To ask why midwives try to prevent / discourage you having an epidural ?

[stripyspider]

I recently had my daughter, ( six weeks old). I knew from the outset of the pregnancy I wanted an epidural, (I don't cope with pain well). Everyone I knew who had one, (including a midwife friend), spoke excellently of them, and had no side effects. Also, what was an important factor was, unlike pethidine, epidural does not cross the placenta and effect the baby.

However, at any antenatal appointment I had, (including the birth planning appointment), my midwife kept telling me I should see how I do, and kept saying, " but you might Suprise yourself and cope so well with gas and air you won't need an epidural," "be so much better if you didn't have one." She then kept telling me I should try and wait as long as possible before having one.....the implication being, that I was being a bit of a wimp for wanting/ being set on an epidural.

I just couldn't work out why it would be better for me to exhaust myself by going through hours of agony unnecessarily, ( which could potentially lead to PTSD/ birth trauma), when the hospital have epidurals that are proven to work, and don't have any ill effect on the baby ?

My anxiety was peeked by the fact a friend of mine had her first baby at the same hospital a few weeks before I had my daughter. She was also clear from the outset she wanted an epidural, and faced the same attitude of "well you are being a bit of a wimp," by midwives, ( she had such bad tokophobia she was referred to the mental health midwife, and the mental health midwife tried to persuade her against having an epidural when making a mental health birth plan !) In the end, this friend went to hospital , was found to be 2cm dilated and was sent home even though she was crying in agony and begging for pain relief. She returned a few hours later and had dilated to 9cm really quickly, so was then told it was too late for an epidural and she had to give birth with nothing. She is very traumatised and upset by this.

I tried to explain to my midwife I was worried about similar happening to me, and she just dismissed it and said, "but your friend is lucky she managed the majority of her labour at home and had an intervention free birth, that is a good thing. Don't worry yourself stripyspider, don't let your friend scare you, she actually had a good experience, and some people like to moan for nothing, she sounds like one of those people"

Anyway, in the end I went 13 days overdue so needed to be induced via drip. Even the NHS website states that induction via drip is likely to be a lot more painful than natural labour, and you may want to request an epidural at the start. I thought if this was standard NHS advice, it would be pretty mainstream.

The midwives kept trying to dissuade me from having an epidural before the drip ,saying it was an "unusual choice," and why would I not want to wait a while to see how it goes ? They also stated that an epidural at the beginning would prevent me from having an active birth and be able to move around.

I pointed out I was hardly likely to be bouncing on birth balls up the corridor given I was canulated, attatched via wires to a massive drip and several monitors, ( and therefore waterbirth would be out regardless). They said I should start the induction and try pethidine first, I pointed out I didn't see why it would be better to try pethidine when I have a family history of reacting extremely badly to opiate medication, the anaesthetists had already told me pethidine didn't really do anything to relieve labour pain and , unlike an epidural, could transfer via the placenta to the baby. In the end , they did agree to allow me to have an epidural before the induction drip started, but I was really upset to hear them laughing about how I was "demanding an epidural," in the corridor. When the shift changed, the next midwife said to me she would have likely had an epidural as she's not good with pain, but would have waited until 4/5 cm dilated. When I asked what the benefit of waiting was, she just shrugged her shoulders.

When I was actually giving birth , they invited a student doctor in to watch, ( he was on placement), and even said to him, ( in front of me ), "sorry you don't get to see a more normal/ natural birth."

I feel like i've been made to feel like a failure and not a "real," mother/ women for wanting an epidural, even though there appears to be nothing to suggest an epidural is damaging to baby at all.

Why are they so, so , so keen to stop you having one, ( to the extent of telling my tokkophobic friend she didn't need one). The only reason I can think of is it costs the NHS more as you have to stay in hospital longer with an epidural , but is there more to it ?

The being made to feel pathetic has really knocked my confidence as a mum tbh.

I'm sorry there are some right bastards working in the NHS that shouldn't be anywhere near a patient. You were not wrong to push for your epidural. There's nothing inherently "better" about not taking pain relief. I was pushed into trying a vaginal birth when i expressed very clearly that i wanted an ELCS. My baby nearly died from a complication of a vaginal birth and i ended up with an EMCS and PTSD.

I was also criticised by staff right in front of me, at the most vulnerable point in my entire life. They made me feel like i was failing my baby which just destroyed me. To them it was a throwaway comment, to me it was a significant trigger to the PTSD i later developed.

You did incredibly well to fight for the epidural. You haven't failed your baby. I would very very strongly suggest a birth debrief and a complaint to PALS. Keep an eye on how you're feeling, you may develop some kind of MH issue that needs dealing with as your friend did.

I don't claim to have any medical experience and I bow to the superior knowledge of midwives on here, whose work I very much respect, and I realise obesity levels in UK are high, so you are starting off with the likelihood of uneven outcomes, but surely you are going to have more cardiovascular problems if you allow women to labour on for days without proper pain relief and prompt intervention? That is a difference you really notice if you have given birth abroad and in UK. There just isn't the same willingness in EU countries to let a difficult birth play out over days until the situation becomes critical, without prompt intervention.

Can I just say not everyone wants an epidural or c section as standard.

I've given birth twice. Both uncomplicated vaginal deliveries. Gas and air with both, water birth with one.

My second birth was beautiful. I was in control, I wasn't in terrible unmanageable pain, I was listened to, she was big (9lb3) but came in under 3 hours.

I wanted to go and was discharged a few hours after birth.

I didn't want an epidural, I didn't need one. I didn't want a c section, I didn't need one.

Over medicalising birth can be as bad as under
Medicalising birth.

But gas and air are both medical!

How is this relevant?

You got the birth You wanted. You weren't dismissed, belittled, shamed, not listened to. No one pushed an epidural or c section on you. If they had, that would have been the equivalent of what OP went through.

So again... what's your point? Other than look smug about your perfect births...
You think giving an epidural to a woman who is begging for it is "overmedicalising birth"?

There is a lot of medical misinformation on this thread.

Having an epidural doesn't necessarily mean you can't feel to push - I had one with two of my births and could feel the contractions and pressure. With both I went home the next day.

There's nothing inherently brave or unbrave about having pain relief. Some births are more painful than others (eg back to back position)

It doesn't necessarily take longer to recover from an epidural. If it has allowed a woman to get better rest during childbirth than a prolonged cb with no pain relief then recovery times can be quicker as the mother is less exhausted.

You can move around with many types of epidural.

Cost is indirectly implied due to staffing levels in NHS hospitals, and the policy of trying to get women home as early as possible.

I thought more recent research was emerging that debunked 'cascade of intervention'? That women who are having a more difficult prolonged and painful birth because of the baby's position or some other factor such as their own health are going to be more likely to need an epidural. So it isn't the epidural that sparks the interventions off, it's the birth itself being more difficult and painful. And the epidural offers them a better way of coping with the pain and preserving their energy for the birth.

I did all the birth positions and hypnobirthing stuff and it was no help whatsoever with the pain, midwives said I was 'coping well' (yeah right ). The epidural enabled me to rest and sleep whilst I dilated to 10cm.

And people describing epidurals 30 years ago - not helpful! Things have moved on since then. You now get a button to press to top up your own pain relief and it's lightened so you can feel to push.

@RandomMusings7 my point is these threads always end up with posters saying that epidurals and c sections should be the norm or standard etc.

My point is that saying women 'must' have these interventions is just as bad as saying women 'mustn't' have them.

Some of those posters are all for patient choice except when the patient's choice is to not have these things.

I'm pleased I live in a country where I wasn't forced to have a c section because the medical staff have lost the skills to deal with vaginal births.

@LuckySantangelo35 not sure but I hated staying in the ward so anything to get me home quicker is better for me?

@twentytwentythree I never said they weren't. I said 'over medicalisation' mean taking what is a natural process and chucking tons of medical intervention at it when it's not needed.

Now just to be totally clear, epidurals and c sections are great and they have really helped to reduce maternal and infant mortality.

But not every women needs them and they should be able to choose for themselves to have fewer medical interventions or non at all based on their own health and risk profile.

Absolutely noone has said that women must have these interventions. You are making stuff up.

Everyone has said women must be allowed to freely choose whether they want these interventions and not be denied on a whim

These are two very different things...

Amazing that we should have the free choice to have no interventions even though most of us go into childbirth with absolutely no idea as to what our pain threshold will be, but intervention that results in the mothers comfort is seen as unnecessary.

@RandomMusings7 more than one person has said things like

In x country epidurals are given as standard or something similar.

The implication of having them as standard is that women should or must have them.

That's just as bad as saying you can't have them.

I do agree with saying to women (especially first timers) to wait and see how the day goes and not to get too wedded to a particular birth plan. You've no idea how things will go. By all means research and make preferences based on this.

When you've given birth you have a better idea of how your body reacts to the process.

I wish there was a like button for that post @Twizbe

In x country epidurals are given as standard or something similar.

The implication of having them as standard is that women should or must have them.

Or maybe they are standard because when not shamed and guilted and fearmongered most women actually prefer to have one? The fact that they are standard absolutely doesn't mean anyone is pressured into one.

Why should a woman wait if she has already decided that her birth plan includes an early epidural? I had this in my birth plan as I saw no benefits in being in pain or discomfort. I have (so I’m told, a high pain threshold) but wanted a pain free labour- which I got.

If a midwife had tried to talk me out of this, I’d have complained as she had already been made aware of my wishes.

You remind me of me. I was adamant for epidural with my first, and was given it with no issue. The experience wasn't that great for me though as I really struggled at the pushing stage, but given DD took 2 days from water breaking to make her appearance, it was probably needed to cope. I did have electric type shocks up my back for a while postpartum and even now still get the odd episode here and there. With my DS I wanted to try without epidural. His labour was so much faster, and I was practicing hypnobreathing until I got to active labour. I managed to deliver on gas and air and i was back on my feet in 2 hours.

Go with your gut always as only you know your body. I would complain about the pressure from the MWs.

I have given birth with gas and air and the first also pethidine. Aside from the contractions which breathing for makes a big difference, it wasn’t particularly painful. And because you can feel what your body is asking you to do, it was fine and I didn’t tear with any of them. Immediate recovery and home a couple of hours after giving birth.

I am absolutely pro epidural or whatever medical intervention is needed but I think it is worth trying without it as long as everything is fine.

I had a c- section under GA with my first.

Whatever method works is fine. I was terrified when I had my first vaginal birth. The doctor said to have an epidural but when he left the room, I asked the midwife and she said that if I was coping with the pain now that I would be fine. And I was.

The biggest revelation to me was that it is the contractions that hurt (and they come and go) and pushing the baby out feels good and isn’t the painful bit.

I can imagine it is a lot harder to push a baby out without needing snipping or without tearing when you can’t feel anything.

I’ve been a midwife for 15 years and I don’t care about what any woman does and never have. Why would I? I’ve had my babies and made my choices. I only care about whether a woman has had the best possible information about her choice and understands the information she’s had. That’s literally the extent of my job. Giving a shit about her choice to the point of persuading or dissuading her to do something is not the remit.

Sounds like there’s a bit of a cultural issue going on here within the unit. These entrenched cultural stances come up time and time again in all these inquiries into Morecambe Bay/Shrewsbury/East Kent etc etc and probably loads more brewing. We need to stop caring about what women do and start caring that they feel supported and they are informed.

In x country epidurals are given as standard or something similar the implication isn't should, it's that all options are readily available. It's not as bad as saying you can't have them. They're not enforced, whereas withholding an epidural is an enforcement of a particular ideology.

When you've given birth you have a better idea of how your body reacts to the process. but every single birth is different - first births are generally slower and many people on here who have epidurals have them when their baby is presenting in a position which is unusually painful.

Your situation wasn’t particularly painful. Good for you! You were lucky. Not better or more virtuous than anyone else. Lucky!

Other people have other situations that need more pain relief, and ought to be provided with it when they request it.

The point is nobody should be forced into anything they don't want. You were very lucky, you had the birth you wanted. Presumably you had no complications which meant that the baby's life was in danger, or stuck, or breech or any other myriad reasons why a woman might want interventions. Other women aren't so lucky. They deserve the experience you had - ie to be in control of the way they give birth. Whether that's csec, epidural or nothing.

For some bizarre reason there is a very strong narrative in society that giving birth vaginally without pain relief is a badge of honour. It's 2022. Why suffer pain needlessly if you don't want to? If you don't want pain relief then that should be fine as well. Since having mine I've always felt there's a school of thought that there's only one correct way to give birth and anything other than a vaginal birth with only gas and air is superior. Having interventions is not a failure. You don't get a medal for not needing or wanting them.

I don't see the NHS doing vasectomies without pain relief and then people boasting about how empowered they feel because they didn't have pain relief. It's so odd.

Your comment about midwives losing the skills to deal with vaginal births is weird as well. It's not the fault of an individual woman choosing a c section because it's best for her if midwives don't keep up to date with their training.

It's probably better actually to have medical staff around that know how to do a quick, safe C section. They can save more babies and mothers.

Exactly...what exactly does 'need' mean in this case? I mean nobody needs to have their gums numbed before a tooth extraction, nobody needs to be relieved of the trauma of horrific pain if a baby is presenting wrong or they've been in agonising labour for hours. 'Chucking tons of medical intervention' is such a nasty expression - medical intervention saves the lives of thousands of babies and women every year, just as this 'natural process' used kill thousands of babies and women. We should be grateful for medicine, not deride it.

You need to be firm right from the first appointment about your wishes. I have had three elective c-sections and the midwives tried everything to discourage me. It was only the intervention of the gynae consultant that finally stopped the "bullying" as I was adamant that this was the only way I was prepared to give birth and it was my right to choose. I knew all the pros and cons and my DH who is a consultant in another area of medicine fully supported my decision which I do not regret at all.