to be shocked at this information/advice from my antenatal classes?

[VerityClinch]

Genuine questions here, I don't know if I am being naive or not.

As background, currently 8 months pregnant, and have been to NHS ante-natal classes and the hospital-run breastfeeding class.

I have been told all of the following: -

1. Exclusive breastfeeding is as effective a method of contraception as wearing a condom (the % quoted was 98% effective in both cases). If this is true, then fine, I am wrong on this point. If it's not true, though, isn't this terribly dangerous advice to be handing out?

1. That I will not get a say in whether or not I have an episiotomy - that if the decision needs to be taken, the midwife will take it and either cut, or let me tear naturally, depending on what she sees fit, without either consulting me or telling me, because there "won't be time". (She can cut me without telling me? REALLY?)

1. That a "mobile epidural" doesn't leave you mobile at all, you still have to stay on the bed and you won't be able to feel your legs, or they will feel too heavy to move(why is it called "mobile", then?)

1. That pethidine given in early labour (ie the contractions stage, not the pushing stage) doesn't affect the baby. (Surely if it crosses the placenta, then it will do that whenever it's given?)

Are all of these really right? I totally accept that what I have read in all of my various pregnancy books might not be the most up to date thinking, but all of these have quite shocked me, and made me doubt some of my choices. Would really value your opinions!

Thanks, V.

1. I would never trust breastfeeding as a contraceptive. My periods returned when dd1 was 8 weeks old, and I was breastfeeding her every 2/3 hours around the clock, sometimes hourly.

Don't know about the others, sorry.

I don't know the answers for sure, but my understanding is:

1. is true, provided bf is exclusive, baby is less than 6 months old, baby still feeds at night and the woman's periods haven't returned.
2. no-one asked me, that's for sure.
3. yes, I think it is just a lower dose with a faster recovery time, not actually 'mobile' as such.
4. I think (hope) they mean won't make a difference to the baby's breathing / suckling when born, which it does if given too late (my mum was given late pethedine with my birth and I was born v.sleepy and unable to suck).

Hi

1. as far as I know I thought that when you were breastfeeding it was unlikely that you could become pregnant but certainly not impossible and I was advised to use condoms etc

2. Pethedine imo does effect the baby in that it makes it drowsy - I had it in early labour and to be honest it just made me feel sick and made the labour slow down - after the birth ds was drawsy for about 24 hours - although that could have been the gas and air?

OMG!!!

1 - - Just because you are BF doesn't mean you can't get pg. Is she an old-school MW?

2 - not sure, AFAIK it is better to get an episiotomy than tear naturally (?) but I think you have to give consent, unless there is real danger to the baby (anyone out there confirm or deny this?)

3 - not sure as I had an epidural which meant I couldn't move (still didn't work after 3 times though bah!!)

4 - Think this is wrong - I had 2 shots of Peth and gave borth about 24 hours later and DS was VERY sleepy for a about 2 days - MW's said this was down to the Pethidine but no concern.

Wow sounds to me like the info you havebeen given is a bit odd, hopefulyl someone else will be along to give their experiences.

Don't doubt your choices btw - you'll have made the right ones for you x

1. I had a couple of shots of pethidine during contractions. DD slept for 24 hours pretty much after birth. I always assumed this was why....

1. yes, technically right, but that 'advice' shouldn't be given without all the extra information and support needed to use bfing properly as a contraceptive ie. co-sleeping so bfing frequently at night, no dummies, no bottles, nothing in baby's mouth except his/her hands and mum's nipples...and so on.

1. SHouldn't happen but probably does so good to prepare you. I think it's that episiotomies are avoided for as long as humanly possible, so when it gets to the point when there seems to be no other option, there probalby isn't enough time to discuss it. Wrong, but that's the way it is I think with some midwives (not all).

1. Yup - mobile epidurals only really mobile for a lucky few women.

1. Yes, pethidine can affect baby, but less likely to make it sleepy as it would if given late in labour. I wouldn't bother with it anyway - doesn't actually get rid of pain, just makes you sleepy and dopey and possibly sick too.

gave Borth?? LOL meant Birth obviously... (sorry I have got sausage fingers....)

My doctor told me breastfeeding only works as a contraceptive if it occurs at least every 5 hours (through the night as well) as any longer than that and your hormones start to work again. So once your baby starts to sleep a bit longer it is ineffective. Of course even doctors get out of date so don't know how true this is either.

The only thing I had on my birth plan was avoiding an episotomy if at all possible. The midwife read it, laughed, and said I had no choice in the matter and that I would probably have an episotomy. How she knew this at 4cm dilated I don't know, but she was pretty horrible all round.

Don't think point 1 is right as I have a close friend whose babies were 10 months apart because she believed that one.... Yes, she was exclusively BF.

no idea about the others but suspect that pethidine will affect the baby whenever it is given but that it might have worn off a bit by the time the baby is born if given early in labour?

Number one is true only as long as you follow some very strict rules. It's called the lactational ammenorhea method.

2 - crap - it would be classed as assault. However in a true emergency where you desperately needed to be cut, the midwife may well choose to use her judgement, and I'd probably go along with it.

3 and 4 - not entirely sure. There are others here with more knowledge than me.

1. This is true but only under some pretty inflexible conditions - no other nipple substitutes, feeding to baby's cues, baby under 6 months, no intervals longer than 5 hours overnight.
2. That sounds highly suspect to me.
3. Doesn't sound right to me but I know it can sometimes work out that way.
4. Pethidine can affect baby for sure. It's not always possible to predict how quickly labour will progress so I would be uncomfortable with that statement. I was given it at the 'safe stage' and then dilated 6 cm extremely quickly. Baby struggled to feed in the first 24 hrs and get bfing established.

Oh and as for being cut, they did tell me about this but didn't think to warn me when stitching back up later till I asked what on earth she thought she was doing!

Thanks everyone. I have some issues with this specific midwife (for example she always says "dilatated" instead of "dilated" and she has extremely long fingernails - get AWAY from my cervix with them, woman!). Small things, but they make me doubt her slightly...

Maybe I am best off just hoping she won't be around when I actually give birth?

And, can I put in my birth plan that I NEED to know if I am getting an episiotomy? I am not dead against the idea, by any means (hell, do whatever it takes to get my baby out safely), but I do want to KNOW what's going on down there.

The 98% effective contraception thing definitely didn't come with all the other advice about periods, frequency of feeding etc. I would never have relied on it anyway (if, indeed, I ever have sex again ) am just a bit shocked that the NHS would be putting that message out there without all the facts attached.

As usual, the most sensible advice is always to be found on mumsnet. Thank you, ladies!

LOL Verity, it took me 8 weeks before I even let DP say the word Fanny, let alone touch it!!!

Can't comment except on the mobile epidural bit - epidurals numb the nerves, so without full feeling in all of you from waist down you can't really walk. Imagine waling normally with pins and needles from your waist to your toes!

Oh and I had a midwife with long finger-nails - it was NOT pleasant to put it mildly

Is this your first?

Cos what you read about in the books and the reality of actually giving birth really are two different things.

It's certainly possible you'll end up with an episiotomy whether you like it or not, I did and wasn't consulted - my baby was likely to die or end up brain damaged if they didn't do it there and then.

The thing about pethidine, it wears off, so what she means by the last statement is that the effects won't have time to wear off if given too close to birth.

One piece of advice - be open-minded, because if you expect everything to be textbook and have very set ideas as to what will happen and what won't then you could be setting yourself up for a shock.

1 Bullshit. I co-slept, BF fed on demand, no dummy or bottles, feeding every 2-3 hours and my periods returned at 11 weeks. If, say, we hadn't used contraception at 9 weeks I could well have got pregnant. Why take the risk?

If you're unlucky and periods have returned anyway then obviously LAM won't work, but if they haven't and one stays within the rules (not all of which have been mentioned here yet, there's some excellent stuff on the Toni Wechsler website www.tcoyf.com) then it is effective. You still have to chart and monitor the three main fertility signs - first waking basal body temperature, cervical fluid, and cervx position. These three together will give an excellent appreciation of an impending ovulation.

All statements true to a certain extent but only with caveats and further explanation.

Bfing can be 98% effective under strict circumstances. My bfed baby fed every 2hrs day and night and I still got my period back at 16 weeks. For every rule there is an exception.

Mobile epidurals often not mobile.

Pethidine is more likely to have dispersed if given early but most newborns are extremely sleepy after birth anyway. My dd barely woke for the first 2 days and that was nothing to do with pethidine. Throw in traumatic births and jaundice and it's hard to state whether a baby is sleepy for any reason other than being a baby.

Episiotomies, I had one without consent, something I would have been horrified by pre-birth. However, had a terrible labour and it was an attempt to get dd out as fast as possible (didn't work, had a cs). They could have painted me green and winched me up a pole if it had ended the hellish labour and got dd out alive. I think it was very honest of the midwife to admit that sometimes they do have to just get on with it. Shouldn't make it sound like it's the norm though.

Her first point is very shocking because all the midwives I have ever met were very much the opposite, to the point of saying less than 24 hours after birth 'You're very fertile right now' which given that I am a human and not a gerbil, probably wasn't true, but I think they were probably right to err on the side of caution. In 3 labours I've never got out of hospital without getting the 'Use a condom' talk. With my second daughter I gave birth at 10 at night and left next morning, they still managed to give me the talk before I left, then the midwife who called on me later that day repeated it. (Exclusive breastfeeding, no dummies etc with all children but never relied on it as contraception.)

Oh, and I had an episiotomy with my first. The midwife did tell me ahead of time. I had a local anaesthetic and felt nothing.

Yes, it's my first - and I am not expecting a textbook delivery by any stretch of the imagination (having already had a far-from-textbook pregnancy). All of the above just really surprised me, because I have read loads and thought I was quite well informed, and then in the space of a couple of ante-natal classes, it seemed like all of that good preparation work was being undone right in front of my eyes.

Am nervous enough at 36 weeks without suddenly being handed a load of conflicting information!

As usual, though, I feel much better for having posted here and for reading your replies.

I would say about the episiotomy that they have to ask your permission unless there is significant risk to you or the baby by waiting the extra five seconds it would take to ask and for you to nod. I remember being asked whether they could inject me with whatever brings out the placenta when I was cuddling DS about 30s after giving birth - I almost said "I don't care, why on earth are you asking?" - but it's all about consent

I'm crossing my legs tightly at the thought of a midwife with very long nails. I'm meeting new midwife for booking in appointment next Wednesday, I will be examining her fingernails very closely.