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?

@Neurodiversitydoctor they mentioned something about there still being a very thin bit of cervix there as part of the reason but that's all I remember honestly. They actually pushed for forceps delivery more than a c section but that couldn't be done.

Safest thing was to get baby there, so I 100% had said do what's needed to get her out safe. Midwife did say also about epidural failing being a reason they went with c section. It's listed as being an emergency c section but not life threatening to me or baby

I had an epidural with DD and when it worked it was great. It was turned right down for when I pushed and so I could feel to push and felt her wriggle out which was very special. Being able to feel didn't make me any good at pushing though and I needed an episiotomy to get her out. It also sucked that it wasn't working when my placenta was removed.

For DS it was an induction and I got an epidural straight away. It made me feel awful and sick for five minutes or so but then was great. It was kind of mild so I could still move my legs and feel contractions but it had to be adjusted as it was positioned wrongly once he moved lower and from then on it was super effective like I literally couldn't feel a thing. Still managed to push much more effectively than I did with DD and he was born with a tiny tear after only 15 minutes or so pushing. I'd take the epidural any day personally.

@kinsters

Fully agreed they are magic when they work.

I had no trouble pushing and it actually helped progress my back to back labour as I wasn't as stressed.

My contractions were actually strongest when I lay on my left side, weakest when walking about before the epi. It also reduced my BP which was getting alarmingly high (140-150) range.

Definitely would have it next time as a planned epidural though not being rushed up the the CLU in agony.

If a woman is suffering and would like an epidural, the risks can be offset with proper care and are worth it. If a woman doesn't consent to feeling the worst pain of her life but is forced to do so anyway because someone else thinks they know what's best for her, then she will suffer from PTSD. Women are not just vessels for pain.

If you really care about the risks of epidurals, then you should know that using a peanut ball to open the pelvis, switching positions in the bed, drinking ice water, putting a cold cloth on the forehead, being calm and well rested can all lead to greater outcomes and prevent the bad ones.

Also, I hate to break it to you but an epidural is a tool used in natural childbirth. Childbirth is a natural process. An epidural does not stop the natural process from occurring.

@MissM2912

It’s not about ‘being a better mum!’- it’s about optimising your chance of having a positive birth experience. The impact of having a negative birth experience can be huge- both physically and emotionally. Yes- you can have an epidural and have a fantastic birth- but many women, as seen in previous comments, do not have such a good time and the reality is you won’t know until you are in the throes of Labour how it will work out.

The whole point of getting an epidural is to cultivate a positive birthing experience for the mother and avoid trauma, PTSD, and PPD. That's what the OP wants one. She is making a choice to have a better birth for herself. The midwives should be in support of that and do what they can to ensure it goes well, not discourage her. She'll most likely have to labour for a few hours unmedicated before getting it anyway and when the time is right and it makes sense to get it, then she can get it.

@MissM2912

My point about natural birth leading to increased satisfaction is to highlight the potential negative impact of needing an assisted delivery or an emergency section.

Epidurals are just a form of pain relief. They are low dosage these days so they allow for some mobility. In order to avoid further intervention, a woman can hire a doula, use a peanut ball to open her pelvis, birth in a semi-recumbant position, "labour down" (meaning let the epidural wear off a little bit). An epidural doesn't mean complete numbness and lying on your back in stirrups. Women who birth with a good low-dosage epidural for pain relief can still feel pressure, the fetal ejection reflex, the crowning, and the birth. It can still be an incredible experience in which the woman feels very accomplished and proud of herself.

@MissM2912

I am not disputing that women should be listened to- if you want an epidural have one, what I initially said was that the midwife had good reason to say to see how it goes without. She won’t have said this to suppress the OPs rights or infantilise or make the OP feel shit, but because she probably has delivered hundreds of babies and in her professional opinion it is preferable to avoid an epidural! I mean would you argue with a solicitor like this? Or an accountant?? Is it just midwifes who aren’t worth listening to?

"see how it goes"

But what if she doesn't want to experience the transition stage or pushing stage unmedicated? She might cope well in active labour but be in extreme agony during the worst of it. If she wants to avoid experiencing the excruciating pain, she should be able to without being forced to experience those contractions in order to see if she likes it instead.

An epidural doesn't mean complete numbness and lying on your back in stirrups. Women who birth with a good low-dosage epidural for pain relief can still feel pressure, the fetal ejection reflex, the crowning, and the birth. It can still be an incredible experience in which the woman feels very accomplished and proud of herself.

This was me, I could still feel the contractions and the baby come out. It felt like doing a humongous poo.

I just want to point out there are some posters on this thread quoting completely outrageous statistics (e.g. some ridiculous 50% number), plus links are being provided to very out-of-date studies and/or studies primarily conducted by midwife departments (which I trust less to be honest, as I often am skeptical as to their ability to produce high quality unbiased studies when it comes to this area).

Things are very different with modern epidurals, for example: www.cochrane.org/CD000331/PREG_epidurals-pain-relief-labour://www.cochrane.org/CD000331/PREG_epidurals-pain-relief-labour

There are many other recent studies with similar conclusions to the above.

Furthermore there are many other factors involved in the potential for an increased risk of instrumental birth, e.g. is this the mother's first vaginal birth, was she induced etc.

While I am greatly supportive of the NHS, it is very much an incredibly basic one size fits all service when it comes to childbirth. Having experienced childbirth in 3 different countries (all with advanced medical care) including the UK, I am of the opinion that the NHS simply doesn't have the resources to be able to offer choices and dignified birthing to women (incl. providing guaranteed access to an epidural if requested). Sadly I think there are incentives in the system to promote births without epidurals, primarily the lack of available required staff (i.e. anaesthetists) due to funding/management.

It seems most people agree women should be able to choose, but it is simply
not possible if the staff aren't actually on the ward.

Midwife's are put in a difficult position in this sense, as they are the front line, and it's much easier for them, to tell both themselves, and birthing women, that it is much safer to try to avoid an epidural, than it is to tell someone who is at extremely low risk of an instrumental birth due to an epidural (i.e. someone with zero complications going having their 3rd child) that they just can't have one because it costs too much and the system doesn't prioritize your pain relief.

As the old analogy goes, we would consider it barbaric to pop someone's dislocated shoulder back in without adequate pain relief, but we just can't afford to give the same option to women going through childbirth.

I wish I hadn't had one in my 1st labour. It provided good pain relief but I couldn't properly feel when to push and I ended up with a fairly substantial 3rd degree tear. Luckily I healed very well but I was determined to avoid it for Dc2 which I did, and had no tearing or damage.
I felt it disconnected me from the labour tbh. I don't think people should be denied one if they feel that need it in labour, but I don't think people need to go into labour already deciding that they're having one.

OP stick to your guns. You are the one who will be giving birth so you need to choose your options and everyone else needs to accept and respect those. Yes, natural birth is great but so is pain relief.

Epidurals are expensive, but tough, there's been enough money wasted in the past few years, so the NHS can stop using maternity services as the first place to save money. Ditto c-sections. If a woman wants one, she should have one. There are no prizes for being a martyr and no need for a woman to have a traumatic and/or painful birth.

All of this stems from our puritanical viewpoint that even if you are married, you shouldn't really be Doing The Deed and pregnancy is sinful, or something, so you need to suffer in pregnancy.

Blow that.

Just be firm OP. I was told that natural birth might be difficult (pelvic issues) but "we will see how it goes" . I told them in no uncertain terms that we would bloody well not be 'seeing how it goes' - I'm not an experiment and I knew what I wanted - a cesarean. Had to argue my case but got one in the end, then had to go through the process again with my second.

I dunno op, nobody really knows how birth will go - your baby could be born in the car on the way to the hospital. Maybe your midwife was just gently indicating that plans don't always work out.

I wanted an epidural for my second labour but I was too far on. They called the anaesthetist but I'd have been having it as the baby crowned!

I had an epidural with my first and felt disconnected from my body, the pain relief was great but I kept dozing then walking to give myself covered with tubes and machines everywhere, not knowing where I was.

I bet the OP does know how the birth went 😂

I had one with my first, I was medically advised to due to having had surgery on my jaw they wanted to make sure they’d be able to deliver safely without intubating me. Total crap now I know but 22 years ago I was young and didn’t question it. So it only worked down one side. Was awful, and not a nice experience for me. My midwife was a cow too which didn’t help. They tried to advise for second but thankfully he arrived after baby was born, and no recommendation for 3&4 and they’d have been born before I got one anyway.

my labours 3 out of 4 were pretty much pain free so I didn’t have any pain relief - 3 came fast once I got to the delivery suite, 3 was born in triage and 4 in the prenatal ward so speedy babies. I never had a birth plan for any. But I knew what I did and didn’t want. If it’s there as a option then women should be able to request one if they want. Informed consent is a thing.

I'm assume the majority of the women on this thread live in the UK, one of the safest countries in the world to give birth in.

No it's not!

I don’t think the MW communicated the risks clearly, it just sounded like she was refusing one and steering you to the natural birth route.

If YOU want an epidural, you should be able to have one, I was given a c section, emergency one because the baby came early but I did have an elective approved.

on reflection, I regret having a c section.
The back pain, continued numbness around the scar. Mine did also get infected so never healed well.

However I was informed of all the risks and it was my decision to make.

It isn't misinformation, research has shown worse birth outcomes when epidurals are used e. g.
Women using EA (epidural analgesia) were more likely to require a vacuum-assisted birth (RRR 3.35, p < 0.01) or forceps-assisted birth (RRR 11.69, p < 0.01). Exposure to EA was associated with significantly greater risk of ≥10 h first (OR 6.72, p = 0.01) and ≥2 h second (OR 2.25, p < 0.01) stage labour, increased likelihood of receiving IV syntocinon (OR 9.38, p < 0.01), antibiotics (OR 2.97, p < 0.01) and a greater probability of pyrexia (OR 10.26, p < 0.01). Women who used EA were half as likely to be breastfeeding at three months postpartum (OR 0.53, p < 0.01). No differences were observed between groups in neonatal outcomes.

www.sciencedirect.com/science/article/abs/pii/S1871519220303188

it is probably also worth including the authors’ observation re the limitations of their findings: ‘observational data cannot show causality, and these results should be interpreted with some degree of caution’.

Given this post was from January, I think it may be a little late for op!

I had an epidural with both first pregnancy amazzzzing second time I had one two years ago it went wrong and I had a spinal headache and had to have blood put into my spine. There are risks took hospital over a week and me repeatedly going in to be taken seriously as was told it was so rare couldn't be that but knew after the labour something was wrong. All I would say if you have someone that isn't confident doing it don't let them carry on poking.

I have had 3 children but only the last one in 1998 was with an epidural- it was the easiest birth of the 3 by far-however it did leave me with frequently getting sciatica down 1 leg and lower back ache- all started straight after the birth.