Why is my midwife trying to talk me out of epidural

[Melvin2021]

Hi I'm 38.5 weeks and I've been pretty certain from the off that I would like an epidural when in labor obviously if everything goes to plan. Mt midwife said I don't want one and to see how I get on? Has this happened to anyone else?

@UuijungKo

I had 3 normal very painful deliveries. One of them was an induction and no epidurals offered. I agree with you OP and other posters about Midwives dissuading women from having epidurals.

With my 4th baby, I put my foot down and refused to be patronised. I kept asking for it and breathed a sigh of relief when the anesthesiologist wheeled his trolley in. The birth was perfect, no pain, went smoothly. I couldnt feel a thing but just pushed really hard when the MW told me too. I wish I had epidurals for the first 3. Felt traumatised by those births.
Good luck OP. Hope it all goes well for you.

I get what you are saying but yours was a 4th labour, which generally I would expect goes a bit quicker and smoother if you've already had three vaginal deliveries, so I'm not sure it's comparable to a first birth.

But planned c sections are way more predictable than vaginal births. Plus they eliminate the risk of horrific damage to your pelvic floor (incontinence, prolapse, tears that don't heal right, losing the ability to shit without pushing the poop out by pressing on your vaginal wall and countless other nightmares). All things considered i expect a c section to be less likely to leave you with ptsd and trauma and long term physical issues.

@Melvin2021

Hi I'm 38.5 weeks and I've been pretty certain from the off that I would like an epidural when in labor obviously if everything goes to plan. Mt midwife said I don't want one and to see how I get on? Has this happened to anyone else?

Have you asked your midwife to explain her reasoning and the pros and cons of epidural?

@Hemingwayscatz

It’s because you can’t move at all once you’ve had one so you just lie there on your back which isn’t a natural position to Labour in at all. It often stops the Labour from progressing and there’s a much higher chance you’ll need assistance from forceps or ventouse. Also higher risk of c-section.

People really need to stop assuming correlation and causation are the same thing.

@HacerSonarSusPasos

But planned c sections are way more predictable than vaginal births. Plus they eliminate the risk of horrific damage to your pelvic floor (incontinence, prolapse, tears that don't heal right, losing the ability to shit without pushing the poop out by pressing on your vaginal wall and countless other nightmares). All things considered i expect a c section to be less likely to leave you with ptsd and trauma and long term physical issues.

But they carry risks from then anaesthetic, infection in the scar, abdominal damage and trauma from undergoing a major surgery. Pregnancy can also damage your pelvic floor and I know several women who've only had c sections and have issues with bladder control.

For someone like me a c section would be the most stupid idea ever. Such a major intervention that I didn't need.

I've had 2 vaginal births. Only needed stitches with one, we're both quick (6hrs then 3hrs) my second was no worse than a very big shit tbh. Gas and air is amazing. I've got no bladder issues, no prolapse, nothing.

I've no desire to undergo surgery if I don't have to.

It's just as bad to instruct women to have a c section as to force them to give birth vaginally.

Hmm...
Why are midwives under pressure to dissuade women from requesting an epidural? I wonder...

Midwife led birth - annual salary £24K - £37K
Add in a consultant anaesthetist required for administering an epidural - annual salary £82K- £110K.
Hmmm...

Big downside to epidurals is having to have a catheter which can cause damage. Also not being able to feel contractions to work with them.

I absolutely recommend a tens machine - thought it was rubbish until the batteries ran out 🤣.

I've given birth with and without epidural. Definitely be open minded to trying without.

Funny how most of the studies done show no significant difference when using an epidural.

However plenty of articles,surveys and reports that women are being denied pain relief or discouraged from asking for it. The most common reasons given are "risks", too early, too late or no anaesthesiologist available.

Risks like increased instrumental delivery or csections aren't confirmed by research. Too early/late is debatable and experts don't necessarily agree unless in clear cut cases like 2 cm dilated or baby ready to come out in the next few issues.

Staffing is a real issue , like in all area if the NHS but definitely not a reason to discourage women to ask for an epidural.

@seekingasimplelife

Hmm... Why are midwives under pressure to dissuade women from requesting an epidural? I wonder...

Midwife led birth - annual salary £24K - £37K
Add in a consultant anaesthetist required for administering an epidural - annual salary £82K- £110K.
Hmmm...

@seekingasimplelife there’s an anaesthetist is on/available for labour ward whether or not there are epidurals to do - we’re there for sections/forceps deliveries/MROPs/tear repairs/resuscitating mothers (and occasionally partners!) as well as providing the epidurals (It’s because of all those bits that we don’t always get there straight away when the request is made). While there’s always an on-call consultant available from a distance, anaesthetic provision on labour ward is also not always consultant delivered - it may well be registrars/staff grades/associate specialists/clinical fellows - all of whom are well trained but a lot cheaper. HTH.

@ldontWanna

Funny how most of the studies done show no significant difference when using an epidural.

However plenty of articles,surveys and reports that women are being denied pain relief or discouraged from asking for it. The most common reasons given are "risks", too early, too late or no anaesthesiologist available.

Risks like increased instrumental delivery or csections aren't confirmed by research. Too early/late is debatable and experts don't necessarily agree unless in clear cut cases like 2 cm dilated or baby ready to come out in the next few issues.

Staffing is a real issue , like in all area if the NHS but definitely not a reason to discourage women to ask for an epidural.

The study I posted earlier actually does show there IS a significant difference in outcomes when using an epidural.

@peaceanddove

Why on Earth would you willingly want to experience agony? Why? I simply don't get it.

People endure many other very painful medical procedures, but HCPs wouldn't dream of setting a bone, or removing wisdom teeth without using some serious pain relief.

I'm reading this thread and thinking the exact same thing. There are some seriously hardcore women on here and I'm in awe.

The fist twinge and I'd probably have a panic attack and be screaming hysterically and hyperventilating. I'm not good at pain at all. I remember reading a statistic in the Positive (hah) Birth Book about being in pain for 76 minutes or something, and it frightened me so much I had a panic attack and threw up then sobbed and hyperventilated on my consultant.

Unsurprisingly I had an ELCS.

Why would you want a fuckoff enormous needle put into your spine and need a catheter (yuck) to avoid a few hours of pain ?
Good job we are all different eh ?

Nothing beat being able to get up off the bed and walk to the bath afterwards- for me, I would put up with quite a lot of pain to be able to move freely during and afterwards, but as I say we are all different.

@Soontobe60 and here's one that didn't find the same thing.

• A total of 7675 vaginal deliveriess_ occurred in our maternal unit during the study period and 187 (2.43%) women had vacuum extraction. EA was given to 3093 (40.3%) parturients whereas 4582 (59.7%) received systemic opioid, inhalation analgesia or no analgesia at all. Instrumental assistance for delivery was applied to 67 (2.16%) women in labor who received EA and to 120 (2.61%) who did not. Three entries (1 case and 2 controls) were not studied due to lack of medical records (Fig. 1).

1. Conclusions

According to our study, labor EA did not increase the incidence of instrumental assisted delivery and the risk of adverse neonatal outcomes.*

There's another one in the Netherlands I think. I'll see if i can find it again.

Oh and even your study showed there was no increased risk for a CS.

@Neurodiversitydoctor

Why would you want a fuckoff enormous needle put into your spine and need a catheter (yuck) to avoid a few hours of pain ? Good job we are all different eh ?

That's as daft as saying why would having a needle bother you if it allowed you to avoid excruciating pain!

@Ionlydomassiveones me neither but when I had my youngest the policy had changed and epidural = automatic catheter.

I had it in my birth plan I didn't consent to one but I didn't need the epidural thankfully.

www.sciencedirect.com/science/article/abs/pii/S0301211514005478

But they are huge ! And straight into your spine !, I'd be terrified of being paralysed. The pain of contractions are natural and you know they will end, you also get a great between them. But as a I say everyone is different just explaining why for me I'd rather the pain of labour than an epidural in response to the "Why wouldn't you ?" Post.

@Neurodiversitydoctor

Why would you want a fuckoff enormous needle put into your spine and need a catheter (yuck) to avoid a few hours of pain ? Good job we are all different eh ?

Why wouldn't you want a needle in your spine (takes like a minute) to avoid hours and hours of pain? Works both ways doesn't it.

@Greybeardy Yes, thank you - I'm well aware there is usually a single anaesthetist available for a labour ward, prioritising sections/forceps deliveries/MROPs/tear repairs/resuscitating mothers.

I think that is the point. Their priority is for emergencies, because with this level of staffing it has be.

Women opting for an epidural as part of their birth plan are at the bottom of the pile (if they haven't been dissuaded from this before arriving at the hospital).
So, - you have a full labour ward of women soon to give birth, all who have opted for an epidural as part of their birth plan. Do the hospital ensure that there are sufficiently qualified staff to enable this on a day to day basis, not just for the epidural itself but their aftercare? As well as having capacity to cope with any emergencies?
That is a very long way from my experience.

So much better for the balance sheet to persuade them that natural birth is best and not to make a fuss, Then only intervene in an emergency, because guess what - then you'll only need one qualified person on the ward.

@Neurodiversitydoctor I begged for the epidural. I didn't get a break at all between contractions like you've said. I actually massively over contracted, didn't get a break between them, and probably would have begged for a c section if it wasn't for the epidural. (At one point I did beg actually-)

The epidural meant I could sleep for 3 hours and regain some energy. I pushed for 20 mins and had no further intervention. The epidural honestly saved me from a really terrifying, painful back to back labour - when I wasn't getting a break.

@Neurodiversitydoctor

But they are huge ! And straight into your spine !, I'd be terrified of being paralysed. The pain of contractions are natural and you know they will end, you also get a great between them. But as a I say everyone is different just explaining why for me I'd rather the pain of labour than an epidural in response to the "Why wouldn't you ?" Post.

I'm definitely of the different strokes for different folks school, but the idea that contractions being 'natural' makes two shits of difference has always struck me as particularly batshit. Either you want the pain relief available or you don't, that's all.

I also didn't have a catheter with my epidural. And was up on my feet in the shower, an hour after giving birth.

Have no lasting damage etc.

Here's some research showing higher intervention rates caused by epidurals
www.sciencedirect.com/science/article/abs/pii/S1871519220303188

onlinelibrary.wiley.com/doi/abs/10.1111/j.1523-536X.2011.00486.x

www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000331/full

One on outcome for babies jamanetwork.com/journals/jamanetworkopen/article-abstract/2784118

NICE guidelines state that epidural is associated with assisted instrumental births but says if the woman requests it, it should be given
file:/C:/Users/Newsdesk/Downloads/intrapartum-care-pain-relief-in-labour.pdf