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 think if we're going to have constructive debate on the subject though we need to get away from this demonisation of the 'medicalisation' of birth. Like it or not, advances in medical science save mothers' lives, and we should be grateful for that.

No doubt there are good and bad maternity services everywhere, but automatically saying 'home birth/MLU good, hospital bad' doesn't help anyone.

For the record, we attempted a VBAC with DS2 in hospital, under consultant care. We had fantastic midwife care, with minimal intervention, no CFM and complete freedom to behave as we pleased during labour. My consultant and registrar popped in to see me in the later stages and were completely hands off.

However, when things went pear shaped, as they did at around 9cm, we had our situation and choices outlined to us in a completely open and no pressure way. We chose a em Cs to be sure of our baby's health (showing signs of distress) and the registrar who had cared for us antenatally also performed the CS.

Had the two 'camps' - midwives and consultants - not worked together in such a seamless way, our experience would not have been the positive one it very definitely was.

But I don't think anyone is demonising medicalised birth, whatfreshhellisthis. Well, apart from maybe one or two militants, and tbh, extremists don't add anything to the debate.

I am in total agreement, that some medical interventions are necessary. I had a csection with dc2 because it was necessary to save her life!

But a vast number of medical interventions are not because of medical need, they are simply a result of badly managed labours, or a result of women not having been supported/educated enough etc etc

The point I was making is that out of 8 of us in my antenatal class, only two of us opted for a low tech midwife-led birth. The six others were not advised to have high tech births for medical reasons. They took that route because culturally they had been led to believe that giving birth is an event which needs drugs, doctors and all manner of interventions. Now, if all those women were totally happy with their choice, then I guess there wouldn't be too much of a problem - although the cost implications of more medicalised births is a legitimate issue for debate. But the irony is, that most of those six women were not subsequently particularly happy with the choice! They all had epidurals, I believe four of them ended up with forceps/ventouse, one ended up with a csection... and they were all desperate to get out of the hospital and transfer to the midwife led unit where the other two of us gave birth! Something tells me that something is wrong here. These women had the potential to give birth without interventions just as much as I did.

We need to make a distinction between medical need, and interventions which have nothing to do with medical need at all.

libra there used to be a system of DOMINO delivery.. where a MW would come to the house and then when it was time , go in with you to hospital.. i think re-instating that nationwide would be a fantastic boon .. giving women the confidence to spend more time at home, feeling supported, knowing things were going normally, and not ending up going in too soon/ too late and being sent home or having to go there and back to the hospital.. would take a lot of pressure off women and the wards i think. i think that sort of care would be wonderful.

No but you're missing the point I was making violethill. The whole point was despite deciding to have our second child in hospital under consultant care, our birth was not medicalised until the point where it became absolutely necessary. The medical staff were completely hands off until the time when they were needed, and I am in no doubt that we would have delivered naturally without any drugs except G&A had complications not arisen very late in the proceedings.

So the women you mention, by choosing hospital care, were not necessarily choosing a medicalised birth, but choosing an option that made them feel safe and cared for. And in a good hospital maternity unit, none of those women would have interventions that were not necessary.

You say "these women had the potential to give birth without interventions just as much as I did." You don't know whether those women, in a home birth or MLU situation, wouldn't have needed those interventions anyway and had to transfer to hospital to get them. You're putting the blame for their outcomes entirely onto their choice of location, which seems rather rash.

You do realise there is probably a long-term hidden agenda here, about refusing women having 'normal' births any pain relief and hospital beds at all, don't you?

Violethill I sort of disagree with your assesment of hospitals, personally I would never give birth anywhere that wasn't within 100m of a doctor, not because I want to medicalise my birth but because I want someone there within 5 minutes if something does decide to go wrong (which it did). If women are properly educated about labour and their options and have proper advicates with them I don't see a problem with giving birth in hospital rather than a MLU.

My question is either why aren't all the MLU connected to hospitals OR why isn't the money spent on MLU spent on the delivery rooms in the hospital? Why can't i have a nice comfy birth in hospital?

advicates = advocates!

violet I chose to give birth in the hospital rather than the midwife led unit. Not because I was determined to have all the drugs going and a highly medicalised birth, but because I needed the reassurance that if things went pear shaped, I wouldn't have to be put in an ambulance and shipped across the borough. I wanted the doctors down the corridor.

i don't think you can assume that women who go to the hospital are automatically going to have all the drugs - just that they feel safer knowing there are doctors around.

Personally if I had to give birth in a midwife led unit I would be in a state of absolute terror and I suspect that would not be much help to the birth process.

As for your friends ending up with interventions - it's not really possible to say what would have happened if they were in the midwife place.

Nice to see kathy is now down on all forms of pain relief in labour

And interesting to note that I was not offered any pain relief when I was induced, something that also came up earlier, so maybe some of kathy's crew were looking after me.

"We need to make a distinction between medical need, and interventions which have nothing to do with medical need at all."

I think for a lot of people reflecting on their own and others birth experiences, this is when things become really perplexing. I personally believe that most interventions are felt to be (and probably are) necessary at the time they are done.

My personal take on this is that the things that happen to MOST women in childbirth in this country as part of routine care are the very things that often result in labours becoming dysfunctional: being moved into an unfamiliar environment during labour, lack of one to one care, often being deprived of food and the ability to mobilise properly, having regular intimate examinations, and being closely watched by someone with one eye on the clock.

And once a labour has become dysfunctional then interventions often become necessary, otherwise mothers and babies suffer.

I am (once again) with Expat and the OP on this topic ...

I'd like to see men giving birth without pain relief ...

boffin isn't that too cynical?

I really hope so.

Imagine the savings though...

No, I am not missing your point Whatfreshhellisthis - I understand that your birth was not medicalised until needing a csection. And your situation was a VBAC, which necessitates being in hospital because it is deemed too high risk for a midwife led unit. I had exactly the same situation for my 3rd baby - I was not allowed to deliver in a midwife led unit, so went to hospital, though managed to have a natural drug free VBAC.

The point about the women in my antenatal group is that this was NOT their situation. They had not had previous csections. They were classified straightforward low risk with their first baby, as I was. OK, so no one can absolutely 100% know what the outcome would have been if they gave birth elsewhere, because each birth is an individual event and can take place only once, in one location!! But it strikes me as a bit of a coincidence that out of 8 low risk women, the two of us who delivered in a midwife-led unit had simple natural births which we were happy with, and of the other six,they all had epidurals, one needed a cs, and 4 needed instrumental deliveries!!

My point is that yes, sometimes a woman who starts labour in a midwife unit may need to be transferred. And sometimes a woman who books into a consultant led hospital will manage a totally natural birth. BUT there is a general pattern which means that the more medicalised the birth is from the outset, the more likelihood there is of interventions. I do not accept that just by chance, those six women all ended up with interventions and phew, wasn't it fortunate they happened to be in hospital where epidurals and csections were available! Nonsense! They ended up having interventions because they were in a situation where the midwife staffing levels were not as good as the midwife unit, but where in contrast there were loads of doctors who are far more used to dealing with medicalised births! If I had opted for hospital, no doubt I would have been pushed into interventions, and then ended up believing they were medically necessary - because that's often a normal response by a woman who's been through that. You end up believing the interventions were inevitable, rather than seeing that quite possibly you didn't need them.

violethill that situation might be avoided in regard to hospitals if we took all the midwives providing such 1:1 care in MLU and put them to work in understaffed hospitals. The problem isn't the hospital it's the support you get in hospital.

violet what about the women who would be utterly terrified of the thought of giving birth in a birthing centre or at home? What of them?

Surely the choice is there for a reason.

Was it a freestanding MLU then LTOS?

Our MLU is on the same corridor as the labour ward. Doctors can be there in a flash if needed.

"i don't think you can assume that women who go to the hospital are automatically going to have all the drugs - just that they feel safer knowing there are doctors around"

In my experience low risk women going into our local CLU are more likely to have difficult births and use more pain relief than women in the MLU down the corridor, and I suspect this is for one simple reason: that in the MLU they get one to one care from a midwife who's experienced in facilitating physiological birth (ie - she helps the mother mobilise effectively, which shortens labour and makes instrumental birth less likely, and she is focused on giving emotional support which makes a mum feel she's coping better).

On the CLU the midwives are almost always caring for 2 or 3 women (or more) at different stages of labour, and sometimes these mothers have complex health needs.

This means that low risk women get less help than they need during the most challenging parts of their labour and so are more likely to opt for an epidural. Pethidine is used quite heavily on the CLU - I suspect because it makes women very quiet and compliant and easier to care for. (you know pethidine is routinely rated higher as effective pain relief by midwives than it is by mothers!)

crosseyed the birthing centre is about 8 miles from the hospital.

Got my wording wrong.

The midwife led unit is down the corridor from the doctors - but you are not allowed to choose consultant led care or shared care if you are low risk.

From what violet was saying I imagine she was talking about a birthing centre, away from the hospital, which is what my comments were about.

"violet what about the women who would be utterly terrified of the thought of giving birth in a birthing centre or at home? What of them?"

I think this is a good point. We've all been indoctrinated to see doctor led birth as safer, even though it isn't for the majority of women. You can't overcome years of conditioning just by giving women the facts - how they feel is crucial. That's why we need more home from home units in hospital and more caseloading - to bring as many of the benefits of homebirth as possible to women who want to birth in hospital.

there are no conspiracies or hidden agenda's.daft to suggest so

nhs policies are pretty transparent log on to
NICE.

ok a good ole conspiracy theory...so

Who
Why
how do those involved seek out and communicate with other conspirators
how come some people claim to know of the conspiracy yet others do not

I am very surprised that there are hospitals who allow low risk women to have expemsive shared or consultant led care as a matter of choice. That is certainly not the case with our trust.

Actually this is making me quite cross, why on earth are all the midwifes in the MLU centre, why aren't they being employed by the hospital. Surely the gov't picks up their salaries in both places.

I'm usually not one for conspracy theories SM, but in this case it's fairly easy to see that homebirth/midwife led/no or few drugs would save the NHS an absolute fortune.

So not even a conspiracy theory really, just common sense.

crosseyed being in a hospital does not necessarily mean doctor led, just that they are there if needed.

Ah, the ScottishMummy is here to give us a bit of rough.

Addenbrookes are moving in this direction by banning CS for many people and also pushing towards HB in a particular way - the have published various documents about this recently. I am sure this is a trend that will spread. It's commonplace in Holland - I think you pay for hospital there whereas HB is free.

"Actually this is making me quite cross, why on earth are all the midwifes in the MLU centre, why aren't they being employed by the hospital. Surely the gov't picks up their salaries in both places"

There are lots of midwives working in CLU's. Far more than work in birth centres.

'violethill that situation might be avoided in regard to hospitals if we took all the midwives providing such 1:1 care in MLU and put them to work in understaffed hospitals. The problem isn't the hospital it's the support you get in hospital. '

• I completely agree that this would be a huge help, but again, it's not as black and white as that. I spent a lot of time talking to the small midwife team at my MLU (yes, they had time to make me a cuppa and sit and chat while helping me establish BF!)

Most of them had worked in big hospitals, but had chosen to move. MLUs were seen as the creme de la creme of jobs, because of pleasanter working conditions, more autonomy, the chance to USE THEIR SPECIALIST SKILLS - ie supporting women in giving birth, rather than handing over to the doctors to do the drugs and interventions bit!

Now of course, in an ideal world, you would replicate those good working conditions in the bigger hospitals, and create such good relationships with doctors that midwives would be left alone unless they needed a doctor... but while that's something to aspire to, it may be that we need to look at what works best within the limited resources of the NHS.

I think MLUs are fantastic, I'm a huge fan of them for straightforward births, and I think the sheer size and scale of hospitals is frightening for many women. Even parking the car at mine is so stressful that it's enough to tip the balance in favour of the MLU!!

Lovelytinofspam - you mention the women who would be terrified at the thought of giving birth in a MLU - well, no one is forcing them - I agree that if they feel better in hospital then that should be (and is) their choice.

I'm talking about the huge numbers of women who actually want to deliver without high tech pain relief and the associated risks of intervention, and are not supported enough, or in the right way, to achieve that.