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. Probably they're being realistic, rather than idealogical. If you're anything like me, you won't have a clue what's happening at the pushing stage and you simply won't care. In fact they started to tell me they might have to use ventouse, I thought they were going to tell me they wanted to do an episiotomy and I said "Just do it, I don't want to know!!"

It's better to tear naturally, but they will do an episiotomy if they think you're likely to tear very badly or if they need to speed things up or do an instrumental delivery.

1. Pethidine isn't harmful to the baby, it makes it sleepy, which isn't harmful in itself, (I think?) but if given too close to birth the baby can be sleepy when born which can lead to problems breastfeeding. So they are half-right but as others have said labour is unpredictable and you can have pethidine early on and then take a leap to being further on and once you have had pethidine you can't stop it, you just have to wait for it to wear off. My (NCT) antenatal teacher gave us a useful piece of advice - she thinks it's a good idea to accept pethidine if you are in early stages (ie under 4cm dilated) for a long time and want to get some sleep/rest before carrying on. I nearly did this but the journey into hospital must have started something off.

as for the rest, i think ebf is meant to be as efective at that if you do it loads, and through the night and your baby is under 6m. I wouldn't rely on it though!
I also thought 4 was wrong, but willing to be corrected by people who know what thye're talking about. I have 2 friends who have been given it - one too early so it had worn off by the time she needed it, one too late so it didn't kick in until the baby was out!

"Just do it, I don't want to know!!"
To me that's good enough as consent. I don't mean you have to sign forms in triplicate, just acknowledge that you know what they're planning and you agree

Good luck!

I had pethidine early on and dd was hopelessly sleepy and dopey. Labour was only 4 hours start to finish so maybe a longer labour would give time for pethidine effects to wear off.

Oh yes, SPB, I know - what I meant (perhaps didn't come across) is that if you have the kind of pushing stage which results in an episiotomy, you are not likely to care that they are doing one. I would have preferred not to know I think (though they didn't cut me or use anything in the end) because I'm a wuss about things like that and the anticipation makes it so much worse.

I refused the placenta-expelling injection but I had a lovely midwife who asked me when I was only about 4cm dilated and so much more conscious

Pethidine takes about 4 hours to wear off I think. Probably depends on your metabolism as well.

I had friends who breastfed exclusively and still got pregnant. My own periods returned long before I weaned dd.

I only got an episiotomy when I asked for it- and I was not at any point so spaced out that I didn't know what was going on

The consent thing is interesting. My midwives weren't allowed to perform the episiotomy, they had to get a registrar in. He made of point of obtaining verbal consent from DH. This was just along the lines of: "We are going to perform an episiotomy, is that okay?" and DH was screaming FOR THE LOVE OF GOD I DON'T KNOW WHAT'S HAPPENING SOMEONE HELP or something like that. So I expect that consent is often sought like that, but you are not exactly going to be taken into an office to sign forms at that point, I agree.

Yes, I agree CC - when I was pushing it got to the stage where I just said "do anythign to get this baby out!"
I still think that giving that info out is potentially very serious and worrying - they should be aiming to ask for consent wherever possible.

V true - If they'd come at me with a chainsaw I wouldn't have cared

1 is true if done according to conditions already mentioned, but remember it's only 98% effective. Remember people do get pregnant while taking the pill correctly. Nothing is 100% effective other than abstinence. This is a popular option amongst new mothers . The average return of menses from women who do breastfeed as described (including unlimited access at nighttime) is 14.5 months. But it's ludicrous to say it's 98% effective without describing the conditions. A friend of mine gave some bottles of expressed milk over the course of a few weeks as she had to go away overnight at 6 or 7 weeks. Her periods came back very soon. Even the slightest "deviation" from the conditions can encourage those pesky hormones.

I really wouldn't worry about the episiotomy consent. I think they are being practical rather than ideological. I think they are trying to prepare you for what might actually happen. They're not actually that much of a big deal. You only hear the horror stories. From my own experience and that of my friends, most are quite a straightforward affair and heal well and quickly. I've had an episiotomy, tear and a graze. The graze was worst by far! (NB not knocking anyone who has had a shit time with a poor episiotomy, just pointing out that it is usually fine).

I had a tear and a graze, how exactly do you get a graze, anyway? - I think the graze did take longer to heal than the tear.

2.My MW said "i'm going to do an episiotomy!" I said "Noooooooo!" she said "I'm doing it now and I'll tell you why later!"

So not exactly consent.

She was worried my CS scar might rupture, I wasn't thinking about that at the time (funnily enough). I did trust her really though, I knew her quite well. It's just that I can't really imagine a scenario where someone says "I'm going to cut your bits with this sharp knife!" and I say "Oh, ok then!"

Then again with my first I was begging for a big needle in my back...

I can't think that anyone wants an episiotomy but in the final crazy minutes of labour you would cut yourself to get the baby out if you were able to do anything other than go "aarrrggggghhhhh". They can be pretty painful afterwards but better than the baby getting stuck or a 3-rd degree tear.

I would tell the midwife when you're in early labour that you're a bit nervous at the idea of it. I think most (by no means all!) midwives want to make you as relaxed as possible.

Be prepared for lots of conflicting advice from different midwives/health visitors/friends etc. And good luck!

1. GP said it's a load of tosh and he can't believe that people are naive enough to believe it. He said it may lower your chances of becoming pregnant but is not as reliable as contraception.

1. Sorry no experience but wouldn't think that would be the case except in emergencies.

1. Not available in my HA.

1. I would think the same as you.

re 3 - I had a mobile epidural and could walk about just fine (and I did).

Re 1. If you follow all the (v strict) rules about breastfeeding to the letter (including no expressing) it probably is as effective as condoms. But condoms aren't brilliant as far as contraception goes. I wouldn't want a 2% chance of being pregnant before my baby's first birthday. There are loads of better contraception options compatible with breastfeeding, such as progesterone only pills, coils, implant, injection, . . . vasectomy

I can believe the breastfeeding thing, if you follow the rules carefully (and given that condoms aren't totally effective.) I can well believe in these conditions statistically it's the same risk. That's not to say bf should be recommended as contraception though - that's something else altogether!

Epidurals - only ever had one with my csection, but I can well believe you're not totally mobile. Epidurals block pain. You might have a slightly lower dose one but I should imagine it's very rare you're walking around!

Episiotomy - they would normally tell you, unless it's a dire emergency. I remember the midwife telling me she was going to cut me with my first - she didn't ask permission but I felt informed.

Pethidine - the nearer to the delivery the greater the side effects, but I'm sure it would pass through the placenta at whatever stage.

LMAO @ 1. I have a 9.5 month gap between my two youngest...I BF exclusively AND used condoms!!!

1. i wouldn't take the chance
2. rubbish - they will ask you
3. mobile epidural means you can move around. and you can go on all fours on the bed if you want (i would recommend)
4. pethidine does affect the baby - numbness iirc

You're not being naive, it's just a fact of having a baby that you are told a lot of either rubbish and/or conflicting information by health professionals.
Get ready for the 'little chat' about contraception when you're all stitched up and sitting on a sanitary towel the size and density of a house brick - oh how you'll laugh!

1. Bollocks to this one - don't rely on bf for contraception unless you don't really mind if you get pg. I think if you are bf exclusively and not getting periods it is pretty effective for contraception but certainly shouldn't be relied on!

1. Yes this will happen without asking you if your baby or you is at risk. There are plenty of situations however where there is more than enough time to ask you. I was paranoid about things being done to me without being involved and put something on my birth plan like 'if either me or my baby are in danger I give consent to whatever is necessary to keep us safe. If there is time I wish every intervention (however small you perceive it to be) to be discussed with either me or dh.'

1. Mobile epidurals work by giving a slightly lower dose of the anaesthetic drugs and this works as the drugs block the action of the pain carrying nerves first as they are much smaller whereas the nerves for movement are a lot larger and therefore need more to block their effects. it's not an exact science though as what one woman needs isn't enough for another etc so you may be able to move about or you may not. true mobility (as in walking about) is not that common but can happen. don't choose an epidural expecting to be able to mobilise if it is important to you that you can though.

1. Pethidine will affect your baby whenever it is given you are right. it is safe for your baby though. The concern about giving it too close to the delivery is that your baby can be very drowsy when born.

Hope that helps!