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.

The midwife telling you that your friend who was traumatized had a good birth experience is just plain wrong. I remember thinking someone had had a "lovely normal birth" and them telling me it was horrific. First thing we learned at university was "listen to the woman" but sometimes health professionals feel they know better. I think also maybe that some midwives feel their support should be enough that someone won't need an epidural but saying "you are doing really well" and a back rub isn't pain relief.

You're not a failure! Don't let anyone tell you otherwise!
I had the pessary thing to be induced

I think you have to be more closely monitored with an epidural and they cost money. I had two "natural births" too early, too late, too smashed on pethidine to advocate for myself to get an epidural although I asked both times. Then I had twins, with twins there is a much higher risk of needing to do an emergency section so they like you to have a nice early epidural to facilitate that if necessary. When it suits them it's considered completely necessary. It was by far the better labour as it was calmer, pain free and I wasn't off my face on gas and air/ opiates.

Essentially you've started that journey of intervention, epidurals can impact maternal blood pressure- it can drop maternal blood pressure quite dramatically when giving a bolus dose and therefore induce a fetal bradycardia (deep drop in the fetal heart rate lasting until the blood pressure is corrected). So once its commenced there's a strict maternal and fetal monitoring pathway that needs to be followed, if the contractions then stopped, it would be treated likely as 'slow progress' then the cascade of intervention begins, artificial rupture of membranes to break the waters to encourage progress then the hormone drip to encourage contractions, the lack of mobility and catheterisation adding to the interventions and likelihood of therefore needing an assisted delivery. Different to if its part of an induction of labour process as you're already committed to that process, but if someone was in spontaneous early labour, an epidural at 2cm wouldn't be advised, which is hard as some women will labour fast. I feel its a lot about observing the woman and knowing the external signs of advancing labour but obviously the state of the current maternity services, one to one care is unlikely until in established labour.

I'm really sorry that was your experience, it's awful and I would recommend making a complaint. That's not normal practice.

I'm a student midwife and work full time on maternity.

I don't discourage my patients to have an epidural, however it does come with a whole host of risks so I like the make them aware of risks and discuss any alternatives they may want to try first.

Ultimately, it is the choice of the woman and our job to respect and facilitate that.

No decisions that midwives make have absolutely anything to do with keeping costs down. That doesn't even come into it.

The pain of a broken leg is designed to make you stop and listen to your body too if you put it that way.We get more pain than other animals because our heads are large at birth, it’s no more woo than that.

There is a toxic culture within some areas of midwifery that force women into unmediated vaginal births, regardless of what the woman actually wants. This is because these midwives believe that they fundamentally know better than their patients. This is the root cause of many of the reports into unnecessary deaths within maternity units.

Standard disclaimer: this is not all midwives. I had the drip and had an epidural and was very much supported by both the midwives and the anaesthetist. Antenatal classes emphasised patient choice. I had a rocky birth but the silver lining was that I was not in pain.

My treatment by the midwives (except one student) really messed me up mentally. Non of them listened to me during the birth, luckily i was given an epidural, sadly i had three cause something went wrong and the tube never actually stayed in so was a complete waste however the pain i was in and everytime i was screamed at to push from some horrible (older) midwives i had the most horrendous pain not coming from labour but from i assumed was my ovary, like it was going to pop. In the end they had to take me into theatre with a spinal block and pulled DD out with forceps with a 3cm cut. That was three days long all together, and that was an induction.

I am not far of ready for baby 2 to be born and from the start i said i am having a c section. Everyone i spoke to who has had a c section after a traumatic first birth said they wish they did that first time round as it was calm, controlled and organised. My induction was a pretty much several midwives and doctors running about like headless chickens making it a complete circus. Perhaps if the epidural actually worked then it wouldnt have resulted in forceps etc. It took me months, poss even a year to fully get over my birth experience , i struggled to bond with my daughter for months, i just shut of. Now looking back, i would describe it as though my body went through a car crash trauma. A lot of people forget that your body needs to recover as well as mentally recover from the birth , and then to be given a baby to just head home with and act like nothing has just happened is mad.

Some hospitals actually encourage Csection as they can schedule it and predict staffing etc. My sister had a baby this year and said several people in her NCT group were offered them.

I had an epidural, no problems with the birth at all, but I lost my sense of balance for months after and reading this I wonder if it was related to the epidural, there was never any mention of that as a side effect.

Episurals do come with. A risk.
I know someone who couldn't walk for six months and was using a wheelchair for one year.
Even now, 2 years later, she doesn't have full feeling in her lower legs and cannot walk far.

1. They are expensive
2. but also there’s a slightly increased risk of other complications, leading to other interventions (i.e being on your back makes it harder to push, which means you might need other interventions to help), so from a medical perspective they don’t necessarily want to give you one as it slightly increases the risk to you and your baby. But the epidural would available if you needed/wanted one.

It absolutely doesn’t make you a wimp, I’m sorry that’s the attitude you experienced.

Posted too soon...
I had the pessary three times and it didn't work but I was in agony for 2 days. I was meant to get a c section then I was dilated by 1cm so got the drip. I asked about an epidural and they said it would depend on how busy it was, so I said I wouldn't get started on the drip until I had an epidural as I had been in agony for days and knew lots of people who had been refused epidurals because "it was too late".

I can't cope with pain at all and have no idea why they would be okay with someone to just be in so much pain

Did they ask you if the junior doctor could stay and watch? The apology they made to him about it not being a more natural birth was out of order. It is not your job to be there to pro

I had same experience as you - kept trying to put me off. During labour when I couldn’t go on I said ‘right epidural now please’ and even then the midwife resisted saying ‘are you sure you can’t carry on a bit more?’ And I snapped and demanded one. She replied saying ‘we want you to have the most natural birth possible’ to which I shouted ‘every birth is natural as no one is born a robot!!!’

this was about 8 months ago.
Still pisses me off today.

I had free choice, no one tried to persuade me either way. Just down to the hospital or individual midwives.

Or your priority to provide the doctor with his or the nurses ideal learning experience.

Definitely not better. I had it in my notes that I wanted an epidural as soon as possible. It was perfect - did my nails, had a sleep and watched Wimbledon. Highly recommend!

First time I had the drip with no epidural as the timing didn’t work out, I went a couple of hours with drip alone. It was like lightning, I was not in control of myself at all. I felt like I wanted to die in all honesty. Vaginal birth though, cord round his neck 3 times but only a few stitches, healed lovely.

second baby was the largest some of the doctors had ever seen, audible gasp when he was born. Via c section after 3 days. Emergency as they wanted to see how long I could go and then if all went wrong, understandably. I had every pain relief imaginable because I gave zero shits, if it took the pain away; give it to me, I had no care for what crosses the placenta or what doesn’t; I needed relief or I was going try and murder myself to not be in that pain. I lost consciousness from the pain but they gave me an epidural happily. the C-section I had to beg for as there was a shift change and the new team didn’t agree so it took some begging for my dignity.

the third time I had none of this shit, arguing while I’m half dead about how much pain I’m in, it was a planned csection or I would make myself no longer pregnant. Sounds harsh but I could not put myself through it again.

In my experience of giving birth four times - many MW are the gatekeepers of pain relief. In my case, the gate was firmly locked and someone had lost the key.

I’m sorry you were treated so badly OP. I hope you gave permission for the student doctor to be there as an observer. It’s comes as no surprise to me that so many Maternity services are under review - many do not seem fit for purpose.

Glad it went well,

I vaguely remember some evidence about epidurals are more likely to lead to c section as you can't actively birth - move around/stand up/crouch. Could be wrong though.
It can be hard to get hold of an anesthetist to place it too in some hospital's.

Very strange! Sorry you had that experience OP. I had an epidural when I went into labour and it was given with no fuss made. In fact the midwife before I gave birth gave a v understanding nod when discussing my birth plan and said they were great.

Source ?! I really don’t think this is true of even a small minority of midwives. This would be pretty serious neglect to deny a woman needed interventions during birth…

Epidurals increase the liklihood of medical intervention being required such as forceps or emergency c section. It also slows labour down which means too early and you prolong labour meaning the mother is exhausted and again increases the chances of intervention.

It also doesn't come without risk as its a spinal tap.
It also contains a opiate unless your notes had about a reaction and they had sourced a opiate free version.

Your not any less of a mother for having a epidural.
medical intervention prolonges recovery and can cause a lot more trauma, epidural increases the risk of that hence there is a good reason for midwives to see how things go.