AIBU - to be really pissed off that epidurals are being restricted?

[christmasmum]

Was just reading an article in Mother and Baby magazine saying that epidurals are classed as an 'abnormal birth' and that they should be restricted in the future to avoid women having caesareans.

What is this all about? Why should women not be free to make their own decision on pain relief, while being aware of the risks involved in every form of pain relief? And is it not the case that women having diffcult births in the first place are more likely to BOTH have an epidural AND end up having a c-section anyway??

Before giving birth to my DD I bought into all the information from the NCT, books and magazines etc and was determined to go for a 'natural' birth. I ended up being induced and despite being told by every woman I have ever spoken to who has been induced, that I should have an epidural the midwife advised me that I would not need one. After 10 hours of intense contractions and finding out I was a huge 2cm dilated I decided enough was enough and had an epidural.

I was instantly relaxed and started to actually enjoy the process, 2 1/2 hours later (despite the consultant arriving to prep me for a c-section) I found out I was fully dilated and delivered my wee girl after 5 minutes of pushing to a room that was full of people laughing and singing Christmas carols.

I obviously only have my own experience to go by but I am absolutely convinced that the relaxing effect of being out pain helped me deliver my baby naturally.

What is this pressure on women to be in pain and suffering to be 'real women'. And why is that every new Dad I've spoken to with wives who did not have pain releif seem so proud of them? Is this just another example of male oppression of women? Even subliminally??

AAGGGHHHHH. Rant over.

Libras/LovelyTinofSpam - I read some of the thread out to DW and discussed it with her and she said the same as you.

"All the female obs consultants have drugs/cs. I think they know what they are doing."

Mind you, DW does object to women just electing for cs without medical reason.

For some women it's not the worst pain they've ever felt in their lives so far.

For others, it definitely is!

I've had major surgeries, broken bones, ripped myself open to the bone and needed stitches, etc.

I still felt childbirth with no pain relief was the worst pain I ever hope to feel.

Pain is subjective. So to apply one policy towards everyone regarding it - restricting epidurals, for example - is ridiculous.

re. this point about what doctors and gynaes would do - you could argue that this is because doctors and gynaes only see the results of bad, traumatic labours. They're simply not involved (profesionally) in uncomplicated labours. Their viewpoint is therefore pretty skewed towards the catastrophic. I'd be more interested in what the majority of midwives would plump for, as they have a much more representative view of the average birth.

"All the female obs consultants have drugs/cs. I think they know what they are doing."

hmm I'm not entirely sure about that last sentence, I think that because most of them see and hear the very bad things that can happen in labour it gives them a terror about labour that joe public doesn't have. Let's put it this way, because of what I have read on this site I am having an elective c-section next time despite the fact that I had a pretty easy labour last time (ended in emcs because of position not because of distress etc). Most female doctors would have seen this problems, not only read about them.

Most of the Doctors and Nurses I knonw smoke too, all that says to me is that they don't take their own advice doesn't mean it's something I want to copy.

I was in labour for 25hours from start to finish. I did 19hours on g&a, then the doc discovered that ds had turned his head and got stuck and that they would need to turn him, I was told I was to have the epidural, If I refused, it would be an em cs! I did have a forceps delivery with him in the end.
I really didnt have much of a choice in any of that, but I did agree that the pain involved with them trying to turn my ds' head inside me would have been just too much to bear on g&a. If I do manage to have another child, I believe I should get the choice to decide what level of pain relief I need.

I think every woman should be allowed to have the level of pain relief they need to cope with labour. Every labour is different, so how can a doc/mw know if you need an epi or not??

I think restricting epidurals is ridiculous

"All the female obs consultants have drugs/cs. I think they know what they are doing."

Feel very sorry for any woman who has to give birth themselves after spending years caring for women in the throes of traumatic, dysfunctional labour. Doctors are women - of course they are emotionally affected by the hugely disproportionate number of extremely difficult births they witness.

Midwives themselves are far more likely to opt for homebirths than your average mum, which suggests that they are affected in a very different way by their involvement in childbirth.

Stands to reason really!

But... is a woman in the throes of a painful labour, without any medical training, necessarily in the best position to make complicated risk-benefit decisions?

Does anyone really think that epis should be handed out to any labouring woman who wants one, no questions asked?

Of course they have to be restricted at some level.

I agree with Spam's point about psychological trauma - maybe this needs to be factored in to the risk-benefit matrix (assuming that there is such a thing for epis?) more than it currently is. This is another powerful argument for women to have one-to-one care with an individual midwife for as much of the pregnancy and birth as possible - a midwife who already has a good relationship with a mother will be in a much better position to recognise that that woman is approaching a point of desperation.

Yes I do farking well think that any woman who asks for effective pain relief should be able to have one!

Unless there's a damn good clinical reason why she shouldn't. And she'd probably know that already.

I do not think you should have to seek permission not to suffer.

'But... is a woman in the throes of a painful labour, without any medical training, necessarily in the best position to make complicated risk-benefit decisions?'

It is not for others to dictate what she does with her body. A woman knows her own body best.

FWIW, I made my decision to have an epi before I was in labour.

Why is it only in childbirth that a woman is treated as if she doesn't know what is best for her?

We'd never dream of denying a woman's choice to have, say, an abortion because of the risks involved in the procedure.

expat - the research seems to suggest that how satisfied women feel about their births isn't just about how much pain they experienced, but how much control they had over what was happening to them.

I've had two very, very long labours - one with an epidural and one without. I was happier after the second very long labour (longer than my first), because I had got the skilled support I wanted in an environment in which I was happy, which I needed to cope with fairly extreme pain. First time around I had less pain because I had an epidural, but I wasn't happier with that birth, because having an epidural was something I felt cornered into by the lack of skilled midwifery support.

I personally feel that all women ought to be given every opportunity to recognise their choices for birth - whether it involves an epidural or not.

I'm glad that worked for you, crosseyed. That may not work for all women and I'm glad you recognise that.

'expat - the research seems to suggest that how satisfied women feel about their births isn't just about how much pain they experienced, but how much control they had over what was happening to them.'

I felt much more in control when I had my epidurals.

I felt panicky and out of control with the drug free birth.

Well, I'm a little bit reluctant to do this cos all I've done is Google - but in the absence of anyone with more knowledge than me doing this: here are some of the risks associated with epidurals...

30-35 per cent risk of hypotension
25-34 per cent risk of postpartum bladder dysfunction (where a urinary catheter has been used)
15 per cent risk of fever
1-10 per cent risk of spinal headache (can last several weeks)
10 per cent risk of epidural failure
unknown risk of loss of sexual feeling
common incidence of prolonged labour
20-26 per cent increase in malpresentation of baby's head
almost always increases the need for pitocin, which has many side-effects of its own
commonly inhibits the ability to push effectively, leading to an increase in instrumental deliveries (which have their own risk factors)
five-fold increase in use of ventouse/forceps (again, with attendant risks)
increased risk of epidural (again, with attendant risks)
26-50 per cent increase in risk of caesarian
(again, with attendant risks)

and for the baby:
increases in foetal distress, abnormal foetal heart rates, drowsiness at birth, poor sucking reflex, poor muscle strength and tone.

Pretty impressive list, no? And that's without the (highly unlikely) risks of death, paralysis etc.

No of course, some women will need an epidural no matter what support they have. Women transfer in from homebirths for pain relief fairly regularly.

'It is not for others to dictate what she does with her body. A woman knows her own body best.' - you can't say this about a medical procedure. You can say that the woman should have input - sure. Or that she has the right to refuse something. But you can't say that a patient, rather than the medical professional, is the person who should be taking the final decision to go ahead with a medical procedure.

'expat - the research seems to suggest that how satisfied women feel about their births isn't just about how much pain they experienced, but how much control they had over what was happening to them.'

That was the point I was trying to make.

Women who want an epidural and who get one have a very high rate of satisfaction with their birth - even if they end up with shedloads of complications.

Women who have homebirths and births in midwife led units where they get one to one care also have very high rates of satisfaction with their births.

In other words - it's not just about how much pain you have. Less pain doesn't necessarily = a happier birth.

Getting what you want = a happier birth.

But having an intervention free birth also (generally) = a healthier birth.

Which is why, quite rightly, the major organisations are all involved with thinking about how they can reduce demand for epidurals.

I think that whatever is appropriate for that person should be the protocol for that labour. An open mind and caring attitude is the only thing that should be consistent from one to the other

I was sooo disappointed to have ended up with an emergency cs as I hadn't even considered anything other than the NCT idyll.

Since I've had "friends" sneer at not being able to do it naturally or without pain relief.
It's all so bloody weird and competitive.

We don't need someone deciding what pain we can withstand or how exhausted we are. Information about how dilated we are yes but not some bloody judgey midwfe deciding how bad you feel.
After the entirely pleasant birth of dd2 I listened to the midwifes discussing some poor mother in the most horrible terms. It made me wonder just how appropriate it is that they decide what level of pain relief we are able to have...

YANBU

Just popped back...

crosseyed I agree with you.

Different women have different personalities and what is right for one is not right for the next. Some people are really into the whole natural idea, some women do not feel at all comfortable with it. Options should be open for whatever makes that individual woman feel happiest.

FWIW my emcs was wonderful, as soon as I knew that something was going to be done I relaxed. The bit leading up to it was the worst experience of my life. Another woman in the same situation with a different personality may well have felt the opposite.

As for there having to be some restrictions on epidural, I totally disagree with that. In all other areas the effective relief of pain is an absolute priority, if a woman asks for a perectly normal and usual form of pain relief it should be provided.

this has probably already been said but am too knackered to read the whole thread

IME epidurals are restricted anyway. I found during my three day labour that a) there are not enough anaesthetists for one to be given on request and b) the policy in my hospital was that there had to be a very valid medical reason for one to be given

I just don't think this is anything new and I don't think they are given out 'on request'

The obs/cons thing is a red herring, I think. dd was delivered jointly by a midwife and our consultant - the mw had been setting up for epidural and episiotomy, as dd had mild shoulder dystocia, when cons came in and decided the episiotomy etc wasn't necessary. He also took away the g&A, because I just wasn't focussing. I yelled at him at the time, but am bloody glad he did, because dd's birth and my recovery was a hell of a lot more straightforward than it would have been otherwise.

After the birth, the mw said to the cons - so, shall I put you or me on the notes as having delivered her? He laughed, and said "You! I'm an obstetrician. We don't do normal deliveries". I suspect dd's birth was the first "normal" delivery he'd done in years, and he stayed with us as he'd seen us through the loss of dd1, plus stressful preg with dd2.

I live in an area where epidurals are not offered as pain relief, only for c-sections (this is due to lack of anaesthetists in region). Prior to the birth of ds1 this terrified me and i explored having my baby elsewhere. As it turned out, I had an epi and em c-s as ds1 was facing wrong way and no amount of ventous, pushing etc would shift him. I too found it a huge relief to have epi. I had a 3 hour labour with ds2 - no time for any pain relief!!

Several hundred babies are born in this region every year without epis being available for pain relief...i don't know if its right or fair but women here seem to accept it and manage ok. Whether they would manage better or worse with the availability of epis, is another matter. I think that because the epis are not available here, mw support has been increased. I had the same mw throughout my 2nd labour who barely left my side - this was a huge help. The mws are also more creative about managing pain from the outset. I believe that it is about the pain coping mechanism rather than drugs vs. no drugs and feeling listened to, calm and in control.

'But you can't say that a patient, rather than the medical professional, is the person who should be taking the final decision to go ahead with a medical procedure.'

So you'd be happy with a doctor having the final say in, say, your cancer care - no more chemo for you, PW, it's not what's best for you, and you're in pain now and can't decide.

You just need a local anaesthetic for this ERPC after miscarriage, PW, this is what's best for you and you're in too emotional a state to decide. I, though a stranger, am a medical professional and therefore know better than you.

No abortion for you, PW, you're just in distressed state right now and having bad morning sickness, but the medical professionals know this is an unecessary medical procedure for you.

Nope, sorry, we won't sterlise you, PW. You, the patient, can't possibly know what is best for your reproductive health. We, the medical professional, however, do.

Yeah, let's just rob women of the right to decide what is best for their bodies when they're in the most vulnerable state and we've got 'em where we want 'em.

I mean, what do they know? They're a lot of hysterical creatures who need to be dictated to about their bodies. Let's start with childbirth and go from there.

Well, in the cancer case, the oncologist does decide when to cease chemo - at least, he did in my mother's case. We were horribly upset, but recognised that, as a relatively objective professional, he was in a better position to take that decision than we were.

hey, if you're cool with always handing over decisions about what you do with your body to medical professionals, great.