused in this thread). I have even seen it used to refer to all vaginal births including instrumental, which seems ridiculous. Anyway, by all means substitute your preferred term to describe vaginal births without epidurals or opiates in the offending paragraph, if you like.

Chunderella Thu 12-Dec-13 15:26:59

I wasn't seriously suggesting that we need proof of how many women poo in labour juliet! Of all the things we need more research on, that's pretty close to the bottom of the list. Actually I don't doubt that most women do, and nor do I think the presence of poo qualifies something as barbaric. I mean, I poo most days. I don't think my toilet is barbaric except sometimes when DH has been in there a while.

Although saying that, i wouldn't mind an enema either. Not that I would need one as my body did one all by itself.

minifingers Thu 12-Dec-13 16:10:04

Chunderella - I think I prefer the term 'normal' birth (by which I mean a birth that starts spontaneously, proceeds without augmentation with syntocinon, concludes with a spontaneous birth and delivery of the placenta. It's a useful term because it's actually rooted in physiology and not culture and therefore a bit less open to misinterpretation.

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