AIBU to have found childbirth unbearably agonising?

[Caff2]

Just that. I had an elective section with ds2 because of it. And yet I have friends and read on here of people who "did it naturally" or "just had a bit of gas and air at the end".

Why was childbirth so awfully painful for me?

in my experience women can be quickly reassured re: how an epidural is administered. It's when they find out about the higher rates of fetal distress, running a temperature, urinary catheter, and association with forceps deliveries that they tend to reconsider whether it's something they want. Obviously these things go to the wind when they are really struggling in labour.

I'm sure a very unattractive picture can be painted of the potential side effects of an epidural. I don't recall any mention of the scarier potential side-effects of VB though. There's a reason for that - HCPs are steering you firmly towards one.

I don't believe women should be "encouraged" to make a decision about where to give birth. Women should be given all the necessary information and be allowed to make a choice based on informed consent.

I for one, would take any recommendation made by a MW with a pinch of salt. IME, the MW that cheerfully told me that I could have an epidural as soon as I got to the hospital, is the same MW that snorted at me "You don't need one you're not in labour" and later smirked "Oh dear, you're too late for that now love', after I begged and begged for help. Cow.

Women won't ever have a true choice whilst current ideology and financial constraints are pushing in the same direction.

leMis Im absolutely in favour of the woman being allowed to choose where to give birth, all factors being equal.

But the fact is that in the Netherlands women really do have the choice (safety factors being taken into account) where to have their babies. Also amazing post-birth support in the home for 8 days.

But women are more and more choosing for hospital births because of the pain relief. Not all, ofc. But the trend is definitely that way which indicates that actually on the whole women prefer the option of pain relief over the option of a home birth.

NB again: not all dutch women, and im in favour myself of women having the choice where to go to.

Random Point:
the stats for death of neonates in the NL is better than the stats in the UK (though still rather poor compared to the EU generally and scandanavia) which makes you think that all those home-births are rather carefully screened. here

"Lemiserable I'm not actually sure I'd 'encourage' a higher risk woman to give birth on a CLU in fact, merely outline the risks of not doing so and leave her to make her own choice. I am a strong advocate for autonomy during birth and this includes making less safe choices. It has to. But for the sake of argument, let's say it's ok to 'encourage'..."

Doctors routinely recommend a course of action which is linked to the best health outcomes, regardless of whether the treatment is acceptable to the patient.

"If you're going to 'encourage' women to give birth at home or in an MLU, the only ones for whom this is appropriate are those who are clear that they either don't want an epidural full stop or are happy to try giving birth without one."

But that's exactly what midwives do: explain to women that choosing the birth centre is what you do if you'd prefer to do without an epidural. They have to explain that there may be a delay in obtaining an epidural in the event the woman wants one, because of issues surrounding transfer.

"It would be nothing short of disgusting to 'encourage' a low risk woman who wants an epidural to give birth somewhere she won't be able to get one,"

It would also be completely bizarre. Like recommending a woman who wants a waterbirth go to a unit with no pools.

I'm not sure it happens very often!

"So no, absolutely not, there is no way in hell that low risk women per se should be encouraged to give birth anywhere that epidurals are not available".

Sorry - I don't agree. Midwives should ascertain what a woman's priorities are and how she feels about pain relief. If a woman is prepared to experience transfer in the event she can't cope without an epidural, and she prioritises a normal birth above (sometimes) quicker access to an epidural then she absolutely ought to be encouraged to consider a birth centre birth.

"Low risk women who don't want epidurals, yes absolutely provided you're ok with women being 'directed' in that way. Makes total sense for them to stay away from CLUs."

Yes - I'm absolutely fine with women being told: "if your priority is avoiding complications and you're ok with the fact that you will have to transfer for an epidural, then a birth centre is probably the best setting for your labour'.

I would bet a lot of money that somebody in government, somewhere, is going, 'Home births are all the rage, you say? Excellent, the NHS doesn't have to provide premises, laundry, drugs, food, well anything, really, except the midwives. And we'll have them in and out as quickly as possible.'

I know that home births are limited in some areas due to a lack of midwives, but I bet the NHS managers will cotton on to the potential savings soon enough. We'll all be giving birth at the bottom of our gardens with a paracetamol and a Health Care Assistant in attendance before long .

"Women won't ever have a true choice whilst current ideology and financial constraints are pushing in the same direction."

They are closing birth centres.

Women are regularly told they can't have a home birth because there aren't enough midwives to send out to them.

95% of births take place in an OU.

More women than ever are having epidurals.

If you are a low risk mother giving birth in an OU, having an epidural is one of the few ways you can guarantee getting one to one care.

Really - things are going in one direction, and it's not the direction you think.

Purbly - you are so, so wrong about women being compelled to have home births.

The compulsion has all been in the other direction.

Yes, you are right Chunderella. I should have said: low risk women who would prefer not to have an epidural and who prioritise a straightforward birth above quicker access to epidurals should be encouraged to use birth centres.

toobreathless, I think I'll have one of your births please!

low risk women who would prefer not to have an epidural and who prioritise a straightforward birth above quicker access to epidurals should be encouraged to use birth centres.

How can you 'prioritise a straightforward birth'

You: 'I'll have a nice straightforward birth please.'

Mother Nature: 'Bwa ha ha ha ha. Did you remember to fill in the purchase order form, dear?'

Re closing of birth centres, I didn't say there would be more of those, I said I thought there would be a movement towards home births, since the NHS doesn't have to pay for the premises.

If you are a low risk mother giving birth in an OU, having an epidural is one of the few ways you can guarantee getting one to one care.

You can't guarantee anything - whether you get one or not is wholly down to luck, and your powers of persuasion.

naty1 I don't think we understand each other because what I said is what you said about your DM! People who live longer (e.g. people who do not smoke) cost society a lot more through social welfare costs and their eventual NHS costs, than people who die younger (e.g. people who give themselves a smoking related condition).

Lemiserable the important bit is the life long cost of care of significantly disabled people. It is so disproportionately huge in comparison to hysterectomies etc that even a relatively few instances of VB gone wrong resulting in acute care, lifelong care and loss of contribution to society easily amount to billions. It doesn't prove anything either way, other that a strictly financial argument leads to absurd conclusions.

Booboo i did get that. But smokers (without cancer) may well live a long life just with a lot of medical intervention. So still getting pensions etc.

I think if hospitals cant cope with demand for epidurals then it should be logged as a failure. More resources should be put into it. Its not acceptable to be left in pain (i had awful first mw). Nobody apart from the patient knows how much pain they are in.
Maybe sending people home does make it more painful as you start to realise you cant have any painrelief and tense up. What i would say is im sure mw behave differently regards pain relief on obem (or they dont show the early stages) i dont think ive seen 'no youre alright you dont look like youre in much pain (as i scream and clench my jaw)

I agree, naty. Looking at it from a costs issue, it is not acceptable to make the decision that more women should stay in more pain because of the cost of hiring another anethetist etc. That's a horrible decision to make. By all means look at encouraging other ways women can manage the pain - birthing in an environment where they feel safe, hypnobirthing classes etc - but a policy decision that says "tough shit, you'll just have to deal with the pain" is essentially unacceptable.

They're not going to start withdrawing G&A and morphine from A&E departments on a costs issue, so that people have to cope with having shoulders popped back in without any pain relief, are they? So why is birth viewed so differently? (And the 'people have been doing it for thousands of years' argument doesn't really apply. People have been dislocating shoulders and needing teeth removed for thousands of years and had to have those procedures done without pain relief - no one is advocating that we return to that, are they?)

However I feel that it is attitude's such as LeMis's in my experience women can be quickly reassured re: how an epidural is administered. It's when they find out about the higher rates of fetal distress, running a temperature, urinary catheter, and association with forceps deliveries that they tend to reconsider whether it's something they want. Obviously these things go to the wind when they are really struggling in labour which really don't help the situation. Clearly she believes that a woman choosing an epidural is wilfully and selfishly choosing not to cope with the pain, and is wilfully and selfishly putting her needs over her baby...

Yes either the OBEM midwives are acting for the cameras or they are just very different to most of the ones i encountered. There was a young woman on my ward in early induced labour, crying with pain, being told by a midwife to 'stop making such a fuss, this is just the start'.

I had an epidural in the end because after 12 excruciating hours I went from four centimetres dilated to just six centimetres. The idea of another 12 hours of agony was too much and I begged for the epidural.

As it turns out, DD was an enormous baby and I was always going to need some help.

But out of my NCT group of eight women, four had C sections and four had various types of VB (although we all had episiotomies).

The women who had C sections recovered fine and give months on are feeling really well.

Those of us who had VBs with epidural, episiotomy, forceps, tears, etc, are still having gynae issues. Prolapses rectoceles, infections...

I think next time I wouldn't hesitate to have an epidural again. But I actually think a C section would be less debilitating in the long term.

*Give = five.

My mw second time was so lovely and professional I was looking for the cameras.

Mw 1st time ignored me and clearly had no time for my screaming

Once labour is over, many women appear to forget about the pain and I was one of them. My memory returned as I was about to give birth to my second DD. You are programmed to forget the pain or no-one would go on to have more children.

I also felt the strong urge to escape the hospital in my nightie as I was "not ready yet" .Staff told me this was not uncommon with an escape heading down the main road into town in her nightdress before the ambulance caught up with her.

My MIL was a midwife on the Unit. She recalled complaints about a buddhist who patients complained was "floating outside her body". It fell to my embarassed MIL to tell the person concerned to get back in (her body?). I think everyone had had a little too much pethidine.

Theeternalstudent - exactly right! It really does depend upon the circumstances of the individual birth. My SIL who just had her fourth, had previously had very easy, smooth births and she was expecting it to get even easier with her fourth. Well she had the toughest birth ever, was in active labor for over 25 hours and had some painful interventions before number 4 came out. I think she has decided to stop at 4 in large part due to this difficult birth.

"but a policy decision that says "tough shit, you'll just have to deal with the pain" is essentially unacceptable."

If you go into the waiting room at our local A&E there are often 20 or 30 people sitting around, some who are clearly very unwell and in pain. They wait for hours and hours to be seen, because the that's the way the NHS is operating right now.

People waiting months for physio, including pregnant women with severe SPD who have other small children and are essentially housebound and in severe pain for the last few weeks of their pregnancy because of a lack of physio.

There is no policy decision to be especially cruel to labouring women, there just isn't enough money to provide a guaranteed epidural for every labouring woman who wants one. It's shit. It's not going to get any better.

And it'll be hard to argue, if there are more money going into obstetric services, why it should be spend on providing more epidurals when we haven't got enough consultant cover to keep women and babies safe at night and at the weekends, even in big teaching hospitals.

If anyone here feels very strongly about this issue and wants to tackle it at grass roots level I'd suggest contacting your local maternity unit and volunteering to sit on the MSLC or labour ward forum. These are committees which meet regularly to discuss local maternity services - doctors, midwives and service users can attend and put their views across.

Lemis - take your point about all of the above and lack of resources.

The thing that bothers me though is that most people would agree that people being neglected in A&E is undesirable.

Whereas neglecting the needs of pregnant/labouring women is justified by policy decisions like 'there's no point in admitting a woman in early labour to hospital as it would interfere with her hormone cascade' AKA 'sit in the car park and get on with it love till you're sufficiently dilated, so you don't take up room and resources that someone else needs more'.

Ditto with proper pain relief - women are made to feel guilty for being 'selfish' enough to want pain relief, whereas it would not be questioned anywhere else in the hospital.