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.

Because if all goes well without intervention eg epidural, you can go home much quicker

I had an epidural. Both times.

It's because if you can manage without, you're less likely to tear, as you can feel the contractions and push with them. You're less likely to require interventions like forceps as it can slow things down. And there are (low chance but severe consequence) risks with them

I couldn't have coped without them so it was the right thing for me but it did slow things down - they have to monitor you and to do that you have to lie still. Doesnt help labour progress. And you can't eat if you've had one and because everything slowed down I completely ran out of energy. I had a retained placenta and think it was connected

I've had 3 Caesareans (1 UK 2 US). Combined spinal-epidural for #1, spinals for the others. My back had some odd pains for a while after #2--felt like the sore spot was gradually moving down my spine until it got to the coccyx and then disappeared. All's been fine since.

The Campaign for Normal Birth was suspended in 2017 after the deaths at Morecambe Bay. The investigation found that "natural birth at any cost" was a contributing factor.

An epidural can be turned down so you can feel to push.

AGREE!

a woman should be able to choose

end of

same with elective c sections

@geraniumsandsunshine

so it’s about saving the nhs money then basically?

I'm not mmmm about it at all. So many members of my family and friends have gone through what op is describing. There must be a cost saving policy at play here. When the manager of a hospital is looking to save money, I am convinced that relatively young, fit women of child bearing age are specifically targeted. We just need some kind clever person to leak the emails!

This simply doesn't happen in other countries. I have given birth in Europe and an epidural comes as standard.

Isn't this at the heart of the failings at Staffordshire etc?
Midwives ideologically committed to a "natural" childbirth and disregarding the Mother's wishes?

There is nothing special as you pointed out about a painful childbirth. Some of those women are bitches.

Please disregard their nasty comments and enjoy your beautiful baby.

And I don't think it is about the money as these drugs are relatively cheap.

And where I gave birth in Europe, they would not dream, as standard practice, of letting women labour for hrs and hrs, sometimes days, waiting to give birth and then having to be dashed off for an emergency C-section.. They intervene much earlier or offer a C-section from the start. Giving birth in the UK, in some hospitals, is medieval. And rarely is any post partum physio offered on the NHS, whereas it is standard abroad. I would love to have a look at comparative figures relating to birth injuries country by country if such a document exists.

Well if it's not about the cost of drugs it's about staffing levels, which ultimately is about money. And it's about turfing women out of hospital quickly (more cost saving).

We know that most UK maternity hospitals or units are lacking midwives. There are severe staff shortages in some. Midwives are leaving the profession in droves and not being replaced. And how often does the cry go up "the anaesthetist is busy or unavailable at the moment" ?

It can cause complications during birth as you are more likely to need assistance (ventouse etc) if you have had the epidural. Also there are links to long term back issues for women who had the epidural. I had it with my first as the pain was shocking and it definitely prolonged the labour, I had to have an assisted delivery which lead to tearing so recovery was longer. I never had it with my next two births as I knew what to expect so felt better equipt to manage.

Because if all goes well without intervention eg epidural, you can go home much quicker

I had an EMCS, I held off on the epidural (having had one for my previous birth) because I wanted the one-shot spinal block instead. I was out of hospital within 24hrs (night time birth, gone just after lunch because they dilly-dallied getting someone to sign me out - not for any reason, just inefficiency).

Ditto Catheter - being catheterised just meant that I waddled to the bathroom carrying a bag of my own pee, didn't result in extra care or being unable to pick up my baby.

Of course, these things are semi-horrifying on their own. Childbirth in the UK really needs some work! I had my first baby abroad, where I felt much more in control, and like the staff had things under control, rather than careering from crisis to crisis which was how it felt in the UK hospital.

Oh, and they definitely avoided pain relief - abroad, we discussed it like adults - even while I was in labour. In the UK, they actively avoided pain relief (warm fucking bath) until it was demanded - which obviously, being in massive pain was hard - I had to send dp to camp at the desk until they did something.

So many comments saying epidurals make it harder to feel your body, harder to push… I could still feel my contractions, could still push fine.
They always say an increase in intervention is because you can’t push well.. I wonder if more people who are going to have issues anyway (like me, baby was in wrong position with head facing upwards) have longer labours or a more painful, drawn out beginning to labour before the active stage and then decide to have an epidural. But because baby was not in a great position anyway then have to have interventions. Is that the correlation instead. I have no basis for this apart from the fact that it kind of annoys me that the inability to push well is always said about epidurals and it just wasn’t the case for me. I would have had to have had intervention anyway even if I hadn’t had an epidural.

I didn’t experience midwives trying to prevent an epidural at all. Mine was suggested not long after I started the drip, I was happy to have it, no issues from either side.

I've had a birth with an epidural and one with just gas and air This was over 30 years ago and things may have changed, but I would pick the one without epidural every time.

I'm no natural birth advocate, but what your midwife says chimes with my own experience. The inability to feel lead to a long and exhausting pushing stage meant I ended up with an episiotomy and was seconds from needing forceps. I couldn't move for hours after the birth either. It wasn't a good experience at all.

The birth without an epidural was a revelation. I could take an active part in the labour and also rely on what my body was telling me. I had a lovely bath immediately afterwards and I was on a bit of a post birth high. I did not feel like that in the previous birth.

I needed the epidural in the first one due to high blood pressure and being on a massively painful level of drips during my induction, so I don't resent having one. Given a choice and no complications I wouldn't want one again.

Epidurals have changed a lot I think. My mum said you got one and that was it.. completely numb no movement. With mine I could control it with a button and when it came to pushing I didn’t keep topping it up and could feel when to push. They seem to have developed a bit.

I’m a midwife and I’d never discourage a woman from an epidural. The comments you had sound awful. The only one I’d possibly agree with would be antenatally when the midwife said wait until Labour to make your mind up because you might surprise yourself. I do think it’s best not to have any preconceived ideas and see how things are on the day.

but absolutely if any woman wants one in Labour she should be able to make an informed choice to have one.

Intrigued by the posts thinking this is a cost saving exercise. Just to be very clear - I’m not aware of any midwives thinking about the cost of things before using them or recommending them. They’re far too short-staffed for side hustles in NHS accounting.

Hesitancy around epidurals is based on all the negatives mentioned here - prolong labour, increased risk of forceps/ventouse, increased risk of bad tears, risk of sudden drop in blood pressure and resultant fetal bradycardia, risk of pressure sores, increased risk of UTIs with catheter use. BUT they give the best pain relief we have on offer. That’s for each individual to weigh up and I don’t know many women who don’t want to just see how they get on, given that list of negatives. But certainly, at the point in labour an epidural should never be denied or delayed.

I would love to know country comparisons. I have a suspicion that every country will have their own issues and flaws, and an epidural utopia across Europe isn’t going to be everyone’s cup of tea and high CS rates are never anything to rejoice in. All that means is we have scared women and a deskilled workforce in labour and delivery care. Or doctors that don’t want to work night shifts, see America. I’d much rather we have women confident in the birth process, staffing to allow for good labour support and highly trained staff to recognise deviations from the norm and intervene safely and promptly.

www.theguardian.com/society/2022/nov/16/uk-has-second-highest-maternal-death-rate-in-eight-country-european-study

www.theguardian.com/society/2022/nov/10/sharp-rise-in-number-of-women-in-uk-dying-in-pregnancy-or-shortly-after

www.theguardian.com/society/2022/mar/30/baby-deaths-inquiry-reveals-issues-across-englands-maternity-services

Researchers said heart disease and suicide were the leading causes of death.

Could one argue that women being denied pain relief and autonomy in labour and ending up severely traumatised by it drives up PTSD and PPD rates, thus contributing to this grim statistic?

Women deserve a right to informed choice over their bodies during what usually is the most dangerous and painful event of their lives.

www.theguardian.com/society/2022/nov/16/uk-has-second-highest-maternal-death-rate-in-eight-country-european-study

Please read what the researchers have noted as the leading causes of death.

I don't deny that our NHS is struggling across the board including with maternity care but no need to be scaring women regarding death rates.

I know the articles just posted are not specifically about epidural use but I've linked them in response to pps saying cost savings are not implicated. One of the articles states that maternity services are barometers for health care services in general.

My experience of the drip was one of utterly
agonising pain. It was like torture until I had the epidural. I was very firm second time round that if a drip was on the cards again I would not be consenting to it unless and epidural was in place first. Once I got the epidural I was a mess to be frank but I was so grateful to the anaesthetist for taking the pain away.

I remember the consultant being quite annoyed that the midwife was talking about pethadine and gas and air rather than ‘proper pain relief’ as she described it.

I had loads of intervention but things were going wrong anyway so I’m not convinced that a lot of the stats re epidurals prove causation. My second birth was v easy in comparison. The pain was nothing like the first at all.