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.

I planned and had a drug-free birth with my DD at a midwife clinic. The pain was horrendous but because I felt in control and listened to, I got through it. The ecstasy and adrenalin rush I felt afterwards (on the natural endorphins) was the biggest high I've ever felt in my life and I would say this hugely helped me in caring for a newborn. This endorphin "high" would be my main reason for not having an epidural again.

I am 38 weeks with number two and I know I am traumatised by the pain of my first labour. But I have arranged another drug-free environment to give birth.

HOwever, if I had to give birth in hospital for some particular reason, for example if I was GBS positive, had diabetes, or had to be induced I know for a fact that I couldn't do it without and epidural. Being in control and having unrestricted movement is the only way I could get through a drug-free birth.

So I think my point is that an epidural-free birth is the ideal regarding the health of mother and baby: It is better for the baby and better for the mother because there is less chance of intervention, the baby can rotate into the proper position properly, and you feel fantastic afterwards. But there no way on this earth that epidural should be restricted if a woman finds herself in a situation where she can't handle the pain.
What we need is to concentrate on "one woman, one midwife" and making sure that women are listened to during labour and making the labouring environment pleasant.

There is surely a creeping lack of compassion for pg women in this country. We seem to spend as little as possible on maternity care, so women are largely unsupported in labour by professionals, and then when the pain is too much to bear, we talk about removing their only chance of a relatively dignified birth, and making them suffer to the point at which they would almost rather die.

Of course epidurals lead to increased risk of intervention BUT THEN SO DOES NOT HAVING ENOUGH SKILLED MIDWIVES, FGS!!!!! AND SO DOES LYING WOMEN IN LABOUR ON THEIR BACKS LIKE SUPINE COWS IN BUSY WARDS BECAUSE THERE ARE NOT ENOUGH DELIVERY ROOMS!!!

I despair, and I am very glad I am not having any more babies now.

I had an epidural with my ds & for some reason it never worked down my right leg so i could still feel when to push.Ds's head was in the wrong position & i pushed for 4 hrs to get him out,the Dr came into the room & told me i had 15 mins to get him out or else i would need am emcs.I remember thinking 'not bloody likely mate,not after all this pushing' & i pushed for all i was worth & 10 mins later ds was born.
I had a wonderful MW & my labour was fantastic.
Shortly after being born ds 'collapsed' & MW had to call the crash team,it was a very scary experience & luckily he was ok.

Someone i know had her first child recently & insisted on a home birth with NO pain relief at all.She succeeded in both but haemmorghaged afterwards & had to be blue lighted to hospital,when she was telling people about her labour & birth she ommited to mention any of the danger she was in as she wanted to come across as a strong woman who had a natural birth.

She laughed at me having to have an epi & going to hospital for my birth but if i had had a home birth my ds wouldnt be here right now & she is going around telling people she is great & her dh is too.

Why do women put these pressures on each other?

YANBU - I find it quite frightening. Unlike most of you, I haven't been through this before (am 7 months pregnant with my first) and naturally, am nervous and apprehensive about what labour will be like... if not - occasionally - genuinely frightened. I would like to manage without an epidural, but have no idea whether, in labour, I'll change my mind.

Hearing other people say they've coped doesn't really help, I must say. But what was / would be reassuring is the feeling that if it really all did get too much, if I couldn't bear it, that I could ask for an epidural and I would be taken seriously, and given one.

From what I can tell, though, that's very unlikely. I'm deeply unhappy about it - but I fully expect the midwives to put me off, to tell me the anaesthetist is "coming" when s/he isn't, and to then tell me it's too late. Essentially, to deny me the choice. Am I wrong? I've heard the story so many times from others that I don't think I am. And now we're being told the NHS is thinking about restricting them on cost grounds. And I have to say if men were told they had to go through any deeply painful experience with restricted analgesia, there would be an outcry.

Longtalljosie, threatening to trash the room with any available oxygen/entinox tanks usually gets the anaesthetist down sharpish IME.

BoffinMum - I agree.

A fairly senior consultant once confided in me that there is a creeping philosophical attitude coming from the top of the Department of Health and NHS, partly driven by budget constraints and treatment targets, that it is only there to treat ill people. If they are not 'ill' or have a disease that cannot be treated and readily cured then the NHS increasingly does not want to know.

This proposal to limit epidurals certainly smacks of that attitude. The cruel logic of this proposal seems to stem from the idea that pregnant women having a 'normal' birth are not ill and do not need intervention or pain relief.

Unbelievable!

If birth were managed better and women were better educated about it all there wouldn't be the need for so many epidurals. The biggest problem with maternity care i the way they treat women like half-wits, giving them edited highlights of information instead of the whole truth.

All pain relief effects the baby, and standard birth practices increase the need for pain relief. Dr's and Midwives need to stop putting women on their backs and tell them to labour on their knees/feet, not lying down.

I'm not going into all the technical details about good birth practices etc, because it's all been thrashed out before, but the truth is that a woman who is calm, confident and labouring efficiently, using body position and gravity to help needs far less pain relief than a woman who is scared, anxious and lying down. End of story.

Longtalljosie - I think you have to have a long, frank chat with your midwife saying just what you have said above, and then make sure it's all in your notes in case they try to deviate from this at the time. Also, are you in a midwife led unit, or consultant led? Is it a particularly busy hospital you are going to? (I know that seems like a daft thing to say but some are worse than others!) Do you know anyone who has had a baby there? Also, (I am ignorant about this) but could you brief your DH to know when 'the point of no return' is re: having an epi and get him to do the shouting for you if you decide at the time you want one?

The unit I'm going to be in has a midwife led area, and a consultant led area. Where I go depends on how complicated my pregnancy is (it's been fine so far, touch wood)

BoffinMum - - I'll put that in invisible ink at the bottom of my birth plan.

BetaDad - sadly, that doesn't surprise me in the slightest... but then, who's waving the flag for epidurals? They've almost become a dirty word, something to be ashamed of. That makes it very easy for them to be downgraded.

LadyThompson - you're right, of course. And I think DH and I will have an advance chat about the protocol should I need him to make an almighty fuss

but there is not room in your average maternity unit for every woman to be admitted

for a lot of women, not all, but a lot, the best place to be before you are in established labour is at home .. in the bath, pottering around, resting, sleeping, eating and drinking.. rather than being confined to a ward.

with no privacy, shared bathrooms, and lots of noise and interruptions

also, before you are in established labour, it is doubtful you would be offered any pain relief other than paracetomal/codeine/bath or a TENS if you are using one. all of which you can do at home

a busy ante natal ward is not the best place IMO and IME to spend many hours in early labour

the system is far from idea, but has to operate the best it can under the constraints of short staffing and limited space

I had an awful 64 hour labour and was in agony even when 'nothing' was actually happening! Had been told by MW's on phone to get some sleep and take paracetemol for the pain FFS!! I didn't sleep for 3 days & when I finally went into hospital on the Fri night/Sat morning I was so exhausted & only 3 cms. I honestly don't think I would have coped without an epiduaral especially since I was 'induced' to speed things up. I did have a forceps delivery BUT only because my DD was back to back (and they didn't know ) That was probably the reason I was in labour for so long & sheer agony from the start! I actually only did 2 pushes with low forceps to get her out & the doctor was surprised that I could do that with the epi, but I did so it is possible. Everyone has a different pain threshold & I think it would be completely unfair to restrict who can have one. You know your own body & what you are capable of, they should listen to you! For what it's worth I had actually intended to have a drug free water birth at my local midwife led unit, but had I gone there I would have been transferred anyway!

This thread is interesting. The thing is, there are two basic 'camps' here, and the danger of that scenario is that people can start arguing 'their corner' and going off the point.

What's clear, is that some women are absoultely fine about viewing their birth as a medical procedure. Someone mentioned 'Why are women routinely turned away from the hospital when they arrive, already having contractions?' Presumably, these women want to be admitted straight away, and provided with high levels of pain relief. (No value judgement attached here - purely an observation from reading the thread).

In the other camp (which happens to be the one I'm in) some women view birth as a natural event, and they strongly feel that they want to avoid interventions unless it becomes a medical necessity. These are the women who don't want to arrive at the hospital in early labour, because they feel far happier labouring in their own home environment - this is a key factor in coping.

My thoughts are that we are always going to have some women with polarised views - that's life. But probably the majority of women are somewhere in the middle. They maybe like the idea of a natural birth, but aren't confident that they can achieve it, or are worried about not feeling supported enough. There are so many threads on MN where women have had a very medicalised birth with epidural and don't feel happy about it - they feel angry, resentful or depressed - and many of them become quite militant about having a natural birth next time round. The important thing is providing a far better service in terms of higher numbers of midwives, better education about different forms of pain relief etc. The most helpful thing I was told when pregnant first time round was that yes, the pain would feel horrendous, like nothing on earth I had ever experienced. And it was. I remember reaching the point in my first labour where I thought I could not go on - but I did manage it, and felt hugely empowered by the whole experience. We need to ask ourselves why some women feel empowered and other women feel traumatised by what is essentially the same experience.For some women, the answer to a 'good' birth will always be an epidural, because they really don't have any desire to give birth naturally, they are genuinely happy to hand themself over to the medical team and will not feel cheated afterwards. Which is fine. And there will always be women who go through dreadful pain, but are determined to do it naturally and end up happy and empowered by their choice. It's the huge swathe of women who are somewhere in the middle who are at risk of ending up with am experience that leaves them feeling unhappy.

lening, i know it is not good enough

but that is how it works at the moment

i would love to see more money invested in maternity services, home from home units, more birth pools. more access to pain relief,one to one care...

but at the moment it does not happen like that

admitting a woman who is 1 cm dilated takes up a bed that a woman with pre eclampsia, placenta previa or other serious issues needs.

tough choices have to be made all the time within the NHS and maternity services fall into that

i posted yesterday about the illusion of choice in maternity services. it is far from ideal, ther eis no choice but to make the best of it and use everything you can to make your experience as positive as possible

You're right, unicorn.

I think there are many improvements that could be made to services, but there is a limited pot of money and tough choices have to be made.

That's why the issue needs serious discussion. There are so many demands on the NHS - and maternity care is just one part of that. There needs to be serious debate about how to prioritise.

Ok, Lenin. My point really was that 'feeling safe' means different things to different women.

For me, it meant being in a small, intimate midwife unit with a midwife I knew and trusted.

For others, it means being in a hospital with an anaesthetist on hand and doctors in attendance.

I think this is maybe the crux of why maternity care is such an issue. There is no one, uniform, standard of what makes a 'good' experience. This comes out time and time again on threads. A woman can have a horrendously painful birth, but still feel good and empowered if she expected it to be painful, and is supported through that pain, and if achieving a natural birth is important to her. A woman can have a totally medicalised birth with epidural and still feel good if that's her choice, and she acknowledges that it will increase the risks of further interventions.

This is a very different scenario from most other situations the NHS deals with. If you have appendicitis, if you have a car accident, you will be admitted to hospital and across the country there will be far less variation in the way you are treated. If you are pregnant, there will be huge variation in what women want and expect. Which makes this a far more complex issue when it comes to prioritising funding.

VioletHill- despite being in the give-me-lots-of-drugs-and-give-me-them-now camp myself....I do see what you are saying, and want to thank you for arguing your points in a moderate and non-hysterical judgemental way, unlike KathyBrown who quite frankly takes smug and judgemental to a new level (nothing like trampling sisterhood completely into the ground when dissing other women's "choices" is there?)

I imagine (although I don't know, as although I'm British I gave birth in Italy, where birth is medicalised (ie c-sec) or nothing, that in many areas of the UK (certainly the area to which I return when I visit) there are so many births- so many families with 3-4 children and upwards, that the NHS itself needs to evolve and try to cope with the increased demand on their services....make midwifery a more attractive career option etc etc.... As with all unpredictable things, there are no easy answers, but you are right, it does need to be discussed, but hopefully in a more intelligent and a less stick-to-beat-you-with way preferred by other posters..

I think you're right, Bucharest, that the NHS needs to evolve, maybe at a faster pace. Of course, it's worth remembering that huge changes have taken place already, in just a couple of generations. My mother gave birth in hospital, no husbands allowed in attendance, women were routinely shaved, given enemas etc... we've moved a long way since then: birth partners, birth plans etc. But I have a gut feeling that there will be a cultural shift over the coming years, and maybe more of a return to non-medicalised births, but with greater numbers of midwives, better access to education about birth etc.

"for a lot of women, not all, but a lot, the best place to be before you are in established labour is at home .. in the bath, pottering around, resting, sleeping, eating and drinking.. rather than being confined to a ward.

with no privacy, shared bathrooms, and lots of noise and interruptions

also, before you are in established labour, it is doubtful you would be offered any pain relief other than paracetomal/codeine/bath or a TENS if you are using one. all of which you can do at home

a busy ante natal ward is not the best place IMO and IME to spend many hours in early labour"

I agree with this totally but I wonder if it would be feasible for when women start to labour they get a visit from the community midwife to check they are ok and give them some reassurance. Sometimes husbands are not very good in these situations and a pat on the arm and you are doing well from a midwife at home might enable them to stay at home that bit longer.

Libra - I think that's exactly the kind of improvement we should be looking at. Ways of enabling women to feel safe and empowered in what is essentially a natural event.

We've gone too far down the route of leaving women to feel that birth is a hugely scary thing, that they won't be able to manage it without loads of drugs - and then hey presto, they end up being given epidurals, which then leads to forceps/ventouse, then stitches, possibly infections, longer hospital stays, or maybe even a csection if things don't work out. How much more cost effective (not to mention humane) to offer better support in the early stages.

I still think education is the key thing, right from the word go. I think back to that NCT class I went to. WHY did 6 out of the 8 women opt for medicalised births? What is it that is blocking women from feeling that they can opt for a natural birth? If it had been one or two women, then I don;t think that would surprise me, because as I said, there will always be a core of women who are totally adamant that they want drugs, and are happy to go for the medical route. But the numbers of women who end up in that situation seems to be way too high in this country, and I think serious questions need to be asked about where we are getting it wrong.