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.

ilove - you were back in sack-action after two weeks? respect!

haha no...the youngest was 3 weeks early as my liver packed up...so it was 5 weeks but yes I got pregnant first time!

About the breastfeeding thing, last time I went to the Drs I was told that this is untrue. Apparently the theory was based on a sample of women living in poor conditions.

They said it turns out that while if you are malnourished it's true, but if you are a well-fed westerner, the result doesn't hold true and the conclusion shouldn't have been applied to everybody.

I'll have a look on the interweb and see if I can find anything about it ...

Anyway I just got my period at 5 months, despite exclusive BFing - so I guess I must have ovulated already so it's lucky we weren't using this method?!

As others have said, breastfeeding is 98% effective as contraception for babies under 6 months old, but only provided it is v frequent and on demand, no dummies, bottles, water, formula, solids or anything else in baby's mouth really AND no bleeding since the post-birth bleeding stops. No long intervals between feeds either. Provided ALL these conditions are met ALL the time then only 2 out of 100 women would become pregnant. Very few bf mums in the UK would meet all these conditions. The earlier the period returns in an exclusively breastfeeding mother, the less chance she will have ovulated before the first period. However, even with all the conditions being met, it's not impossible: 2% of the time it will happen.

Mobile epidurals are not mobile at most hospitals.

An episiotomy without consent other than in a dire emergency would be assault and against the code of practices for midwives and doctors. Doesn't mean it doesn't happen, though...

Pethidine can have longer lasting effects on babies no matter what stage of labour it's given at. Babies who have been exposed to pethidine (or in fact epidurals, which often contain fentanyl a drug from the same family as pethidine) are often sleepier in the first week or so after birth and may well have more difficulites with breastfeeding. Recommend this book. The acute effects of pethidine immediately after birth are lessened if there's a bigger gap between it being given and the birth.

I'm sure it's been said already (only got to read page 1) but you can still ovulate when exclusively bf even though your periods might not have re-appeared. So definitely possible to get pregnant. This happened to me (the ovulation part not pregnancy thankfully!) even though I xclusively bf (7months and counting) and baby fed through the night regularly, no bottle or dummy ever etc etc (yawn). I think your body suspends periods when bf to retain iron/nutrients etc even after ovulation has restarted (that's my untechnical description). In my case it's always very obvious when ovulation is occurring so luckily I knew, it would have been very foolish and scary to rely on bf for contraception though!

Erm, 1 yes it can the baby needs to be exclusively bf, must feed at night and should spend at least 65 mins on the breast through a 24 hour period.

BTW just because you have a period does NOT mean you've ovulated. I'll dig out the scientific studies to back this up if you want them.

dxx

All the info in OP is true, as far as I know.

The 98% thing is true, but 98% is not 100%, of course. Somebody is unlucky enough to be in the 2%. And conditions apply (as others have applied). But 98% is as good as condom or The Pill, I believe.

MW cannot do anything to you without your consent.

Yeah, a "mobile epidural" is not that mobile at all.

Pethidine affects the baby but doesn't potentially harm baby unless it's less than 2 hours before birth; unfortunately, by the time you are willing to have pethidine, you may be a lot closer to giving birth than you or MWs think. So Pethidine really only very safe earlyish in labour.

Oh gosh, I'm a dunce, I meant all true but NOT Item 2, that is complete nonsense. Unless you were unconscious, maybe.

I had a mobile epi. I walked (ok, shuffled, with help) to the loo, but had to wheel a thingy with a saline drip with me. Thats still just about mobile to me. I still had feeling in my legs, but they were very 'heavy' and I had to concentrate on what i was trying to do!

I don't remember being asked for consent to be cut either, i was basically told thats what they were going to do and i wasn't in a position to say no, it was a matter of do what you think you need to.

Oh dear, sounds like you have one of those Midwives who can't explain herself properly. Lots of half right information.

FWIW, the breastfeeding info as detailed by others is what the evidence shows, but I think you would have to be extremely committed and not mind if another pregnancy happened. I tell women to use another method if they really don't want to get pregnant.

Episiotomy without your consent in the UK is technically an assault. Don't know if anyone has ever taken it further but that's the legal situation. I aim to discuss the issue before labour or at least in the earlier stages when you can tell me how you feel. Saying that I can't remember the last time I did one!

Mobile epidurals aim for you to be able to mobilise but most women find they don't go too far away from their room. It does depend on your individual response and for effective pain relief you might need a heavier dose which would confine you to bed but still allow movement and different positions.

Pethidine - hmmm, love it or hate it. It does cross the placenta and can affect the baby for 48 hours regardless of what stage of labour you have it. The respiratory depressant effect is less after 4 hours though so that's why some people think it's safe then. The pain relief aspect is a whole other thread so I won't go there.

Hope that helps. Incidentally, can you ask to go to a differnet class? Hopefully you will find a Midwife you click with.

I had a mobile epidural and was fully mobile throughout - gave birth in a squatting position and then walked out of the delivery room carrying my baby. But then the hospital I used only does mobile epidurals so I guess they have had a lot of practice.

Mobile epidurals are different drugs to a normal epidural. They are not very common in UK hospitals and it might be worth asking if they do them before you go into labour (am guessing your community midwife should know). Apparently mobile epidurals are less common than epidurals because when you have an epidural you have to have some sort of monitoring and it's much easier to monitor someone when they are in a bed than it is when they are walking around.

I wouldn´t worry too much re the episiotomoy, I´ve had 2, both without permission and performed by a consultant, I didn´t even realise what was being done, you don´t feel anything at the time. With DD1 I was very sore afterwards, with DD2 no discomfort whatsover.

The jury seems out on whether episiotomies are useful or not.. I know in the UK they are against them but in many European countries they are still fairly routine.

There are no no clear truths around childbirth; when you look at standard practice in different countries, you can see how much depends on cultural norms. I don´t see so much science in it : (