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.

Then why do you get better (or more anyway) midwife time in a MLU. Why isn't the ratio of MW to women in labour the same in MLU and hospitals?

"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." - this is exactly the attitude I find distressing and was trying to contradict in my post.

Not all hospitals and doctors do push people into interventions, as clearly evidenced by my experience and the experience of many other women on this thread.

High risk women get pretty ropey conditions in CLUs, and it does seem unfair that they can't access birthing pools, special lighting, lots of mw care and so on. Surely they need it more?

violet when you talk about MLUs is it what we call birthing centres around here ie a completely separate place well away from the hospital, rather than a section in the same hospital as the CLU?

BoffinMum/LovelyTinofSpam - I think you have hit on an important point. I recall a year ago or so there seemed to be a kind of low level campaign to encourage women to have home births. I cannot remember exactly what it was but it seems to have died off a bit and now this initiative has come forward.

I did strike me there is an agenda here to 'nudge' women into a situation where they are 'encouraged' to stay at home and give birth without epidural.

I do not think it is too cynical to say the idea was spawned out of saving money rather than for the benefit of mothers and babies. As I said earlier, fine if a woman wants that but not fine if she really wants to go to hospital.

Unicornvomit - the DOMINO system sounds wonderful. I am pretty sure my Mum gave birth to me and my sisters under that system. I was born in hospital premature and my sisters were born at home totally naturally with close midwife assistance throughout. It would relieve a lot of pressure on maternity suits.

I can't answer about the ratio thing Libra. I just know that for my VBAC in hospital, the place was very understaffed, whereas the MLU was great.

I think the quality of care you may get is another issue. And actually part of this is about freedom of choice for midwives to work where they are happiest. At the end of the day, if I were a midwife I would probably opt to work in a small 8 bed unit, where I would have the chance to build up a relationship with the labouring mother, and where I would be able to utilise all my skills, rather than working in a large hospital where it's probably a nightmare journey to work every day, an even bigger nightmare to park my car (yeap, this parking thing is an issue for me!!), and where I probably just wouldn't have the autonomy of a MLU.

I'm not suggesting we shouldn't aim to make hospital better - of course we should!

But I also think that MLUs will always be an attractive option for many mothers,and an attractive career option for many midwives.

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

True.

It's a toughy though isn't it?

Stay at home and you're less likely to need medical help - but if you do need it you're going to have to transfer.

Go to hospital and you can have a consultant at the end of your bed in minutes (as long as the unit has good consultant cover, and if so that the consultant isn't already in theatre with someone else), which is a good thing, as your labour is more likely to go pear shaped.

And it seems the outcomes for home and hospital are roughly comparable for low risk mums (in terms of neonatal mortality that is . Maternal morbidity is worse for poorer for risk women birthing in hospital).

Would add that I've twice been with someone in hospital where it took longer to get the doctors to her bedside when they were needed, than it took me to transfer to hospital when my second homebirth went pear shaped.

But I live a very short distance from my local hospital.....

Lovelytinofspam - my MLU was separate from the hospital. Just staffed by midwives with doctor called in from the GP surgery if needed. Small 8 bed unit. Excellent standard of care, exemplary safety record. Available only for low risk mums. I am so pleased that I managed to deliver my first there. My dc2 was a csection, so there my VBAC made me 'high risk ' and I had dc3 in hospital.

If I'd been able to, i'd have delivered all 3 at the MLU. As I say, I'm a big fan of this type of set up, provided everything is straightforward.

I think we're going at cross purposes here a little.

In our area we have the hospital, with a consutant led part and a midwife led part, on the same corridor.

Then there is a birthing centre, which is some miles away, and offers a more "home from home" experience but you need to get in the ambulance if things go wrong. You can have G&A and pethidine but no epidural.

Then there is homebirth.

I think that violet is talking about what we call a birthing centre. And that is the place a lot of women didn't want to go due to the complications = ambulance thing.

Aha that's what we call a birthing centre in this neck of the woods. The whole ambulance thing is a real turn off for a lot of people.

Why not just have a birthing centre on the grounds of the hospital so that it's easy to move people if needs be? Best of both worlds then.

Oh I agree a lot of women don't choose them lovelytinofspam. Which is fine if they personally don't want that choice.

For women who do want the home from home experience, they are fab! The possibility of the ambulance journey was the one thing that made me waver...not because of any safety aspect but because I thought I would find it very scary to transfer. But the safety record of these MLUs/birthing centres is exemplary - it has to be or they would be closed down!! Far better than hospitals, which tragically do lose babies and mothers. Obviously in most of these cases, it's because the mother was high risk in the first place,of the baby has serious complications/illness so you can't blame the hospital. Having said that, there are cases where hospitals have been negligent (remember those case a few years back - was it Wexham Park in Slough??) - cases where babies have been injured or died through mismanaged instrumental deliveries etc. Plus a tragic case in the papers recently of two mothers who died after contracting infections in hospital.

Not wanting to scare anyone here at all btw - it's just that when people talk about MLUs, they often say they the possible transfer to hospital makes them risky, when in fact to get this into perspective, MLUs (and home!) are statistically just about the safest place to deliver your baby.

Personally I think they should shut all MLU and divert those resources to making the hospitals a nice and friendly place to give birth. Why should high-risk mothers labour in a shitty place without MW support just because they are unlucky enough to be high risk. I realise this is an extreme view and I might be biased as next time I will be classed as high risk because of my (unavoidable whereever I had decided to give birth) c-section.

I think it would be outrageous to shut all MLUs!!

Having MLUs doesn't mean that high risk women should have a shitty time! They are two separate issues!

If I ever had another baby, I would not be able to deliver in a MLU because of my previous CS, but why the hell should other women be denied that choice? I was bloody glad I had my first baby in one, it was utterly fab, very very painful, but an amazing and positive experience. It would be a totally backward step to deny women that choice.

"Aha that's what we call a birthing centre in this neck of the woods. The whole ambulance thing is a real turn off for a lot of people."

I'm a homebirth rep in my local area. Over the years I've talked to lots of women who have booked homebirths.

So far I've not met one who regretted the decision, even those women who have ended up transferring in and having a CS. They all say 'the best part of my labour was at home. Thank god I didn't start out in hospital - the whole experience would have been far more negative'. Generally they feel they gave their bodies the best chance of a normal birth, and have no regrets or 'what if's'.

I had my second baby at home, but with my third I transferred in after 30 hours for failure to progress. I felt no grief about tranferring in - I was more than ready to go, and the trip there wasn't in any way traumatic. It would have been hellish to have spent those 30 hours of active labour in one room at the hospital, rather than beetling around my own home with a midwife snoozing on the sofa.

I think the point I'm making is that fears and expectations about having to transfer in labour aren't generally reflected in the experiences of people to who this has happened.

"Personally I think they should shut all MLU and divert those resources to making the hospitals a nice and friendly place to give birth"

It would be counter productive. You'd get more women having c-sections, which would use up resources needed for higher risk women.

It's also the case that you'd lose loads of midwives, who'd leave the profession if they weren't able to practice in the way (and in an environment) in which they feel comfortable.

CLU only means a consultant (and team)oversees and is responsible for clinical decisions

consultants dont staff the unit or provide the care.so if it is ropey then that would be as a result of care delivery by someone other than consultant

some high risk cases mean that water birth is contraindicated that is why it isnt offered.not a purposeful attempt to deny accessto the facility,but a clinical decision to minimise potential risk

"Having MLUs doesn't mean that high risk women should have a shitty time! They are two separate issues!

If I ever had another baby, I would not be able to deliver in a MLU because of my previous CS, but why the hell should other women be denied that choice? I was bloody glad I had my first baby in one, it was utterly fab, very very painful, but an amazing and positive experience. It would be a totally backward step to deny women that choice. "

the resources for the MLU come from somewhere, if those resources were diverted to a hospitals then MORE people could benefit from one to one MW care etc rather than the few who a) actually qualify and b) don't mind being a ambulance ride away from medical help. It's actually quite selfish of you.

However I wouldn't worry too much I doubt the MLU units are going to be closed down just to one persons opinion on the internet.

I agree with that crosseyed. I know a very few women who have had to transfer, and none of them regretted having started at home, or in the MLU.

In contrast those friends of mine from antenatal classes who went through their entire labour in hospital, mostly felt at best disheartened, and at worst, cheated.

And that's the real issue isn't it. Because for the women who are perfectly happy with their hospital births, and are completely ok with their medical interventions, then what's the problem? There have been quite a few of them on this thread, and I have a colleague who also fits this category - she has just had her first baby, she chose to go hospital, she was quite upfront about wanting an epidural, and although she ended up with forceps, she's not angry or disillusioned about it. She didn't want a painful birth, so made her own, informed choice.

But just read the thousands of posts from women who aren't happy with the medicalisation of their births! I just don't see how anyone can ignore that.

"It would be counter productive. You'd get more women having c-sections, which would use up resources needed for higher risk women."

Actually you are missing the point, if more women who decided to give birth in hospital got the same care IN HOSPITAL that the women do in the MLU then there is no reason for either the c-section or epi rate to go up.

In fact it's more likely to go down because the women who choose the hospital would get the support they need to do it without an epi rather than being leaved to get on with it leading to fright leading to epi.

No Libra - it is selfish of YOU to want to restrict other people's choices! Of course there is a limited amount of money in the pot! That doesn't mean it should ALL be given to MLUs or ALL to hospitals - it needs to be shared around to give women as much as choice as possible to make their own informed choice. And as I keep saying, you are banging on about women who are high risk and have no choice but to go to CLU, but actually as I keep saying, the majority of women in CLUs choose to go there - they don't have a medical need!

I have no personal axe to grind here, as I've been on both sides of the fence, having had my MLU birth, followed by becoming high risk through my csection. It's not selfish to want to keep MLUs open. What is selfish is saying 'Well, I can't deliver in one, or I don't want to deliver in one, therefore No one should be allowed to!!'

Can I ask midwives on here (and there seem to be a few) whether they try to dissuade mothers giving birth from having epis when they ask for them?

To clarify I mean during labour, not pre-booked ones.

I may well be repeating someone else here but I think the whole 'natural birth' campaign does need looking into to be honest. Of course, in an ideal world women would like to deliver their babies in a comfortable environment with little pain and encouraged along by partners and professional midwives. However, my problem is that this is held up as such an ideal. In my experience, despite wanting a natural birth in a MLU I ended up being induced in a hospital. I remember crying my eyes out on the way in and feeling like I had personally failed because my waters had broken 4 days previously without labour starting.

Of the 6 women in my antenatal class, 3 had sections, 2 were induced and one had a 'natural' labour and has sworn never to have another because of a 4th degree tear with no pain relief.

Natural births seem like a nice idea but how can anything be seen as the best, indeed ONLY preferable option when they seem to happen to so few women.

I remember getting everything completely out of proportion and only realising after being handed my wee bundle that actually it doens't matter how the hell they get out as long as they do get out alive and well.

If that needs an epidural, a section, pain relief or some nice deep breathing who cares? As long as women have all the choices available and none are promoted as being intrinsically better than any other option.

Feel like making a nice big banner and marching on Downing St. Choice for all. NO restrictions!

"And as I keep saying, you are banging on about women who are high risk and have no choice but to go to CLU, but actually as I keep saying, the majority of women in CLUs choose to go there - they don't have a medical need!"

Actually I didn't bang on about it, I mentioned it once and it is a valid reason.

If the majority of women CHOOSE to go to CLUs it's because it's where they feel comfortable giving birth, you seem to equate giving birth in hospital to medicalisation, what I am trying to point out is that it doesnt have to be that way, if you could provide the support in hospital that women get in MLU then less medicilsation would take place even in hospital.

You don't have a personal axe to grind but you do have an opinion and it differs from mine. I have no personal axe to grind either, I would never give birth in an MLU but agree in an ideal world everyone would give birth exactly where they want and how they want. However there are finite resources and I think they resources should go I think it's more important to concentrate firstly on the place where the MAJORITY of women give birth.

Who is disagreeing with you though Christmas?

I just think there's a bit of a myth surrounding this natural birth thing.

No one is saying it is 'best' because 'best' is different for different women. For some, best is an epidural and as pain free a labour as possible, even if that increases the risk of intevention.

For others, best is a drug free natural birth, even though it hurts like F*!!.

I have seen very few people holding up an 'ideal standard' on here - in fact one of my posts was precisely about the fact that there is no one 'ideal standard' because women have different expectations and desires.

I would see it as a very backward step to try to deny people the choice of natural births in MLUs, as Libra advocates though.