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 ended up needing forceps but I don't think that was due to the epidural. Big baby in awkward position. Glad I had the epidural as I was pain free for a lot of the labour and this meant I was relaxed and could rest. No complications from epidural. Will keep an open mind regarding next labour

@AsYouWishButtercup

I also think that we just blindly accept hospital care is gonna be so shit that “a long stay in hospital” is considered a bad thing. It should be a good thing! In an ideal world - rest, Round the clock support, being where the experts are. It’s so sad that postnatal care is so universally terrible that people want to avoid this

THIS

‘Wait and see’ is just another way of saying “Bear excruciating pain”, not everyone wants to do that

I was basically forced into having an epidural in my last pregnancy due to be induced for pre eclampsia and back to back contractions as horrendous pain as there was no break. I was between 9-10cm and the anaesthetist came in handed the paper over to my husband to read out and was like it will take the pain away. I didnt want it and felt forced into it.
They did it, it didnt work at all. The pain was just as bad and baby ended up in distress had they had to do an emergency episiotomy and pull him out.
This time in my birth plan I'm refusing it unless its necessary (for example emergency c section)

I know for some women it works well but for me it didnt so I'd never opt for it again.

@TheVanguardSix

You must go into your delivery with YOUR plan. Leave room for error. Shit happens. But trust that it won't and that your body will do what it's meant to do. Breathe. But definitely make sure it's your plan, OP (and yours sounds totally reasonable!). I've had 3 epidurals and not one issue. The first one I had was almost 20 years ago. The last one I had was 7 years ago. I love an epidural, me. What you DO NOT want is pethidine. That is just awful. That slows things down to a halt AND you feel sick AND it doesn't help with the pain. It just turns you into a vegetable in pain. Horrible stuff.

We're all different. I had pethidine and it allowed me to sleep when I'd been awake for 36 hours, I didn't feel sick and it didn't slow the birth down.

There have been some excellent posts on here ( @Totallydefeated for example), plus some complete misinformation. I believe women are all individuals and each labour will be different and we shouldn’t judge other’s choices based on purely our own experiences (eg posters stating “my labour was fine so why would anyone else need an epidural?”). People reading this thread who are considering their options for pain relief in labour may want to look at this website for evidence based information to help them make an informed choice. Written by experts in the field (several from the Obstetric Anaesthetists Association) who have reviewed available data. This does not mean it will be correct for every hospital nor every individual patient, but it may provide some with the information you need.

www.labourpains.com/home

www.labourpains.com/Epidural-Information-Card

[quote TrenchArse]@MollieLarksabout an epidural is morphine, just injected directly into your spine. It very definitely stops you having a clear head[/quote]
@TrenchArse This is wrong. Epidurals for labour are usually local anaesthetic with fentanyl. The systemic absorption of both drugs is negligible (which is why it doesn’t interfere with neonatal respiratory effort). If the epidural block rises high enough o affect the brain directly, feeling ‘clear headed’ should be the least of your problems - that would be an anaesthetic emergency situation.

Epidural drugs are also not delivered directly into your spine. As the name suggests they’re delivered into the epidural space, usually at a level below the termination of the spinal cord. (More confusingly, spinal anaesthetic also isn’t delivered directly into the spine but into the csf at a level below the cord).

@Melvin2021 you’ll have spotted by there’s a wide range of experience and understanding about epidurals. A useful site to learn more about the risks/benefits of the different modes of pain relief for labour is the labourpains.com website (the patient facing site run by the obstetric anaesthetics association). The anaesthetist covering the labour ward on the day should be able to answer any questions that you have. Hope that helps.

Cross posted with @Showmetheevidence!

@Showmetheevidence Thank you so much for the link

I'm being induced next week after a horrific first labour (induced, two failed epidurals, interventions, back to back).

I am planning on an epidural when the drip goes in after experiencing it without pain relief last time.

As you say, there are a lot of anecdotes on here and what works for one won't necessarily be right for someone else.

The link provides clear information to make an informed decision. I don't plan on 'seeing how it goes' without pain relief-It was the worst pain I've ever felt and left me with PTSD.

‘ Of course there are women who have epidurals and are fine- but statistically a high number, something like 50% end up needing an assisted delivery or section. This is a WORSE outcome for the mother and often leads to further problems including post natal depression.
I stand by my comment that it is better to try and manage without an epidural if possible.’

I had one with my first labour due to needing hormone drip (they don’t give one without the other here it seems) and I ended up needing an episiotomy and lost just over 2 litres of blood.
I was very unwell.

Wouldn’t ever do it again, it was terrible not being able to feel what my body needed to tell me to do.

If you do want one then you need to be very very clear in that and not be fobbed off.
I wanted one with my 2nd birth and has asked for it to be noted on my records. When the time came the MW said I could manage fine without so I asked her if she was refusing me an epidural and if so what was the medical reason for that? I said if that was the case then I wanted it recorded on my records that I had asked for one at x time on y date and (name of mw) had refused me one for the following medical reason.
Anaesthetist arrived as if by magic
There are sometimes good medical reasons why you can’t/shouldn’t have one and that’s fine but if not then don’t be fobbed off.
Mine was great and I walked out of the hospital unaided 6 hours after my son arrived

I also had a bad experience with my second, back to back labour and very quick. They wouldn’t give me anything and I was losing the plot mentally.

Yes, @Greybeardy!

Thanks @Greybeardy, thought I was going mad for a minute! Glad my recollection of clear-headedness wasn't a false memory. I'm not the only woman I know who has appreciated this about the epidural.

I had this with my 3rd. She asked what pain relief I wanted and I stated 'epidural'. She was like oh but you did it without twice before! I said 'yeah, it was hell and I didn't get a medal. I want the epidural.' She soon shut up. Coincidentally, it all happened fast and I didn't have time. I was furious

Oh and they tried to push diamorphine on me during my 2nd and they were told to f off. I had it with my first and it made not a jot of difference other then making me vom my guts up. They can be very pushy! You have to be quite firm.

@MollieLarksabout

Thanks *@Greybeardy*, thought I was going mad for a minute! Glad my recollection of clear-headedness wasn't a false memory. I'm not the only woman I know who has appreciated this about the epidural.

Yes I was fully aware and could even push a bit at the end. It was all very chilled out and I felt in control With DD I had pethadine, was exhausted, in pain and had no idea what was going on THEN I had a spinal block to remove my placenta and I remember thinking “bloody hell I should have had one of these hours ago”

Theres pros and cons to it just like everything else.
Its less your choice than you realise tho because when you get there its dependent on their being an aneasthatist available and also it may not even work depending on the position of your baby etc...
So do be psychologically prepared that it may not happen

I think they say to try without one just to lower your expectations a bit tbh..
And also it can take longer to leave hospital after having one as you have to wait to regain bodily functions... however for me it was very fast to recover from mine

With my second birth tho the epidural didn't even work!! He tried it several times.. turned out the baby was too low down. I was not happy. But it was okay in the end I did it!

@abbs1

I was basically forced into having an epidural in my last pregnancy due to be induced for pre eclampsia and back to back contractions as horrendous pain as there was no break. I was between 9-10cm and the anaesthetist came in handed the paper over to my husband to read out and was like it will take the pain away. I didnt want it and felt forced into it. They did it, it didnt work at all. The pain was just as bad and baby ended up in distress had they had to do an emergency episiotomy and pull him out. This time in my birth plan I'm refusing it unless its necessary (for example emergency c section)

I know for some women it works well but for me it didnt so I'd never opt for it again.

epidurals have to be offered when the drip is otherwise you have the right to complain (my dc even won a small amount of compensation due to PNA developed as a result of the pain). Seems like your original mw cocked up & lucked out because you didn’t have a chance to create a birth plan in the event of complications. That isn’t the epidural’s fault.

Perhaps mw knows there may be a delay in getting an anaesthetist to administer it. It can also make labour longer and less mobile.

@LIZS

Perhaps mw knows there may be a delay in getting an anaesthetist to administer it. It can also make labour longer and less mobile.

All of them are trained to give walking epidurals now - many just choose not to because it requires a pre-labour appointment and planning which can only happen if you say you want an epidural in advance (even if you then say you will decline it on the day). I had one and was mobile and was pushing even with forceps -my assistance was because DS heart rate was falling not because of some kind of ‘delay’ caused by an epidural. Epidurals don’t have to affect natural labour but they do because too many women don’t bother with the NHS advice to create a birth plan.

@ozanj there is no widespread requirement in England at least to have declared pre-labour that you want an epidural or to have an appointment pre-labour. The availability of walking epidurals depends on the infusion protocols the unit runs not the technical ability of the anaesthetist. Most places will have a limited number of infusion options to reduce the risk of human error in managing them.

If you want one have one. I declined one and was sorry. Then I changed my mind made a huge fuss they said it was too late but I insisted and they agreed. Go for it.

I tried for the only G&A approach and birth pool with back to back baby.
18 hours in labour later with blood pressure spiking and only 7cm I had an epidural, guess what.

BP lowered, baby less distressed, I was in no pain and had clarity of what was going on. My baby was born naturally and gently with minor tearing (without the epidural I was going crazy and losing my mind so guarantee that wouldn't have happened).

I've recovered fine, get the epidural if you want it, don't let anyone persuade you otherwise.
Chances are if anything went wrong that would have happened anyway, there's no way of knowing.
If I ever have another child I am getting an epidural again, trying to "do it naturally" traumatised me and really ruined my experience of labour.

@MissM2912

I would rather be in agony for a few hours than months of healing from a forceps delivery and worrying about incontinence but that’s just me! And before anyone says ‘but that might not happen’- I know that but it is more likely and not a risk I would be keen to take if I could avoid it.

This was my opinion. I really wanted not to have an epidural and didn't need one either time. First time was much harder and I had pethidine. Pretty sure epidural was probably discussed at the same time but I don't remember. It was an absolute last resort for me.

I don't think @missM2912 has said anything controversial here. Yes women need to be listened to, absolutely. But to make demands without taking any account of the professional opinion seems a bit naive. I think midwives are generally just trying to ensure all information has been considered which seems far more professional to me than just saying, "sure, have whatever drugs you want" right away.