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?

I gave birth for the first time three months ago. For me, childbirth was a lot less painful than I had anticipated (I know I was very lucky). The contractions before I got to hospital were painful, although not unbearable, but I experienced the sensations of transition as pressure rather than pain.

I don't have a particularly high pain threshold (needed g&a for stitches following an episiotomy) but honestly I just didn't feel the need for any pain relief during the birth process itself.

You should definitely not be refused an epidural if you want one at the time, but it might be worth considering you may not actually need one? Nothing to do with being a martyr or suffering unnecessarily, you might just find that childbirth goes differently from how you expect.

It's chicken and egg lies the mum could be in pain due to any number of reasons meaning intervention or tricky birth was on the cards anyway.
I wish I had been allowed one.
Elc by choice second time and much better

Having had the pleasure of fighting for a maternal request ELCS, I am now extremely wary of medical experts that blatantly have an agenda towards disempowering women at one of the most vulnerable and important times of our lives.

I urge you to look into the evidence properly yourself and don't just read headline figures. As mentioned previously it is vital that you look at causality as more complicated and difficult births will disproportionately appear both in stats around epidural/C-sections and worse outcomes. This absolutely does not mean that the epidural or C-section caused the worse outcome.

You also need to look holistically across a range of statistics and sources. Often you are trading one set of risks with another and there isn't necessarily one objective best way of doing things. The amount of people that buy into the NCT and NHS rubbish about C-sections being more dangerous or expensive is testament to how statistics and public opinion can be manipulated to suit public policy.

It's also important to remember that midwives don't really get involved with postpartum care, so their experience of the long term impact of birth can be extremely limited. A 'good birth' from their perspective may well not match your view of a 'good birth' with positive outcomes.

I can't stress enough, do your own thorough research and don't take what the medical professionals tell you at face value. I am the opposite of a conspiracy theorist and I am usually the first to advocate listening to experts, but I can't tell you how messed up my experience of dealing with the NHS was in this area and how much it undermined my confidence in the institution when it comes to being able to provide unbiased information and advice on childbirth.

Years ago someone linked to a forum midwives use and posted comments. It made the papers.

Talking about mums wanting pain relief in a degenerative manner etc.

At the time I was asking for an Elc the biggest cost to maternity wasn't c sections but life pay outs to babies damaged in birth.

@MissM2912

SheWolfOFFrancee I am not disputing that anyone can have a traumatic birth- what I am saying is that an epidural increases the risk of needing an assisted delivery or a section.

And you don’t seem,to get that for some women that isn’t a concern. They would rather take that “risk” than have any amount of time in pain. And that’s up to them.

As long as they are informed of the “risks” and benefits they should be able to make an informed choice. I do agree with people though saying to have an open mind, you might find labour is ok with gas and air. But if you don’t then you’ll know that fairly quickly and can change to an epidural.

OP, this is what the NICE guidelines say;

1.9 Pain relief in labour: regional analgesia

Information about regional analgesia

1.9.1 If a woman is contemplating regional analgesia, talk with her about the risks and benefits and the implications for her labour, including the arrangements and time involved for transfer of care to an obstetric unit if she is at home or in a midwifery unit (follow the general principles for transfer of care described in section 1.6). [2007, amended 2014]

1.9.2 Provide information about epidural analgesia, including the following:

It is available only in obstetric units.

It provides more effective pain relief than opioids.

It is not associated with long‑term backache.

It is not associated with a longer first stage of labour or an increased chance of a caesarean birth.

It is associated with a longer second stage of labour and an increased chance of vaginal instrumental birth.

It will be accompanied by a more intensive level of monitoring and intravenous access, and so mobility may be reduced. [2007, amended 2014]

@Newyearoldyou

Years ago someone linked to a forum midwives use and posted comments. It made the papers.

Talking about mums wanting pain relief in a degenerative manner etc.

It was a student midwife forum. I’d like to think as they progressed through their training they reflected on some of the comments they made.

Have one if you want.

From personal experience, having forceps with zero pain relief is no fun at all.

I would say absolutely make it very clear in your birth plan you want one but keep an open mind. In my birth plan I wanted “options” so I felt there was always something else I could have if I needed it.

I had all these wonderful ideas about TENS machines and water births, maybe a little gas and air, strictly no pethidine, then moving onto an epidural. The reality is my first DD came so quickly (an hour and a half start to finish) that there was no time for anything other than gas and air. Also, my perception of Labour pain was very different to reality. For me it was like the worlds worst diarrhoea cramps. So highly unpleasant and feeling totally out of control but not exactly pain.

The gas and air made me feel very woozy though and I can’t really remember DD being born.

Second time around I kept the same mentality but the only pain relief I had on my birth plan was an epidural if I needed it. I felt that if it all happened as quickly as with DD2 then I could actually cope. I started with a TENS machine which really helped focus my breathing, used a birthing stool which I found VERY helpful with the poo like sensations but then two and three quarter hours later with my DD being back to back and me being totally exhausted, the midwives recommended an epidural as it looked like we might need a ventouse delivery. In the end after an episiotomy she came without the epidural or intervention, but I was so ready for it. I’m happy I didn’t have it straight off as I wouldn’t have had that “go to” when I needed it. I wasn’t trying to win any prizes or be some no pain relief champion. I just listened to my body and went with it.

Stick to your guns! I was very much a hypnobirthing (attempted) kind of girl but ended up being induced on a hormone drip and my goodness I was so glad of my epidural! It was honestly the best thing ever and I think I would’ve married the anaesthetist If I could’ve at that point. The only downside was having to be on a catheter as obviously I couldn’t walk or feel anything. But honestly I had a wonderful birth experience with no other interventions x

There is NO evidence that epidurals cause more intervention. It is now thought that mothers having difficult births are more likely to request epidurals and that it is the challenging birth that means intervention is more likely, not the epidural. Other countries with high epidural rates have lower C section rates than the Uk, for example.

I have seen midwives delay and actively discourage epidurals, so don’t place 100% of your trust in your midwife…

I had an epidural with my first DC and I really regretted it. I couldn't feel the pushing properly and ended up with a 3rd degree tear and DD having a ventouse. I recovered very easily but I regretted not feeling in control of my birth. When I had DS I was determined not to have one and I didn't - it was a much better birth experience with no injury to me and no intevention to the birth. Both babies were on the big side.

I think that an epidural is not always needed but wanted. There are some instances where it has its place but (I guess) for the majority it is not needed.

My DS had an epidural and I think it made her delivery a lot longer / traumatic than it needed to be.

My first was delivered with pethidine (which also prolonged birth) and my second with gas.

It's not about being a martyr. You can't say "I'm going to have an epidural in Labour" anymore than you can say "I'm going to go on ventilation when I have Covid".

You don't know at this stage how your Labour will progress, it's good to know all the options, understand all the benefits and drawbacks but keep an open mind. It is not misinformation but just fact that the more intervention you have the more risk develops for you both, so you take those risks when the benefit outweighs them.

Work your way up the pain relief and if you get to epidural that's of course absolutely fine, but no midwife in this country is going to give you an epidural from the start.

I had 4 children ..the last 3 I wouldn’t let anyone near me while in labour ,due to being forced to have an epidural with the first .the midwife decided I wasn’t coping ( I was I had zoned out to concentrate on contractions ,) and made my dh hold me still with another staff member while they tried and failed to insert the epidural while I screamed ,cried and shouted at them to stop.my back was black from top to bottom with bruises..,from failed attempts
From there I was placed in stirrups where I couldn’t move .yet they deliberately let the epidural wear off at the pushing stage ,which made me hysterical as I’d had a couple of hours pain free ,then suddenly it was horrendous again..they performed episiotomy with no pain relief as they let epidural wear off ,yet kept me in stirrups going absolutely mental to get out of them..
They then stitched me up with no pain relief ,because the doctor said she was needed else where ,and didn’t have time to wait for the pain relief to start to work .i was absolutely hysterical at being trapped in the stirrups ,and this was the Rosie maternity hospital in Cambridge .caused major problems with my husband as I blamed him for not standing up to the midwife ,and allowing them to go against my wishes

@MissM2912

Because the birth outcomes for you are likely to be much worse. An epidural often leads to what is known as the cascade of intervention- episiotomy, assisted delivery, c section, plus longer recovery time. She is right- you don’t want one unless you really aren’t managing and it should be last resort.

Not at all surprising to see the first post quote the entirely debunked ‘cascade of intervention’.

Health care needs to be evidence based I’m afraid.

An epidural should be the last resort. If you want one, put it on your Birth Plan, but on my Plan I specifically said I didn’t want one so not to keep asking. I found the midwives mention them at intervals so they know whether you’d want one (for organisation purposes) and also so you’re aware that you can have one and when it’s approaching ‘too late’ time.

Epidurals mess with the natural birth process. On a small number of occasions that’s needed, but mostly it’s not. By ‘natural’, I don’t mean avoiding all meds, I mean actually pushing the baby out. You can’t feel anything so can’t push. If you do push, you can’t gauge damage to your nether regions. I’ve heard horrendous stories about that. I’d rather feel what was happening, even if I had meds to take the edge off that pain, I’d at least still be able to feel my body’s requests and feel potential damage starting. They can also slow down leading to interventions like forceps, and increase the risk of a section.

So, your midwife was probably just trying to point you towards understanding they’re not some magical solution to birth, and that they come with potential downsides. Ultimately it’s up to you, but if I was you I’d do plenty of research and just see how it goes. Preparation mentally and practically is everything. Good luck with your birth.

God why would you actively want an epidural?! Definitely wait and see - you might surprise yourself when it all happens.

I've had two labour's. One with an epidural and one without. I would never choose to have an epidural again.

Epidural =
Zero pain, but also zero sensation.

Didn't feel in control of the situation at all.
Episiotomy.
Almost a forceps delivery - literally seconds to spare.
Very long second stage, with some signs of distress from baby.
Very extended recovery time - I had no sensation from the waist down for a few hours after the birth and was confined to bed for the night.

Without epidural =
Bloody painful, but not unbearable and I was able to trust my body.
Much more involved in the whole birth process.
A minor tear with a couple of stitches.
Felt amazing after the birth - a complete high.
Was able to have a lovely bath afterwards.

I will add that I had to have an epidural due to high blood pressure. The epidural was topped up just before the second stage, which added to the issues. This was over 30 years ago and epidurals are probably better now.

The birth with an epidural didn't traumatise me, but I would never want to repeat that experience. Give me the pain of childbirth any day.

I had an epidural with my second....the pain relief was welcome at the time but I ended up having a very long drawn out labour and had to have intervention. I certainly wouldn't have intended on having an epidural again, only as a last resort. Like a pp commented you are restricted with wires etc and that in itself is a challenge when giving birth. Each to their own but you should go in with an open view.

Ask to talk to the anethatist. Then you can make an informed decision, when I was in to be induced with DS I was able to chat and hear the pros and cons and decided for me the cons made it not worth doing. But that discussion helped me decide

I had an epidural for my first and only birth, no instruments, less than an hour of pushing, fast recovery, zero ongoing issues, I'd have one again. Is this helpful for you to know? Absolutely not.
Every woman and every birth is different and there is no knowing in advance what it will be like for you, there are no cheat codes. So, all you can do is be prepared, do your reading so you can make the best decision for yourself at the time. All the best OP

My birth with an epidural was much better than my birth without and didn't require intervention. My birth without required spinal block and forceps. Stick to your guns!

I've not had an epidural. Both of my labours were too fast to have one even if I'd wanted it.

Basically OP, if you want it you'll be able to request it.

I think the midwife is preparing you for it not being instant or possible in all situations.

1. an anaesthetist is required to administer it. There are a finite number and they will prioritise on medical need. Women requiring a c section will go first.

2. they don't always work / are not suitable for everyone

3. they don't work instantly. If you're already at 8/9/10 cm when you ask for it, it's unlikely you'll be able to get one in time / be able to sit still for it to be put in / it to work by the time you push.

Is there any information available about how many women request an epidural but aren't able to have one? You can request one but it's not a certainty for a variety of reasons.
If you go into labour thinking I will have an epidural but it turns out not to be an option how will you feel? For me personally that would send me into a panic.
I spent time before I had my first writing a birthing plan, but none of it happened as expected. With subsequent birth I didn't bother to write a plan. I had an idea of what I would like and just went with the flow. It's not for everyone but it worked for me.