to wonder why a midwife would offer a woman, labouring beautifully in a pool, an epidural?

[FeckinFurious]

I have namechanged as I'm not sure if this is a bit obvious and I need to ensure confidentiality.

But...

I am utterly fuming.

Scenario.

Woman. Baby no 1. Labouring spontaneously in hospital, in a birth pool.

Long and painful but baby fine. Mum tired but coping, using entonox.

Midwife 1 goes off for lunch. Midwife 2 takes over.

By the time midwife 1 comes back from lunch midwife 2 has suggested an epidural to knackered, labouring woman who accepts.

within haf an hour epidural is sited and hormone drip going.

Woman is now being monitored continuously in bed.

Please comment.

standandeliver Thu 11-Feb-10 11:49:23
"Don't recollect any particular euphoria or feeling of strength related to having pushed the baby out"

"Cory - it's mainly a hormonal thing. Women who give birth without synthetic oxytocics and pain relieving drugs generally have much higher levels of endorphins and oxytocin in their bodies immediately post birth. "

I am fully aware of the hormone argument. I am just pointing out that I did not feel this hormone rush after my vaginal labour. Maybe it was very wrong of me not to feel something I ought to have felt. But that's how it was for me.

I did otoh have a feeling of euphoria after my emergency section and that is the day I look back on with pleasure as being very relaxed and unworrying.

When I had DS, DH was freaked out by the volume of blood (2L), and by the fact that it was nothing like lambing. Although the obstetrician did have a good rummage Herriot-style to deliver the placenta.

He was elated after DD certainly. I heard him on the phone describing it to various relatives as a 'doddle'.

I on the other hand was euphoric after DS (morphine?) and just bleeding knackered, and frankly somewhat shocked at the pain, after DD.

I buzzed all night (DS was born early evening) which was actually a PITA because he had a big feed and then slept for 12 hours. So just as he was waking up and wanting feeds and being all gorgeous and alert, I was dropping off.

cory if it was "very wrong" of you to not feel euphoric then it must have been insane of me to think I was a god. There is no normal, there just can't be, the vast differences between women have to mean that there are vast differences between even quite average birth experiences.

I can still manage to feel euphoric looking at dcs though. Not all the time (remembering this morning) but often enough.

"I remember ds's homebirth (which involved a shoulder dystocia, two ambulances and paramedics running up the stairs with resucitation equipment) as the happiest and most exciting day of my life. I had the biggest, biggest high after the birth."

Well, surely a birth is about a baby being born as safely as possible, not about the mum's levels of euphoria.

I find a bit of euphoria never goes astray.

True Morloth, but otoh it isn't absolutely necessary either. I didn't have the euphoric high from labour but I fell in love with dd straightaway- I don't feel I've missed anything.

To me, giving birth is a bit like a wedding night. It can be a wonderful thing if it goes right, and a traumatic experience can certainly do a lot of damage- but it's not the last stab you're ever going to get at the relationship.

I wasn't all that fussed about DS TBH, I mean he was nice and all and I felt quite protective, but mostly I wanted a shower so gave him to DH.

Was much more interested once we had both been cleaned up a bit.

I wish I'd been offered an epidural sooner rather than labouring for hours on end. It is VERY tiring.

YABU.

I wish I had allowed them to give me pain relief sooner instead of being terrified of caving in too soon (and I had been on the synto for hours at the time)

what i think is being missed her

1. the attitude of medical professionals t various procedures doe affect the choices of their cgarges - women with anti-interventionist mws are less likely to have interventions. It is not purely patient choice - such choices ar emade on th ebasis of the advice offered at the time.

) the attitude of the mother to pain is importnat - 85% f amricans hav epidurals in labour - no doubt most believe it necessary - almost no Dutch mothers do - no doubt most believe they were ok without it. Possibly, it actually is more painful to labout n the US (very medicalised approach) - but possibly what dutch women believe about the pain makes it more possible for them to cope.

this woman was in a pool - so at the outset an active-labour approach. for someone to walk in and ofer an epidural would (had it been me) have been a sign that either 1) something wasn't going right 2) made me very angry as it ignored my choice - depending on how bolshy i was feeling. how bolshy do most of us feel after a long labour?

obviously not enough to judge, but i think the op has a point.

Haven't read through all the posts, so apologies if I'm repeating.

I kind of know where you're coming from regarding the epidural. If the woman was really set on a natural birth in the pool, then having an epidural offered when she's at her most vunerable (and coping well) probably isn't the most helpful and will put her straight onto her back and maybe on the road to more interventions (e.g forceps).

However, it's such a tough call isn't it. Especially if you don't know the woman well and haven't been with her in the earlier parts of her labour. It's difficult even for the birth partner to know. I guess that's where some people find a doula useful?

I've only had one child, and I basically said right from when they broke my waters that I wanted an epidural, and after 5 hours I had it in - I have fibromyalgia and was exhausted before I began and knew I stood a better chance of lasting the course if I had an epidural (didn't matter anyway as I had an emergency C-section).
I am in pain every day, and I know pain is a lot more unmanageable when you are very tired. Maybe the lady in labour just got to a dip in her energy levels and panicked, or genuinely wanted to carry on trying for a natural birth without pain sapping her already depleted energy stores so took an offer from MW 2 - it is all speculation.
I don't think knowing what happened during the early parts of labour, or knowing the woman well, would help - she didn't have to take it. I got offered G&A when my epidural failed temporarily but was very reluctant to use it as I knew it could make me nauseous and feel spaced out, however I found it was great - the MW saw I was in a lot of pain and struggling and offered it - if I didn't want it I didn't have to take it.

EdgarAllan has a definite point. I come from it from a slightly different perspective having given birth at a place where they were very sensitive to your birth choices (apart from ghastly midwife 1 who thought she knew best) and generally positive towards non-medicated labours. This being the case, I would have resented it like hell if someone had not respected my right to change my mind over the episiotomy.

The thing is, we don't know what state the woman was in. We don't even know if the OP was present when the epidural was offered- she hasn't said. So we don't even know if it was the midwife pushing the epidural or the woman asking for it.

In my case, it was definitely me changing my mind and screaming for an episiotomy when I felt I was going to tear, so would have thought it rather unfair if midwife had been blamed for that, just because the change of direction happened very quickly and I had been labouring beautifully shortly before.

But we weren't there, we can't know.

The expectations thing works two ways: if you have a midwife who thinks pain is good for you (as my first one did), then it is also very difficult to ask for pain relief. And if you are writing your birth plan together with a midwife pushing non-pain relief, then it can also be difficult to put down that you do want pain relief. So if you start speculating on whether women want what they say or not, you could easily end up in either camp.

I agree that this thread highlights the difficulty that midwives often face; it can be a damned if they do, damned if they don't situation.

It's actually fairly poinltess speculating about this particular OP, because we really don't know very much about the situation, and also the OP seems to have conveniently disappeared. I still suspect it's most likely that the OP is the labouring woman.

I know midwives are human, they aren't going to get everything 100% right, and some midwives are better than others anyway. But I also think some women, if they regret their birth choices, then transfer the responsibility elsewhere, maybe subconsciously even. eg I have a couple of friends who had an epidural with their first birth, but second time around were really keen to try without and actually managed it, and they then started saying 'Maybe if I'd had more support the first time, maybe I could have managed without...' etc. They forget that at the time thjey were grateful for that intervention, they accepted it. Second births are often easier anyway, which may be the reason they managed a natural birth that time; it doesn't necessarily mean the midwife did anything wrong the first time.

I also think that out of all possible interventions, an epidural is such a major procedure that it's hardly something that catches a woman unaware. An anaesthetist has to be called (often takes a while) the epidural has to be set up, the woman has to totally co operate by curling up and lying still..... it's a complex procedure. No one is coming up and jabbing a needle in your leg while you're not looking! The woman the OP describes clearly accepted it. Maybe she later regretted it, but she needs to examine her own choices and come to terms with it, not look elsewhere to shift responsibility.

I have been reading this thread with interest, and it throws up the dilemmna around epidurals we all face

(a) have one, lessen pain, but risk you cant push ergo intervention, stitches etc etc

(b) dont have one, but have hours of unbrearable agony with no end in sight (as it seems to a labouring woman)

so you are kind of fucked both ways, but obv option 2 means you are less likely to have painful stitches etc, and recover quicker

I would love to hear from some that had an epidural, AND managed to push the baby out OK? surely they must exist?????

OP I think cant be the mother, as if she was why did she accept the epidural??? My bget is she was a birth parner/midwife or doula

"OP I think cant be the mother, as if she was why did she accept the epidural??? My bget is she was a birth parner/midwife or doula"

Have you read the whole thread?

She could easily be - perhaps she accepted it in a 'moment of weakness' and afterwards deeply regrets it, and is looking to lay the blame elsewhere because she didn't get her 'perfect birth'. It's not unheard of.

I wonder why the OP hasn't been back to answer the question about her role in the birth.

Morloth - I loved your dh's reaction - 'We can make our own people now'!!

My dh always says he coped very well with childbirth all three times (I'm sure he'd say he laboured beautifully - lol) - although apparently it got a bit painful when I held onto his hand very tightly and it felt like I was trying to push his wedding ring through his finger. And he breathed through that pain - no need for any pain relief at all.

Ziggurat , yup read whole thread! thats just mu opinion, anyway there is such incomplete info here thats its pointless to guess anyway

am more interested about my epi question tbh!

From the original OP": "I need to ensure confidentiality"

That, to me, says they're an NHS employee. I think it's MW1.

I don't think it was midwife 1, because I get the impression that the OP was in the room when the epidural happened, which is when midwife 1 was on her break.

I had an epidural with DC1, no forceps etc. Giving birth to him was by far the most euphoric I have felt in my life. Nothing will ever top that feeling.

DC2 was very quick, no pain relief. All I felt afterwards was in shock and a bit numb. I wanted to hold her and know she was ok but I was disapointed that I never had the same rush of emotion.

DC3 was also quick with no pain relief. I did feel euphoric but still on on the same level as with DC1.

I'm not sure whether I have ever 'laboured beautifully' but my midwife with DC3 told me she didn't think I would have a tear as I 'pushed him out beautifully'

I just want to also say to Standandeliver that I breastfed all of my DCs very soon after birth and that having an epidural did not effect this with DC1 in anyway.

I was up and about very shortly afterwards and able to shower etc. without any problem.

After DC3 who was born with no pain relief i felt like I had been hit by a bus. I ached all over and could hardly move. DP had to help me shower and get dressed as there was no way I could have managed alone.

I'm not saying that anyone should have an epidural if it isn't what they want but it doesn't always have a negative effect on the birth or recovery.

The OP can't be the mother or father (or baby) as they wouldn't have any confidentiality issues. Either doula or midwife. I'm going with MW1.