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.

If you are going to make statements like that please explain exactly what I said, I want to deny people the choice of natural births in MLU BECAUSE I think they should have the safety of natural births in hospitals and to do that resources are needed. Not because I am a horrible old witch who thinks all women should give birth in stirrups. As it's never going to happen I don't think you have too much to be worried about.

Genuine question to MLU users however - why didnt you choose a homebirth?

I still disagree Libra - there are many women who don't see birth as an event that needs to take place in a large consultant led environment. They don't want that and they don't need the resources it provides.
MLUs are a home from home, safe, supportive alternative, and to remove them would be limiting choice.

To answer your last question, Libra, I chose not to give birth at home because a)the house I lived in at the time of my first baby was very small, paper thin walls and not conducive to me feeling comfortable to scream all night! and b) I knew that I would be able to get more rest and more importantly, better quality of support in establishing bf in the MLU than at home.

"I still disagree Libra - there are many women who don't see birth as an event that needs to take place in a large consultant led environment. They don't want that and they don't need the resources it provides.
MLUs are a home from home, safe, supportive alternative, and to remove them would be limiting choice."

You know it's only consultant led once the midwife has made that call? I had never seen a consultant until I got to hospital and I needed one.
Many might not but I still maintain the majority do, wouldn't it be better by providing the majority with a place they can feel safe and comfortable in (which for most means access to medical help if required) and yet still have a natural birth in.

Tbh I think we both want the same thing, I am just suggesting another way of getting there.

I only asked whether any midwives on here have tried to persuade someone in labour not to have an epidural when they wanted one because the thread is about epidurals being restricted and it seems to me (but I am no expert) that, effectively, they are already being restricted.

Yes, I don't think we're a million miles apart Libra, but I suppose what I find strange is this assertion that most women choose to give birth in hospital because it's where they feel most comfortable, but at the same time, there seems to be this underlying resentment at women who make a different choice.

If these women are choosing the place they feel most comfortable, then what's the problem? My colleague fits this description - she has just had a baby, in hospital, with epidural and forceps, and she is quite happy with her decision. She didn;t see a consultant either btw - I agree, you rarely see them - she saw an anaesthetist and doctors.

But many women do not want to give birth in a hospital, and I think it would be a very backward step to try to restrict their choice.

woah there is no underlying resentment I am just discussing best use of resources. And the words safe and comfortable have different meanings. I think the majority of women choose hospital because they feel safe there not necessarily comfortable, it was me who misused the word comfortable to begin with, I meant safe.
I think they should feel safe and comfortable in hospital.
I still don't think you are taking onboard what I am saying which is why can't you provide the same facilites of a MLU in a hospital so women CAN have the best of both worlds, a natural birth in calm nice surroundings and lots of midwives to support but medical intervention quickly if you need it. If this existed there would be no need for MLU.

Last time I checked consultants were doctors they just don't have to work nights anymore.

Agree women should be allowed to choose their pain relief, however I personally don't like epidurals. I had to have one following birth of dd1 so they could stitch me up. It was fine until I wanted to cough and found I couldn't, all rather uncomfortable, being paralysed from the waist down is not a good feeling IMO.

Also I've never understood why anyone would want to volunteer for a c-section. In an emergency then yes but otherwise no way! its major surgery! I think it would be no bad thing to restrict c-sections to cases of medical need.

I have encouraged women who are progressing well and getting to transition to try and keep going without an epidural, because it isn't uncommon for women to feed a bit panicky at that stage and they ofetn ask for an epidural or a CS! These women have usually stated in their birthplan that they did not want an epidural and usually they are really chuffed with themselves afterwards.

If a woman is having her first baby and has epidural down as first choice for pain relief I will then make sure that they fully understand what the epidural enatils - I am often surprised that women seem to know very little about their choice of pain relief, not knowing that they need a drip first.

If a woman wants an epidural prior to her contractions starting I will advise her to wait until she has experienced some so that we know that the epidural is in the right place. IME, epidurals that are in before any contractions have been felt tend not to work well.

I have encouraged women to have an epidural in situations where the labour has been protracted and the baby is not in a good position.

I am very fortunate to work in a unit that has a midwifery unit attached to the consultant unit. If a woman needs transferred out of the MLU for an epidural, the midwife looking after her goes with her.

High risk women in the consultant led unit can use the birthing pool for labour if the baby is fine. That includes previous caesarean section. There is 1:1 midwife care in both units.

"There is 1:1 midwife care in both units."

That sounds fantastic - how did your trust manage this? Is there any chance this is a goal all hospitals are working towards? Have you worked in hospitals that didn't have that ratio and do you think more patients had medical intervention because of that?

"In an emergency then yes but otherwise no way! its major surgery! I think it would be no bad thing to restrict c-sections to cases of medical need. "

That's a WHOLE different thread.

The aim is to have 1:1 care for all women in labour. Scotland does not have the midwife shortages that England has although it may well happen to us too.

There are hospitals who are not able to achieve that level of care nearby though.

YANBU at all. I totally wanted a natural birth with birthing pool and no drugs etc etc but the reality was quite different.

I was slow to progress and because i had been having painful BH for days I opted for Diamorphine which left me so utterly sick that I couldn't move off the bed.

When the midwife came in and said 'the pool's free now if you want it' I just peeled my head off the bed and carried on vomiting.

After another 24 hrs of not really dilating I was hooked up to a drip to help speed things along. I didn't want to but I said there was no way I was going to be sped up without an epi so they gave me an epi.

It failed and only worked down one side so I had another, and another but they all failed and I was in so much pain as baby had moved position and I was feeling each conmtraction in my back. It was excrutiating and I couldn't even move.

In the end they gave me a spinal and for a while it was absoloute bliss. But spinals wear off and pretty soon I was back to the agonising back pain- begging for a caesarean.

72 hours later they finally allowed the caesarean after examining me and discovering I was only 7cms dilated.

I was so relieved to be prepped for theatre and whilst they supported me sitting up to insert the needle for the spinal, I felt with each contraction a little bit pushy. I told the midwife this but she dismissed it as me trying to get out of having a casearean I think.

Anyway I had the c-sect and baby was born all was well.

What I'm trying to say is no pain restriction shouldn't be restricted as it is the women's choice. Nobody has a right to withhold pain releief from a labouring woman-it's barbaric but epi's and other drugs are not without their problems as it was made clear to me. I wish I had never had the epi as being laid back on the bed prevented my dilation, turned my baby around and caused the most excrutiating back pain and of course only worked down one side.

I'm convinced if I hadnt had it then I would have had a natural deleivery.

Next time I am going to stick with the GandA and use the pool and avoid an epi like the plague.

I gave birth to dc1 in a hospital that had a MLU unit attached to it. It was perfect. I started in the MLU, but moved to the consultant led unit when problems arose.

Libra... forgive me if i'm wrong, but i think i agree with you. It seems to me you are trying to suggest that the best use of resources would be to have all MLU's attached to a consultant led unit in a hospital? Like the place i went? It's the perfect solution as the midwives can then move around the 2 units giving continuing care if timing allows. Should an emergency arise then it is a quick, safe and easy transfer without the need for ambulance intervention.

FWIW, i don't think Libra is particularly wanting to limit choice, just put them all together so pool resources. Hope i've read it right Libra, sorry if i've misunderstood.

No the best use of resources is to bring the hospitals up to MLU standard so everyone can have the benefit, from what I understand you can still only use a MLU attached to a hospital if you are low risk (please tell me if I am wrong). However I think more people would choose MLU if they were attached to hospitals which would be a good thing (in the absence of hospitals bringing their standards up)

But Mears, not all midwives are as sane, reasonable and professional as you, sadly, or work in units where 1:1 is possible

To be honest it wasn't until i got to the hospital in labour that decisions were made. They asked if i wanted an epidural and i said no, so they suggested MLU as everything was going well.
The MLU was lovely, very peaceful. However, things went somewhat pear shaped so i had to be moved to cons led unit. The lovely midwife who i had become attached to came with me and stayed throughout. Can i just say that the cons led unit was just as nice, just more equipment.

Does anyone else feel that this issue has become politicised? Ridiculously?

I don't like the idea of MLUs and my personal experience of both the NCT and midwives has been horrific. But I don't try to deny the choice of women who want to do the whole natural thing.

Why do people want to deny women pain-relief?

have been dipping in and out of this thread all weekend :

i would have liked to see this article and to find out , factually, what is going on with epidurals.

i have been involved in teh NCT and in local maternity services for a couple of years and this has not ever been discussed

normalising birth and encouraging women to give birth other than on the bed is something discussed frequently. reducing c.s and IOL rates also discussed frequently

but rationing/restricting epidurals has not been discussed

so would very much like to know, and see some evidence for this

I don't think anyone does Quattro.

Apart from maybe a few extremists!!

As mears explained, various forms of pain relief carry different risks, and some women feel that they would rather go through the pain than take the risks. That's not making a value judgement, just stating a fact. And I totally understand where mears is coming from, that when a woman has perhaps laboured with no or minimal pain relief, and has expressed beforehand that she doesn't want an epidural, but then nears transition and begs for one (or begs to die which is not an uncommon thing as I discovered later!) then a real supportive, experienced midwife may be able to support her through transition rather than go for the whole medicalised epidural route which carries a greater risk of forceps etc.That's good midwifery in my book - not denying someone pain relief. I was dead impressed with the skills my midwife used in the MLU. And equally, a good midwife should be able to tell if a woman really isn't going to manage without more pain relief.

I don't agree that the whole issue has become politicised. I think we just need to accept that some women view childbirth as an event to be got through as painlessly for themself as possible, while others view it as something which they want to do naturally. And I honestly think that if you belong in one camp, you are probably going to find it very hard to see the other point of view! You can't understand it - you just have to accept it! Some of my friends thought I was nuts to have my first baby without pain relief. But I didn't understand why they wanted to be numbed up and not able to feel what was happening to their bodies. There is no right or wrong - it's just important to make an informed choice, knowing all the facts.

Re the safety record for the (what I call) birthing centres.

Only low risk women allowed to use them.

And due to the whole ambulance tranfser worry many low risk women are also put off them for their first baby.

Women I know who have used it have mainly been second or 3rd timers, who know what they're in for and have had successful births in the past with little/no pain relief etc. They then have the confidence to go for it with midwives only as that is what happened before.

So the women using the birthing centres are almost by defintion the ones who are unlikely to have any trouble.

Plus agree to a certain extent that it seems unfair that women are denied the "home from home" experience if they are not low risk.

Why not simply build the birthing centres on hospital grounds so that if transfer is required it's easy. Then women won't be put off giving it a go.

Also want to reiterate that it is certainly not possible to choose consultant led, or shared care, in my area. If you are low risk you are midwife led in hospital or birthing centre or home.

I can see what you are saying re: the safety record of birthing centres/MLUs. If only low risk women are allowed to deliver, then obviously some of the high risk deliveries which tragically end with a bad outcome would never have happened in a birthing centre anyway. So obviously you can't blame the hospital for those.

BUT I was referring to the tragedies which ARE avoidable. They may be rare, but they are still terrible. There was something in the media a few years ago about several babies being injured very seriously (brain damaged) by mismanaged forceps deliveries. Plus a hospital (Wexham Park I think) which had a shocking safety record.

Whereas MLUs and birthing centres HAVE to be exemplary. They would be shut down like a shot if they didn't have excellent safety records. Likewise with home births - if statistically they weren't as safe as they are then they wouldn't be allowed.

Did anyone else feel totally betrayed by and angry with their female friends and family for failing to tell them how truly horrendous and unbrearable labour really is?

Swedes, no, I always remember the first friend of mine (as opposed to family) holding her newborn and saying to us "Don't ever let me turn round to you all and say it wasn't that bad, because it fecking was".