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.

@TheCraicDealer
I do think it’s another part of birth that doesn’t necessarily work for everyone. The ‘active’ birth. Fine if you feel good. Not so fine if you are exhausted and in agony. I had a drip with my second - awful and again it was only when I finally had an epidural that I relaxed enough to be able to finally push him out.

I don't think it's noble or special or anything like that. Just that the message it's communicating is different.

Sometimes that pain is communicating that something is wrong and then interventions are luckily there.

I feel some poster on here have just decided to lay into me.

I've never said anyone was wrong to take pain relief or that I'm better than anyone because I didn't have an epidural. I don't believe that I'm a hero or anything special for how my births went.

I talk about my births as an example of when epidurals and c sections would have been total overkill. They would have exposed me to more risks that a vaginal birth would have. I'm not alone in that and that is what I mean by over medicalising. It's like taking putting your whole leg in plaster because you grazed your knee. It's a very fine line for each woman though between under and over medicalising their birth.

Other posters like to compare other countries with high epidural or c sections rates with the UK and present them as the right way to do things. Sadly though in some of those countries the right of choice has been taken from mothers because medical teams can't cope with vaginal births anymore.

I've stated many times that I think the pain relief and interventions we have now are good things.

Where is the evidence some countries can’t cope with vaginal births?

Well I don't know for sure, but in my research prior to birth (I didn't have an epidural and planned to try to manage without although I am a wuss with pain!) I found out there are some risks with epidural so although people you knew had a good experience some people have permanent nerve damage afterwards. So avoiding interventions is usually better. Also its harder to tell when to push, and I imagine this increases chances of needing other interventions such as forceps.
Having said that I think it is your birth and as long as you are informed of the risks you should be free to make your choice

I still don’t think you’re getting it.

I talk about my births as an example of when epidurals and c sections would have been total overkill.

Women aren’t given interventions unless necessary. However, pain relief isn’t an intervention. So what you seem to be saying is women can’t cope with pain as well as you and they’re asking for pain relief you don’t think they need.

No one is arguing that women being forcibly numbed or have their babies born by forceps/ventouse/section unless necessary. We’re arguing that a woman who wants pain relief should be given it in a timely manner.

I don’t think that anyone who didn’t have an epidural is brave - it’s down to personal choice how you give birth unless there is a particular medical reason- all birth is natural.

I’m very pleased that my birth plan included a notification that I wanted a very early epidural and perhaps I was lucky I got it in the very early stages.

it was a straightforward delivery and I was pain free

Having said that I think it is your birth and as long as you are informed of the risks you should be free to make your choice

This is the point @TheGoogleMum. Women are making the choice and are being prevented from accessing it. Just like the OP, who was very clear about what she wanted.

The only country we have been talking about is France and I’m pretty sure they can cope very well with vaginal births. The right of choice has not been taken away from them. It’s just the epidural hasn’t been demonised the way it has in the UK.

French women will have seen other mothers/friends giving birth with the necessary pain relief that they CHOOSE and having a good experience (or they wouldn’t have it!). This is empowering. They don’t have the NCT ‘cascade of intervention’ scaremongering rammed down their throat. There’s no ‘ooh see how you get on’ - whilst you writhe around in agony for 2 days..

Now I’m sure if a French woman wanted no pain relief that would be an option too. Not many seem to go down that route. I wonder why?

I think they dislike epidurals because the pain of the contractions makes you push the baby out (no other way to stop the pain). If you don't feel them it's harder to know when to push, so you're more likely to tear and have other complications afterwards. That's how they explained it to us - but we could still opt for epidural on our birth plan if we understood the importance of pushing when instructed. Don't know why they just didn't explain that to you instead of all the shrugging and smirking and giggling in the corridor!

@Apennyforthem56 Actually I think the main thing these statistics show is that there is a huge variation in experiences and outcomes depending on where you give birth, by which I mean which hospital and which doctors, not which country.

The stats for the different clinics and hospitals in the Paris area show that in most cases, places with a very low rate of assisted vaginal births tend to have a correspondingly higher C-section rate and vice versa, indicating that in some places they have a policy of persisting with a vaginal delivery whereas in others they prefer to avoid an instrumental delivery at all costs and move to a C-section. The higher rate of C-sections in public hospitals compared to private clinics is also partly explained by the fact that private clinics are usually only equipped to deal with uncomplicated births and so if you have a high risk pregnancy or something goes wrong during labour you will most likely be transferred to the nearest public hospital.

What I'd really love to know is what they do differently in the places which have both a low assisted vaginal delivery rate and a low C-section rate. Unfortunately the data doesn't tell us what their secret is.

I think the main difference between the UK and France is that in France women have a lot more choice over where they give birth and even which doctor delivers their baby, meaning they can actually use these statistics to inform their own decisions.

My sister in law went to register at the nearest clinic for her second baby and was told they don't do VBACs, so she went somewhere else and had a successful VBAC.

I don't know whether they feel less stressed or not. Everyone is different.

I didn't get the birth experience I wanted last time, as I wanted a straightforward vaginal birth and ended up with an induction, epidural and C-section for failure to progress. But I was treated very well, I don't feel scarred by the overall experience, and now, at 7 months pregnant and preparing to give birth at the same clinic for the second time, I don't feel stressed.

I've just come out of an appointment with the same anaesthetist who did my fantastic epidural last time, having agreed pretty much the same plan I did last time. Hope for a spontaneous labour, aim for a VBAC, have an epidural if and when I want one, keep the dose as low as necessary so I can stay as mobile as possible.

@babyjellyfish - you’re the opposite of me - I wanted a high dose in my epidural as soon as possible!

Arguments about the rights and wrongs of child birth intervention aside the way they spoke to OP and about her was totally unacceptable. I would suggest complaining as it was totally unprofessional and would not have set a good atmosphere for birth.

@Delatron I’ve had two children with no epidural, and it never crossed my mind to ask for one or need one. I was lucky. My mum has had three children with no epidural. My closest four friends didn’t have epidurals and didn’t want them. I see lots and lots of women who do not want or need epidurals, not just those women who have been to NCT and been pressured into thinking epidurals are the work of satan (don’t get me started on that one). That isn’t informed consent, that’s some weird NCT/cultural issue going on. Please don’t insinuate that nearly all women would choose to be pain free in birth. We’re all very different.

@babyjellyfish that explains some of those stats and is interesting. So is your current experience of private healthcare?

I wonder how many of those c-sections are emergency? The UK figures for emergency c-sections seem pretty high by comparison - unless they're of the c-sections, x% are emergency - does anyone know?

unless my maths is wrong, it looks like 32% of births in the UK are by C-section, higher than any of the French hospitals cited, and of those 50% are emergency. The 'cascade of interventions' explanation really doesn't stand up at all given those figures - unless the emergency c-sections came after the epidurals (and hardly caused by them). So - I'd ignore anyone on here mentioning the cascade...

@twentytwentythree the 18.9% figure for emergency c-section is a percentage of all deliveries.

For the France figures, emergency and electives are lumped together, so we can't really know.

Ok thank you. Levels of epidural in Ireland seem to be c.40%, with c.32% having c-sections. I haven't heard of anyone giving birth in Ireland having to battle to get an epidural so it's interesting to think why these stats differ from France. Birth cultures vary so much! We lived in the Netherlands for a while and you almost have to give birth at home, without an epidural.

@Apennyforthem56 I’m not sure what your point is? Yes some women don’t want or need epidurals. Many do. I don’t think I’ve said anything different other than it’s unfortunate that in this country we do get it rammed down our throats that epidurals cause a cascade of interventions. This means many women and midwives try and avoid them when actually they may have had a better birth if they’d had one earlier.

Well done you though 🙄

I’m due to give birth next month, and not having my birth plan respected or my wishes honoured regarding an epidural is something that’s really been worrying me.
As a first time mum, I’ve heard horrific stories about women being dismissed and ignored by midwives, basically telling them to suck it up and that they’re overreacting as they’re first time mums, and then it getting too late and having to do it without an epidural. This would absolutely horrify and traumatise me.
I have suffered with incredibly painful periods that have caused me to throw up and almost faint with nausea and a temperature. That’s how much pain I’ve been in with that level of pain. They are pretty much unbearable and totally incapacitating to me, so I have always dreaded giving birth, because I’m assuming it’s going to be much, much worse than that, and that’s as much pain as I can physically cope with. I totally sympathise with you OP, and I believe anyone should be entitled to have pain relief they ask for if they feel they need it, no questions asked.

Cost kind of comes into it. When I had my baby last year I was desperate for an epidural (once I was in labour) but there were no anaesthetists available. Apparently they only have two at my hospital and both of them were busy with c sections. This is not a small town hospital. It's a large teaching hospital. I shudder to.think what would have happened if a third woman had needed a c section. They didn't find anyone either who could administer pethidine....

Oh well...I survived.

If you click on the links for individual hospitals, a more detailed breakdown is available.

So for Necker's C-section rates:

30.6% overall C-section rate
13.5% ELCS - not sure whether this is percentage of births or percentage of C-sections
76.6% for multiple births
79.6% in case of breech presentation
66.9% in case of previous C-section

If you look at the American Hospital, they have a 100% C-section rate for multiple births and breech presentation, and 97.5% in case of a previous C-section. So if you want a VBAC, it's not the place for you.

My own chances of having a VBAC are also not looking good according to these stats, whereas the at the hospital where my sister in law gave birth, 56% of women with a previous C-section have another C-section.

The detailed stats also give the overall rates for France, which are quite interesting too:

Spontaneous vaginal births: 64%
Assisted vaginal births: 14.3%
C-sections: 20.4%
Epidurals: 81.4%
Episiotomies: 3.9%

So the overall trend in France appears to be more "natural" and less interventionist than hospitals in Paris, but still with an epidural rate of over 80%.

There are some big hospitals in other regions which have a reputation for very low C-section rates, almost zero episiotomies, alternative pain relief options such as gas and air and bathtubs, which aren't usually available in most traditional maternity units.

The trend for more medicalised births in Paris might well be a reflection of the fact that the most ambitious doctors tend to gravitate towards the capital, as well as a more affluent population. So you will have a higher number of IVF babies, a higher number of high risk patients who have been transferred from other parts of the country, and ultimately a higher number of more expensive doctors who want to justify how much they get paid, as well as a higher number of wealthy patients who want the very best care available in case anything goes wrong.

There is definitely a push for more natural methods to be available and supported, because not all French women want an induction and an epidural, and if you don't want these things it can be as difficult to say no to them as it can be to get an epidural if you're in the UK.

That said, I'd be wary of putting too much emphasis on low C-section rates. Whilst it's clear that some interventions are unnecessary and mothers might do just as well or better if left to labour in peace, in many instances they are life saving. Before the news of the maternity care scandal broke, the Shrewsbury and Telford NHS Trust was proud of its incredibly low C-section rate. But unfortunately, some families paid the very highest price for that.