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?

Happened to me. Was convinced to try other pain relief methods first.

The result?
Still needed an epidural.
Ended up with an EMCS. Needed general anaesthetic for it too.
I was exhausted by the end and traumatised.
I had PND afterwards.

I do often think about what would have happened if she had just let me have it when I asked. Sure, EMCS still could have happened but I wouldn’t have been so exhausted and in mental despair. I would have had a small breather. It could have made all the difference.

Did DD2 I had an elective c section and took control. I had an amazing experience.

Sometimes you know best. I’d see how labour goes but make the call and insist. Also tell your birthing partner your plans and boundaries so they can advocate for you. Some midwives think they can ride roughshod over vulnerable women. It’s best to have someone who isn’t in labour to back you up if necessary.

The hospital I gave birth in didn't offer epidurals as a form of pain relief...it was never an option. And this is less than 10 years ago!

@Cherrytart23 I think you might be in a huge minority there. The fact that for some reason you enjoyed giving birth and your personal pain was not that bad is by no means a universal experience.

OP have you read Give Birth Like a Feminist by Milli Hill? It’s a fabulous book that I read before giving birth to dc2 and it made me feel so much more in control of the experience than I was the first time.

I had a epidural in fact I was 7-8cm's and changed wards (birth centre to maternity ward) after I slipped in the tub as the water made it worse for my pain as my birth plan was water birth. I had excellent care from my local hospital and midwives who listened to what I wanted and arranged a epidural very quickly. When I was all plugged in, I just felt so lucky. I had a first degree tear however, I did deliver a fairly large long baby. I was able to walk a few hours later and never had any issues with it.

Everyone's pain threshold is different, every delivery is different, everyone's mind, mental health, body is different. My limit was at 7-8cm, if I was refused a epidural, I would have lost my mind back then which would have caused a whole lot of other mental health issues later on, pnd, birth trauma. I had a terrible pregnancy (HG) and was already in a dark place and if they had refused that epidural, I don't think I would have been the same ever again.

@MissM2912

No I clearly said that many women have an epidural with NO issues. I am not in anyway disputing that. But the fact remains that there are significant risks with them and many women who have had them have a poorer birth outcome. THEREFORE- to reduce this risk, it would be worthwhile attempting to manage with lower risk pain relief where possible.

The fact remains that there are significant risks involved with childbirth full stop, the very least we can ask for is to feel as in control as the situation allows, understandably things can change throughout labour but going into it feeling in control and empowered will most likely result in a positive birth experience regardless of any complications.

I had a rough birth experience, not because of pain but because I wasn't listened to and was spoken down to by the midwife on the ward, she thought she knew me and my body better than I did, but from your viewpoint I had a very positive birth experience as I didn't have any pain relief or stitches and no intervention. Every woman and every labour is different and every woman should have full autonomy of the process.

OP, the decision is 100% yours, its your labour and your body, the midwife cannot make that call for you.

@CallmeHendricks

Would you have a tooth extracted without an anaesthetic?

Exactly.

If the anaesthetic greatly increased the chances of the extraction giving me long term issues, then I would consider alternatives yeah.

Of course you can have an epidural but be open to try other methods of pain relief, they might be helpful. I had 3 children and for my first DD I wanted an epidural ( stated on my birth plan) so badly. When I was in labour ,the midwife offered me the gas&air .it worked so well for me. After that experience I used gas&air for my other 2 children.
So just be positive and consider also other methods but ultimately it is your choice of course.

The data about epidurals leading to the "cascade of interventions" is outdated and not supported by current research. Your hospital statistics are not proper research. The link does not appear to be causal.

As for midwives, for a long time the RCM took quite a strong stand against epidurals with their "Campaign for Normal Birth"--which ended because of the horrors at Morecambe Bay. There's still a lot of midwives who have an ideological grudge against epidurals.

Birth itself can cause incontinence and tears.

Have the epidural if you want it because there are no medals for pain endured, IMO I tried every pain relief option apart from epidural, they did nothing, gas and air was great at first but quickly stopped working as effectively after the 10th hour of painful regular contractions, pethidine didn’t touch anything and I wanted an epidural but the midwife talked me out of it, even though I’d spent days in labour, and by the time I was begging for it she said it was too late, It ended in a traumatic episiotomy and instrumental delivery in theatre...wished I had pushed for the epidural, I’d of probably been able to sleep through labour and had a much more positive experience...I wasn’t able to do any skin to skin with her straight away because I was just so exhausted when I got into recovery, feel like I was robbed, I couldn’t even hold her until she was a few hours old and I’d had a few hours sleep

This thread: why is my midwife trying to talk me out of epidural
One brave, informed poster: reasons, rational reasons
Everyone else: you're entitled to have what you want, choose what your instincts tell you

It hurts! Have the epidural.
Chances of it going wrong are slim.
There is no guarantee that you won’t need medical intervention if you wasn’t having an epidural so why suffer?

Put your foot down, it’s your body!

If men had to give birth I bet other men wouldn’t talk them out of pain relief.

I don’t know why women do it, but it is always women! I think it’s a case of I’ve suffered before so you have to as well.

@Avarua

This thread: why is my midwife trying to talk me out of epidural One brave, informed poster: reasons, rational reasons Everyone else: you're entitled to have what you want, choose what your instincts tell you

You’ve got this wrong.

There shouldn’t be any talking “out” (or “in”) of ANY options.
There should be a rational discussion about pros and cons of the options available. It’s up to health professionals to provide information so women can choose for themselves. It’s simply informed consent.

And the one poster I’m assuming you are referring to really isn’t as informed as she or you think!

‘Just wait and see how it goes’ was said to me by at least one midwife.

But I felt the benefits to having an epidural were when you get it early. Not being tired so energy to push (so I didn’t need further intervention), time to get the level of sensation right, being present and remembering the birth, first moments with my babies.
Also I asked my anaesthetist DH what he would recommend and he said epidural.
I am happy with my choice. I’ve had three early epidurals.
And I felt the pain of contractions initially anyway because my hospital wouldn’t admit me until I was 3cm dilated (and that took many hours).

"I had one and actually enjoyed giving birth..absolutely no medical intervention was necessary!"

To get an epidural you need an IV cannula inserted; an infusion drip; a VE to determine dilation and station; a continuous CTG (as having the epidural increases the chance of a dip in blood pressure which results in no blood delivered to the placenta and a baby whose heart rate dips dangerously... yes I've witnessed many of these); the sterile insertion on a needle and an epidural cannula in between your vertebrae (which does not always work); the injection of Bupavacaine/Fentanyl and other opioids of choice in your epidural space; the insertion of an indwelling catheter as you cannot get up to pee anymore; more often than not oxytocin augmentation, as an epidural often results in dwindling contractions; and to be told how and where to push, as you lose the urge, which often results in a prolonged second stage (2.5 hours pushing for my last birth this morning, I am a midwife) which often results in ventouse/forceps for first time mums, and sometimes for second and third. if your baby is posterior, an epidural increases your chances of cesarean section by 50%, as your reduced ability to move and reduced ability to push means the baby does not have the chance to turn.

You have an interesting concept of "absolutely no medical intervention".

@Avarua

This thread: why is my midwife trying to talk me out of epidural One brave, informed poster: reasons, rational reasons Everyone else: you're entitled to have what you want, choose what your instincts tell you

Please don’t patronise women who have had/wanted to have epidurals as pain relief during pregnancy. No one is a spoilt brat for wanting pain relief. You wouldn’t say someone having a hip replacement is a brat for having pain relief, so don’t dare allude to it when it comes to pregnant women.

If epidurals were so risky, they wouldn’t be allowed. It’s up to the individual woman and I really don’t see why it’s better for women to come out of childbirth traumatised and in agony rather than them making a decision where this type of pain relief has smaller increased risks of intervention etc needing to happen.

The poster you’re referring to is not brave. The women who wanted pain relief but were denied it due to midwives’ personal decisions are.

As a midwife, it is your job to provide information on all options and allow the woman to decide. Obviously there are situations where medical intervention is required but in terms of pain relief, that’s very much a woman’s choice. The days of uncaring matrons in hospitals telling women to suck it up and leaving them traumatised and depressed should be long gone. The poster you’re referring to is clinging on to an old ideology that should be dead in the water by now. Nothing brave or informed at all.

Oh, and a management position in a hospital is not actual experience in pain relief. No medical degree, no opinion that has any more standing than anyone else’s.

Mine led to an episiotomy, 3rd degree tear and various postpartum issues from this. It also wore off so I had intense pain in one area, and I had weird sensations in one legs for weeks after.

Of course, not the case for all and I really had no choice as my body reacted strongly to an induction (back to back contractions etc).

They absolutely have their place but you have to go in with your eyes open to all possibilities and weigh up the choice

It really depends on labour. My first (twenty years ago) was over 24 hours and very shocking in terms of pain. I had gas, then pethedine (just made me sick and woozy) then epidural. I couldn't feel what was happening which made pushing a lot harder it became touch and go and in end needed ventouse (sp?) but avoided caesarean. With my next child labour was only few hours and I managed on gas and air.
Your labour is absolutely your choice I would just read up on the pain methods. If you are wanting an epidural make sure you know the risks as well as benefits.

And no, the risks of an epidural are not "slim" or "rare". They are fairly common. I have assisted with hundreds, probably close to 1000 of them so far (I couldn't care less which pain relief the woman wants, I just give them the stats and they choose. Supporting a woman with no pain relief is actually harder and much more taxing than monitoring a woman with an epidural) and it is actually not that common to have one where absolutely nothing goes wrong. Unfortunately some women think that things would have gone wrong anyway and are "grateful they were in hospital", when actually I could have told them: your baby was distressed because of the oxytocin you needed as your contractions dwindled after your early epidural; your baby had a terrifying prolonged deceleration and you needed an emergency cesarean because the epidural drugs cut off its blood supply; you needed forceps because your body didn't know how to push your baby out, I could see your vaginal muscles doing fuck all while you exhausted yourself pushing the wrong way. No, it would not have happened without an epidural.

I personally don't care what options women get, but "instinct" is useless when the decision is about taking on a complex medical procedure they know nothing about. If you are not a midwife, obstetrician or anaesthetist yourself, you cannot have an "instinct" that tells you to have an epidural, or a cesarean section. Your "instinct" may well be to avoid pain, but in order to choose how you do need to know the statistics first. And the ones given here by professionals are spot on. Remember, we are the ones who work with them all the time, and we literally see all these "rare" side effects all the time.

@NoNameHere12

If men had to give birth I bet other men wouldn’t talk them out of pain relief.

I don’t know why women do it, but it is always women! I think it’s a case of I’ve suffered before so you have to as well.

I also bet pain relief would have had more investment and research put into it!!

I wanted one but it can slow down the birth so I went as long as I could on a tenns machine (highly recommend) then asked for the epidural. They gave me gas and air while I waited for the anesthetist and I actually would have coped well on that too but epidural was great as I was entering my 2nd night of labour and was able to get some solid sleep.
Check out the positive birth company course, I found it really useful x

I'd say wait and see.
I went in with #1 saying I didn't want an epidural and had one.
With Dd2 I wrote on my birth plan I wanted one ASAP and then didn't get to the point of wanting one.
Didn't bother with a birth plan with #3, but again didn't need one.

Sorry you had such a pushy midwife OP. I had one during my actual labour and had to ask to change midwives 🙄 mine was the opposite of yours though -
I was mid induction, pessaries done, waters broken, needed the hormone drip and she told me I wasn’t allowed the drip without an epidural first as I ‘wouldn’t cope’ and my baby would become distressed 😳 I literally had barely made a peep at that point and felt very in control of the situation, it’s not as if I had reached a point of struggling etc and baby was doing absolutely perfectly. Luckily the midwife that swapped in was an absolute angel and listened to every word I said. She could not have been more supportive!!
I’m absolutely not against pain relief at all but I was delivering during the height of the pandemic and know that statistically epidural can make your hospital stay longer so I hoped to keep that as a last resort. As it turns out, I managed fine on G&A and was home the same day.

My best advice to you would be to do all your research - know the risks and benefits of each type of pain relief. Have an order of preference noted down if it’s important to you and make sure your birth partner knows it too 😊 if you want an epidural straight away then that is 100% your right to choose and you tell them firmly that that is what you want. Very much worth looking at other options too though - my best friend was very much of the opinion that she was having an epidural straight away but reached the hospital too far gone to have one and was in a bit of a panic over other pain relief as she didn’t really know her options

I had one in my first labour after god knows how many hours and just before the drip and it only worked on one side. I also had really rubbish midwives. Baby was coming out so it was an emcs after even more hours
Number two felt really different from the start progressed well, much shorter labour had pethedine and gas and air and tens machine. Much easier recovery even with the episiotomy.
I would wait and see how you feel when you go into labour. Most women who gave birth around the same time as me had a less than 6 hour labours
Do make sure they give you pain killers afterwards however you give birth!

I had an epidural with my first birth. The sudden pain relief felt like ecstasy, but - but! I hated being confined to bed with tubes and machines everywhere, a catheter etc. It felt really dehumanising. If you're on your back it also makes it harder to push. I had a CS in the end.

With dc2 I just had gas and air and it was fairly fast and furious. The pain was intense and I promised myself I'd never do it again! But it was confined to a short period, and once DC was out I felt absolutely fine, could walk about with no catheters or bags of piss hanging off me etc. Overall it was much better.

I think you should be able to choose an epidural if that's what you want, but I think it's important to think of the whole experience rather than just labour alone. So the effect on recovery and early days for the baby.