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?

Shagmund, WTF?!

Comedians are well known for exagerrating situations and conversations for comic effect. I think you are investing far too much thought into what Dara O'Briain said about episiotomoy/tears - it is quite likely that is wife never said that at all, yet you are going on about the 'prejudice' of doctors (who obviously sit in the hospital wielding their knives, just chomping at the bit to cut women open left, right and centre!)

I dont think we should really rely on anything a comedian says to give us info about best medical practice during childbirth!

I would imagine what pain relief options you get depends a bit on the prejudices & experience of the staff on offer when you go to hospital. Never mind about 60 other things you can't control. So I wouldn't worry about 8th dilated & all the rest of it, when the time comes you don't really get to weigh things up like that. You go with whatever gets you thru it.

One thing MWs repeatedly told me is that by the time I got to where I wanted an epidural, it would be too late, it would take so long for doctor to arrive & then set it up & then get it working, that baby would be born by then & the epidural would have been a set of unnecessary risks. That's how I would interpret the 8cm thing, the staff will assess how fast you're progressing & go with their experience over dry NICE guidelines.

Oh and we had a plastic pelvis, so she could show how the baby sort of engaged and twisted and came out and it sort of exploded in a very wrong way when she twisted the dolly, which was amusing (not).

Also she did a little mock-up of an operating theatre and who would be present during a c-section with Playmobil figurines so those of us who ended up having sections (about half of us!) weren't overwhelmed with the sheer number of people present (about 10!)

Hackmum, I had a full on epidural in theatre for my forceps delivery and I was still able to push

Trexy intrigued about your collection of 'weird stuff' -would a knitted boob have made it complete?

Personally I wouldnt bother with the NCT if I knew I wanted an epidural, even at a late stage in labour.

IME the teaching in NCT is variable... But the general ethos of focusing on natural birth, with non invasive pain relief methods, breathing, massage etc is excellent.

So sure- I would correct the teacher if she's factually wrong. But I would not be spending considerable money on classes if I were planning a medicalised birth with epidural. I think the NCT gets a tough press sometimes. If the teaching isn't up to scratch that's fair enough. But sometimes people expect it to be all things to all people. If you want straightforward facts and stats about pain relief etc then go to NHS classes. The NCT was established to promote natural birth (even though it's title has been adapted since the early days) and I don't see why it should apologise for this

Oh TittyWhistles, not complete no. It will never be totally complete

My NCT teacher was a real self absorbed, delusional ,control freak,full of self importance! She talked so much bollocks that I missed lots of the classes as I couldn't bear to go and listen to her drivel. I just went to make some friends in the same boat. I didn't mention to anyone what an arse I thought she was. But it turns out they all agreed.
We wern't allowed to tell anyone our profession (don't know if that's usual at NCT) when we had ahd our babies and got together,it turns out one couple were a GP and dh an aneasthetist.
They said she didn't know what she was talking about and they had had to bite their tongues. The dh missed loads of classes too,as he couldn't take the innaccuracy any longer!
Just so you know,I love those girls I met at NCT and we are very close,as are our children...so for me it was well worth a few weeks of irritation

Sorry for tpos and spellin...am half watching a film at same time!

O yes. Like the "most csections are rarely emergencies. You can get the csection you want"
Try telling me that after a crasg section with GA where dd had a apgar of 2.

bignutbrownhair: "Hackmum, I had a full on epidural in theatre for my forceps delivery and I was still able to push"

But how? How do you push when you can't feel anything? I did my best - I sort of pushed from my upper back, iywswim - but I never really had any idea whether I was doing it right.

'you get the c section you want' is very harsh and I not true but it is true that most c sections are not true emergencies. Lots of c sections could have been avoided. I don't think individual women are to blame in any way though.

Just because that is may not be true of yours does not mean it is an invalid point in general terms.

Our NCT teacher spent a lot of time telling us how the midwives and doctors didn't have our best interests at heart, and that they were only interested in what was easiest for them.

There is huge variation in NCT teaching. I'm sure I read in the Guardian that the organisation was trying to become more balanced and not so biased towards BF and natural births. That's desperately needed IMO as it contributes hugely TP new mums feelings of failure/guilt if they don't do either. It's flipping ridiculous really.

I just wish there was a viable alternative to NCT. Most people do it to meet other mums in same location and I don't quite get why the NCT seems to hold a monopoly on this (and indeed charge nearly £300 for some courses). There must be a better way to get mums together!

Well she is right in a way. Some Midwives won't give you an epidural at 8cm as that means you are near the end of labour. It takes about an hour or more to call the anaesthetist then administer the needle and then about 15mins for the drug to kick in- most women get to the pushing stage by the time everything is up and running so a bit of a waste.

As for less traumatic - I agree in a way. If you can feel the head coming out you feel you have more control. But I had an epidural with dd and suffered a 2nd degree tear and had nothing with DS and still suffered a 2 ND degree tear but still felt more in control.

I am not sure Hackmum! And I cant really remember it all that well - had been in labour for 3 days and had had one epidural already (for syntocinin injection due to very slow progress) so this was a top up. DH said I fell asleep on the operating table as soon as it was administered and they had to wake me up to push, and I was saying 'how will I be able to?' But I do distinctly remember them telling me to push and then me doing it and having a very strong sensation of being able to, I couldnt tell you how though! I guess it was helped by the fact that the doctor was pulling DS out with a pair of forceps at the same time!

hackmum People are different.

I had an epidural and never lost awareness of sensation (except pain mostly) and could feel my muscles working enough to push effectively.

Some people loose a lot more sensation and can't push meaningfully or walk etc. other don't.

People are different.

I'm not sure why you have chosen NCT classes if you know that you are likely to want a 'medicalised' (for want of a better word) birth. Their leaning towards natural childbirth is pretty well known. I know people want to make friends, but try aqua natal classes, pregnancy yoga etc. rather than an NCT class!

entropy: "I had an epidural and never lost awareness of sensation (except pain mostly) and could feel my muscles working enough to push effectively."

That's interesting. I was completely paralysed from the waist down, couldn't feel a thing, which was why I was so puzzled at the obstetrician telling me to push! In the end, we did manage to get the baby out (well, obviously) but she had quite a bit of help from the ventouse.

"People are different".

More to the point, epidurals are different. How much sensation you have left to push with will depend on a number of things, such as how long your epidural has been in place, whether it's patient administered, the particular drugs used in the epidural mix.

"Our NCT teacher spent a lot of time telling us how the midwives and doctors didn't have our best interests at heart, and that they were only interested in what was easiest for them."

Unfortunately it's true that sometimes when it comes to what actually happens on the labour ward, decisions are sometimes made with a view to managing the largest numbers of women in the most energy efficient way, with the fewest number of staff, instead of trying to obtain an optimal birth for each woman. I understand why they do it and I'm not condemning them for it. But I think it's a good idea to be realistic about the level of service you may get in the NHS and not think that maternity services are somehow completely immune from the inefficiencies, deficiencies and plain crapness that is sometimes a feature of other parts of the system. Obviously if you felt the teacher over-egged the cake by raising this issue over and over again then that's not helpful - confidence undermining much. But not to raise this issue at all? That's not right either.

I wish someone had suggested it to me when I had my first. I went in with a belief that the midwives would... massage me , put their arms around me and be encouraging me all the time to have an active birth, which is what I wanted. In the event they pushed pethidine on me, which I was adamant I didn't want, but ended up having because they kept telling me it was a good idea. It was. For them. Because after that I stopped asking them to help me as I was too busy being sick and passing out.

"it turns out one couple were a GP and dh an aneasthetist"

I do find it really interesting that there's this assumption that doctors somehow know all about what it's like to give birth. Why would they? The vast majority of doctors have had minimal involvement in normal birth. Anaesthetists only ever get involved as technicians to administer epidurals, spinals or GA's. And in theory, although they may know about how births become complicated, and the medical procedures involved in resolving a problem, they generally know fuck all about ways of optimising your chance of a normal birth,or how to cope other than by using drugs. The role of doctors is to diagnose and treat illness, not to manage normal birth, or to teach women about what giving birth can feel like.

"Obviously if you felt the teacher over-egged the cake by raising this issue over and over again then that's not helpful - confidence undermining much."

She told us not to trust them and say no to everything they suggested. Was a little OTT

I chose NCT because my training meant I knew a lot about complications and medicalised birth but had far less experience of normal labour. As Shagmund says this may be because I was on a CLU as a med student. Also they were recommended by midwife and consultants alike. I do think she is trying to be as unbiased as possible we have discussed c sections. For example. I also know how difficult it is to not have an agenda when discussing childbirth! In general the classes are reasonable and I've learnt some useful things, including about less medicalised pain relief options. However, I like to know all my options and need a back up plan. I am obsessive enough to have back up plans for many different scenarios, not just about pain relief. Once I feel Ive thought it through, made some preliminary decisions and equiped myself to make real decisions when the time comes then I tend to relax and not worry. For me personally, one of the worst things was seeing women screaming in pain and being denied pain relief for several hours when they were asking for it. I may well be able to cope using other methods if I know that situation will be taken seriously. I think because of my profession I will be. I will quote NICE, threaten to complain and write in my notes myself if need be. But- if I did not know this then maybe I might end up relying on the knowledge gained from NCT.
On the other hand I don't want to get on my high horse in the middle of an NCT class when some women there may not want to enter a deep discussion about the details of epidurals.

Cross posts but interestingly the anaesthetist said pethadine was the one thing his wife didn't want when she gave birth but even with the two of them stating that she still felt pressured to accept it. No pethadine is one of my other decisions so that story didn't give me so much confidence!

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

That surprises me. Mostly because i had an epi and couldn't feel to push the baby out and so needed intervention.

Skeetle: "For me personally, one of the worst things was seeing women screaming in pain and being denied pain relief for several hours when they were asking for it."

Why were they denied pain relief? Was it because the anaesthetist was "busy" (seems to happen a lot), or for some other reason?