To correct NCT teacher

[Skeetle]

Lurking through pregnancy but thought I'd try my first AIBU

I recently went to an NCT class and spent quite a bit of the evening sitting on my hands due to the dubious nature of some of the information on pain relief. Having researched myself quite a bit, including a detailed conversation with obstetric anaesthetists and reading up on NICE guidelines I was surprised to hear the following:

They won't let you have an epidural past 8th dilated.

Epidurals are now allowed to wear off for the second stage as this reduces birth trauma.

And most strange of all, she managed in a roundabout way to link entonox with postnatal depression

There were some other inaccuracies too. As I say, I sat on my hands and didn't say much apart from a quiet comment to her when no one else appeared to be listening that I'd been told I could have an epidural past 8cm dilated.

Without wishing to start a fight on pros and cons of pain relief in labour, I do think accurate information should be given so a woman can choose accurately. I don't like to think of my fellow NCT classmates making decisions based on this but equally don't want to undermine the teacher.
So WIBU to send her an email pointing some of this out or have I missed the chance to say something without making a big issue of it. Should I have simply made a comment there and then?

I think many people use Nct classes as a way to make friends rather than actually learn anything.. My teacher was rubbish and talked a lot of crap.

From my own experience, once the contractions ramped up, I forgot all snout visualising my pain as a pebble/cervix a flower and begged fot drugs.

About. Not snout

Tricky, what does she say she is basing her info on ?

If it's feedback from attendees who have given birth locally she could be giving the 'how it is' rather than 'guidelines' info

It's difficult to make a comment in a big group without sounding like a pita. If you feel you have more up to date info then yes e-mail her. She may not respond particularly well as it sounds like she has an agenda of her own (of course - we all do) and hers revolves around the body's ability to give birth without pain relief. Taken to the extreme you end up with a scenario such as I heard at a post birth group. One poor woman talked about how she felt she couldn't go back to her hypno-birthing group to give her birth story because she hadn't done it properly. She'd had a crash c-section when the baby ran in to problems.

Arthur will try the cervix flower thing.

Finally - she didn't say but I know from the anaesthetist that the second stage wearing off thing is a local issue. He told me to put it in my birth plan that I wanted the epidural to be kept going. He said there shouldn't be problems locally with requesting an epidural in transition.

I think sometimes the Nct classes give women unrealistic expectations about birth- I had a pretty traumatic experience, which I didn't think the classes remotely prepared me for.

In theory you can have an epidural at any stage in labour, and women do.

In practice if your labour is progressing normally and you're 8cm it's probably more likely than not that you won't get one. It's common for midwives to tell women at 8cm that it's 'too late'.

Common practice in many places to let epidural wear off for second stage. Of course though you don't have to agree to this! I'm surprised as it's NCT that teacher didn't emphasise that you can say no or make requests that go against normal protocol!

Honestly - don't sit there saying nothing. You have paid shed loads for your course. Tell teacher that you have heard different! Other parents will thank you!

Just out of interest, did she talk about epidurals leading to fever in labour, and therefore higher rates of babies being admitted to SCBU for a sepsis workup in the hours after birth? There was a big article about this in this quarter's MIDIRS journal. If she was trying to put you off having one she should have included mention of this... I think most women are unaware of this issue.

Sounds like she is a bit rubbish, but the epidural thing may well be true. If you spoke to a consultant anaes at our hospital they would probably say there is no problem with getting an epidural at 8cm, but in practise you would be very unlikely to get one as the time it takes to get the anaes there (not even considering that they may well be busy at an EMCS etc so you would have to wait another hour or two) means that the anaes might not even get bleeped as there would be no point.

I requested an epidural at 5cm and other peoples emergencies meant that I didn't get one at all, so your teacher may well have been telling you the reality as opposed to the theoretical.

They usually let epidurals wear off for the second stage as this increases your pushing ability (as you are more mobile and can feel the contractions) and so decreases the risk of forceps/EMCS, rather than just to be sadistic!!!

Shhhhh - I think you are right. Doctors and midwives get treated differently in labour I reckon. I know someone who had an ELCS at the hospital in which she worked who was allowed to pick her own team for her NHS c/s. .....

Re: letting epi wear off - most up to date Cochrane review suggests it makes no difference to likelihood of a spontaneous birth.

I wouldn't touch the NCT with a bargepole. A friend of mine went and having paid about £250 all it did was make her feel inadequate and nervous. She felt ashamed that she had had forceps in her delivery, until she realised practically everyone else in her group had also had intervention of some kind. They didn't talk about it with each other though. I went out with her and that group a couple of time and there was just a tense horrible feeling among them. Friend explained that they had been made so self conscious about doing the right and wrong thing in the class that they were all afraid to say anything. She doesn't see them any more.

look on Youtube for

Dara OBriein
NCT

I had issues with some of the stats presented on pain relief at NCT - I deal with unpicking statistics at work and knew they were unlikely to be that black and white on something as subjective as pain relief. But having a bit more experience of pain now - not only childbirth but a year of chronic pain with a slipped disc - I now realise that a lot of the stuff I dismissed as "woo" actually was a lot more sensible than I thought. Particularly the link between fear and pain. As far as getting an epidural at 8cm is concerned - I would imagine that while it could happen, it would be pretty unlikely. Remember obstetricians tend to see "interesting" births, while midwives see ordinary ones. So if your midwife said it was unlikely too, I'd tend to believe her.

That maybe what happens and I know people it has happened to. Which is why I've been careful to ask everyone from the community midwife to the obstetric and anaesthetic consultant at the hospital about these points. They've all said I shouldn't have to wait longer than 30mins to 1 hour for an anaesthetist (except in the very rare event if there were several emergencies) and the anaesthetist specifically mentioned studies showing continuing the epidural through the second stage does not increase the chances of an instrumental delivery. Which is why it is now in the NICE guidelines.

"Dara OBriein
NCT"

Dara O Brien's wife is an obstetrician and he's joked about the NCT being ridiculous in suggesting that having a tear in labour is usually better than having an episiotomy. Because his wife says that episiotomy is better.

My understanding is that the evidence supports the NCT's view on this one, which is why routine episiotomy is no longer standard practice in NHS.

But he is very funny, even if he's wrong.

"They've all said I shouldn't have to wait longer than 30mins to 1 hour for an anaesthetist"

I think the important word here is shouldn't.

Shagmund - I am medical though not in obstetrics or anaesthetics so have had to do a fair amount of reading and discussing. I suspect you are right and I won't personally have difficulties myself in getting what I want in labour. I also imagine they are being very careful with the infomation they give ne. Though that in itself, whilst lovely for me, makes me annoyed - why should they not take the same care with every woman.

The fact I'm medical is also why I feel particularly uncomfortable with sticking my oar in with the NCT teacher.

I went to nhs classes.

During the BF session the midwife spouted this gem. 'it is a CLINICALLY PROVEN fact that babies who are breast fed are more loved by their mothers' I gave the face. Now the benefits of BF are so great there was no reason to add this, if I'd have been a bit more believing, when I was unable to BF, this comment could have made me feel pretty shit.

Although where pain relief was concerned they were pretty good, made a big thing about everyone being different etc...

If she's any sort of teacher she should be able to cope.

Seriously. Stick your oar in! Give it a good old stir!

By the way, the 'special treatment' thing can be both a help and a hindrance. You're more likely to get appropriate monitoring and evidence based care. However, sometimes sticking rigidly to protocol because of fear of criticism isn't a good thing when it comes to childbirth.

YANBU. I wouldn't go near the NCT either.

Our NCT teacher was lovely, in her 50s, had 4 children, and was a midwife in a local hospital. Not at all woo or judging of anyone.

Guidelines and reality are 2 very different things. National Institute of Cost Effectiveness IMO.

You can have an epidural at 8cms.....but by the time they get an anaethetist, get it in and get it working, bubs will probably be half way out already

Midwives will suggest letting it wear off a little for pushing, so you can feel when and where to push, giving you more power and therefore helping to avoid a prolonged second stage and use of ventouse/forceps

So not totally inaccurate - but probably not explained in the best way

As for the gas and air bit though.....no idea where she got that!

Have to say, although I like a lot of the info on pain relief of the RSA website, I'm interested to see that they give so little information about fever in labour associated with epidural.

The fact sheet on epidural states that epidurals have 'almost no effect on babies'.

I think anything which leads to increased antibiotic use in labour, and increased likelihood of separation of mum and baby after birth can't be said 'to have almost no effect on babies'. But hey ho, I'm not an anaesthetist. I suppose from their point of view, once baby is safely delivered it's job done, and they're not that concerned about what happens in the first few hours, even if it does sometimes disrupt breastfeeding and spoil the first few hours of motherhood.

My epidural didn't work at first so I had it topped up, meant I was completely numb until hrs after DS1 was born. Couldn't feel at all to push, had to go by what the monitors were saying. But after 1.2hrs pushed him out, although apparently I was lucky not to have forceps/ventouse since I was also induced.

Try not to focus too much on how you get your baby out, the main thing is a safe delivery and healthy baby. Good luck.

Definitely look up the Dara O'Briain sketch. It's just so good.

The trouble is everyone delivering these courses has their own agenda, and he NCT also has its own agenda. I would send the e-mail, it may just help a future set of mums.

I've read a bit on fever and epidurals though she didn't mention that in the class. Will look up the paper though thanks.

A hideous few weeks on the labour wards as a student nearly put me off having children entirely so I guess I feel the need to be prepared for all eventualities. I'm quite willing to admit it has somewhat biased my opinion

Well aware of the other side of the coin in that hcp not doing what they normally do can be bad for the hcp as patient. Cardiologists I hear do very badly if they have heart attacks!