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.

I don't think she can be midwife 1, because midwife 1 wasn't present when the epidural was offered, and feckingfurious said she was there, but not in a position to overrule the midwife.

Lucky her she got an epidural within half an hour I was howling for one for over 3 hours and it still never materialised.

I can see the point, in that the natural birth maybe was probably nearing the end until the epidural went in along with the drip, but a friend of mine arrived at the hospital and was told the baby would be out within the hour, 12 hours later still no sign, you never can tell with these things.

porcamiseriera - there isn't an answer to the dilemna you raise about epidurals!

Yes, there are some women who have an epidural and manage a non-instrumental birth, but the fact is, statistically you are more likely to have forceps/ventouse or Csection if you have an epidural. That's why many women try hard to avoid it. The downside of that is yeap, it hurts - loads!

It's a balancing act isn't it? If the perfect pain relief were to be discovered, which blocked the pain but without requiring the mother to be on a bed, continuously monitored, and with an increased risk to the baby of instrumental delivery, and which could be administered in the home rather than in a hospital, then I suspect we'd all be jumping at it. But there isn't. So we each have to make an individual judgement about what we want.

Surely the 'answer' is to create an environment where you make sure a woman has all the information as soon as she comes in. And then you let her keep control of her labour and tell you if she is finding it hard to cope with the pain or tiredness. Only offering something if the situation changes significantly.

What comes across clearly in posts is that it doesn't matter what type of birth a woman ends up having anywhere near as much as it matters that she felt supported and either in control OR kept informed of what happens and why if in a genuine emergency situation.

Although the OP doesn't give the information, if the impression given is right, the midwife offered an epidural that would require leaving the pool. Why 'offer'? Even if the midwife was concerned about the woman, surely you approach it in a different way; 'How are you feeling?' 'Are you still happy with your choices or can I do/get anything for you?'. And it is true that very often the people caring for women in labour don't bother to provide woman-centred care or to think about how the language they use influences womens' decisions at a time they may be feeling vunerable.

Have to say, I wouldn't be jumping at this perfect pain relief if it was suddenly invented; although I would be happy to know it was there if I found I couldn't cope without it.

What is this "epidural" of which you speak?

No sign of such a thing when I was in labour begging for pain relief.

Hope the lady in labour mentioned in OP was ok and her baby too. That's the main thing eh?

All this "not getting the natural birth you wanted" - what a load of old self indulgent nonsense.

Hopefully it was a healthy baby

and happy Mummy and Daddy

and anger and reprisals and regret can often lead to depression afterwards so whoever you are, whether Mummy or Doula or midwife number 1, support the parents, encourage them to see the amazing thing they have achieved and move on for everyone's sake.

I think you posted in anger and have had probably some time to calm a little and reflect on this now.

goodness, sorry for not reading everything but epidurals are wonderful pain relief for some who need them. Please can we get as far away as possible from making people feel bad for having one. And never mind what they wanted half an hour previously. Most of us know how quickly these things can change

It's impossible for me to comment on the OP without knowing more about what the labouring woman had planned for her birth, or about her own feelings toward having the epidural.

It seems a shame, if it wasn't really needed, if it slowed down her labour or meant she ended up with unwanted and unnecessary intervention as a result, but we don't know do we?

I have only given birth once, and we had a pretty shit time of it. Partly because I had so much amniotic fluid that DD struggled to descend (resulting in v v painful, ineffective contractions), partly because she was back to back, and partly because I had appalling care from the midwives on a very overworked labour ward at St Thomas's.

I had an epidural that I didn't want, and did end up with an instrumental delivery. A far cry from the home birth I had wanted, but the epidural I had after 24 hours of contractions with no gap between them was much needed. I had failed to dilate at all for about 10 hours, then suddenly after the epidural went from 3cm to 8cm in about 2 hours. So while it's not what I wanted it may, possibly, have saved me from a c section, who knows...

Couldn't it be that the reason you're more likely to have an instrumental delivery after an epidural is because the reason for excessive pain requiring an epidural was that something wasn't right in the first place. I was in a lot more pain with ds2 & had a much longer labour than with ds1 which meant I asked for an epidural. It turned out ds2 hadn't got his head positioned quite right which was why my labour was so long & painful.

That was certainly the case in my labour Claire. DD was badly positioned because of all the extra fluid = unbearable constant pain = need for epidural I didn't want = instrumental delivery (that could have been needed anyway because of how she was positioned. Either that or c section).

However, there was the added challenge of having no midwife support at all, all night long, being left on a CTG all night on my back and terrified. Perhaps without that, the pain wouldn't have been so bad and I could have managed, perhaps escaping epidural and forceps. Who knows? There are so many factors to consider.

But it is well documented that once an epidural is in place the lack of mobility means previously well positioned babies can end up badly positioned and/or mums find it impossible to push their babies out because they can't feel anything. So therefore the increased incidence of instrumental deliveries.

I don't understand the 'being confined to the bed'. You can have a low dose epidural and sit for your whole labour on a birthing ball as I did with last labour.

I dilated SO quickly after having epidural with DC1 and the midwife said 'Ah, that's because you relaxed'. Plus I got to doze a bit and had energy to push.

I am sure that epidurals and intervention correlate... but I do wonder if the CAUSE is as strong as we all think. Most epidurals are for first births which are trickier anyway. Then people say 'Aha, and I didn't have one 2nd time round and it was great', when maybe that's just because it was a 2nd baby.

What I find lacking is the 'Active Epidural Birth' support. It doesn't have to be EITHER epidural or active. You can be upright and not in pain which for me was the best of both worlds.

Ooh I am quite inspired to start 'Active Epidural' Classes.

That's a good point coffeeaddict. I don't know enough about mobile epidurals to know why they never seem to be offered/mentioned, but it certainly was never offered in my case. And that was at St Thomas's where it seems most things are possible!

It seems to me that a lot of women get given an epidural then left flat on their backs which is obv not helpful when you're trying to deliver a baby. I was on the bed but mw got me into all different positions to try & get babys heartrate back to normal & to progress my labour. Don't think it's quite as simplistic as intervention is more likely with an epidural

That's a great idea coffeeaddict!

Crazycatlady - I also gave birth at St Thomas' and asked them about mobile epidurals as I had read about them and various other forms of pain relief prior to doing their ante-natal course. What they told me was that as they couldn't guarantee that the epidural would be a "mobile" one, they just didn't call it that. I thought this was a bit weird, but didn't push it.

As it turned out, I was able to move my legs and give birth perfectly well without forceps etc after my epidural, so they might as well have called it a "mobile epidural".

I thought there wasn't any fundamental difference in a conventional epidural or a mobile one anyway. I believe they fundamentally work in the same way, by blocking the nerves to stop pain. Isn't the difference to do with the strength or mix of drugs rather than a difference in procedure?

That may be why some hospitals don't want to commit to exactly how mobile you might or might not be.

It's good to hear that some people aren't having to lie flat in bed after one, but I still think the best way to guarantee being completely mobile is to avoid an epidural.

The best way to avoid an epidural is not to have a horrifically painful long labour like my second one but sadly I didn't get to choose

The debate about epidurals is a hugely important one, and it's a complex issue. I think most labours are very painful (apart from the rare cases where people say they genuinely didn't experience pain, just discomfort). They are often very long too, especially first labours, and often the baby doesn't position itself in the optimum way.

I still think there is so much variation in women's experiences though, and the extent to which they feel supported and informed, that there must be room for improvement. I found my first labour extremely long, extremely painful, even excruciating in parts, the baby also wasn't well positioned, and I think I owe the fact that I got through it on gas and air to the superb midwife. OK, I must have done pretty well too! And DH was marvellous! But the point is, there are a whole range of options before epidural which is a major medical procedure.

I hope the OP comes to terms with her decision and realises that it doesn't need to be like that.

Agree violet that labour is often long and painful and that inadequate support can make the difference between coping and not.

I think feeling in control is the crux of it really. And when you have good support from a skilled midwife who is good at communicating with you in an appropriate manner I'm sure that goes a long way to maintaining that feeling of being in control. Difficult when maternity units are so badly overworked and under-resourced.

Had I known how little support I would have at St Thomas's (basically none, other than a midwife with poor English coming in every 3 or 4 hours to painfully examine me) I would have hired a doula. Neither myself or DH really knew what to expect but we did expect supportive midwives. Sadly we were wrong and it may have changed the path of my labour and birth unrecognisably.

Agree violet that labour is often long and painful and that inadequate support can make the difference between coping and not.

I think feeling in control is the crux of it really. And when you have good support from a skilled midwife who is good at communicating with you in an appropriate manner I'm sure that goes a long way to maintaining that feeling of being in control. Difficult when maternity units are so badly overworked and under-resourced.

Had I known how little support I would have at St Thomas's (basically none, other than a midwife with poor English coming in every 3 or 4 hours to painfully examine me) I would have hired a doula. Neither myself or DH really knew what to expect but we did expect supportive midwives. Sadly we were wrong and it may have changed the path of my labour and birth unrecognisably.

Oops, I agreed so passionately I posted it twice

Er hands up here I've had two epidurals, DS2 was 10lbs 1oz and I delivered naturally with no intervention. Both epidurals I have been able to feel the contractions but without the exhausting pain. Also there are such things as mo ole epidurals for those of you who don't want to lie on a bed.

On the hand my work colleague had a 5lb 3oz baby with Gas and Air and ended up with a third degree tear.

Neither of these scenarios fits with the pages of posts before. Each labour is individual let's not all assume others will experience the same birth as the next woman. I had no qualms about pain relief, it saw me through a very long labour ( induced as overdue) and me and my boys are just fine, no problems with feeding (both feeding in the delivery suite) or bonding, no back problems or headaches just happy mum and healthy babies.

so the Op STILL hasn't come back to offer any rationale for her post ? My money is now on a midwife who realises that she has come dangerously close to crossing the line of confidentiality on a public forum and is hoping that this thread will quietly drop away. Bloody shameful-both in terms of attitude AND practice if that's the case.

well thanks for posting that you CAN have epi and push baby out. I am BRICKIN it ref the next birth, and if I cant bear the pain I will have an epi. I just want to be able to push it out myself!

we will see, we will see....

porcamiseria, yes you can and I did. I understand what others have said about intervention being more likely but that does not make it a CERTAINTY.

It depends on where you are as to whether you can have a mobile epi, mine was at High Wycombe and they don't do them there but I know Queen Charlottes do (west London) as two of my friends had their DCs there and had them.

Despite not having a mobile epi I could still feel the contractions and did not need to be told when to push. Do not be scared of having an epidural, you must do what is right for you. Make yourself aware of the options and be prepared to state what you would like to the MW caring for you - whether that be an analgesic free birth, a full epidural or anything in between.