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.

Sassybeast - 'long and painful' doesn't = epidural is always the answer.

You can have a long and very painful labour and NOT always need or want an epidural.

I would quite like to know what the OP's stake is in this and how the mum feels about having had an epidural if it wasn't in her original plan.

Is midwife 1 sure that the woman didn´t ask for the epidural?

Every labour is different, and a woman's needs when she is in labour may be very different to what she thought she'd need when writing her birth plan. Indeed, what she needs can change during the labour.

As long as the woman made a choice that she was happy with, and wasn't pressured into making that choice, I see nothing wrong with what happened.

Indeed, I think it is right and proper for the midwife to assess the situation at that time, and offer the care that she thought was appropriate and neccessary. She was using her professional judgement to assess the situation and ensure that the woman in labour knew what her options were.

If the situation had changed dramatically whilst midwife 1 was on her lunchbreak, and the woman had needed a caesarian or the baby had started to be in distress, do you think midwife 2 should have waited for midwife 1 to return from lunch before taking any action? Of course not.

"It's difficult to say but a labouring woman can always ask for an epidural, she knows this is a possibility and she can be relied upon to ask for an epidural if she feels she needs it. "

Don't think this is the case at all, what happens if the labouring woman wants an epi but having spent the last 9 months proclaiming natural drug free birth and reading about how epidurals can increase the risk of interventions etc feels guilty about wanting an epi and doesn't feel she can ask for one. Maybe she thinks shit the MW doesn't think I need one so maybe I will be seen as wimp for asking for one? Maybe she NEEDED the MW to offer her an epi and if she was labouring beautifully and coping then she could have said NO.

Arggh, keep wanting to chip in!

Makes me sad that it's only mums who have short and completely straightforward labours seem to have a chance of getting out of hospital without having felt they needed an epidural or without being offered one. I feel very strongly that in the right circumstances, and with skilled care many women can cope with more difficult and longer labours without an epidural, and will probably be better off without it (as long as it's their choice).

I had such good care with my third baby that I coped fine without an epidural - even though I was in active labour for over 30 hours (6cm dilated on Tuesday am, by lunchtime midwife getting her gear out to deliver baby..... ds born Wednesday 4pm after three hours of synto). The difference was for me that I was mobile, I was at home for most of the labour, and I had a fantastic relationship with the midwife who was someone I knew well and trusted. It does make a HUGE difference how you cope with pain when you are labouring in optimal conditions - by which I mean you have had continuity of care, you are in a sympathetic environment and you have true freedom of movement. It really isn't just about individual 'pain thresholds'. It's about quality of care. There is no denying that some midwives are hugely more skilled at helping women cope well with pain than others.

I honestly think the conditions most women labour under make the pain of birth intolerable for far, far larger numbers than necessary.

RollBaubleUndertheTree - I am utterly shocked at your poor opinion of midwives. All those I have met have had the best interests of mother and baby at heart. Saying that the midwife had her own agenda for the labour is, frankly, offensive.

A midwife who has attended a lot of labouring women will learn to read the body language and reactions of a woman, and will offer care accordingly. Midwife 2 may have seen something in the reactions of the woman in labour that told her that the woman needed more pain relief than the waterpool was offering - so she offered the epidural.

You don't have much of an opinion of the woman who was labouring, either. How do you know that she was thinking that the midwife's offer of an epidural meant that things were going to get worse? I can assure you that even at the end of a very long and painful labour, I was still able to judge what was best for me, and to express that to my midwife.

Libra - would want to ask you, how can a midwife 'know' a mother 'needs' an epidural?

What constitutes 'needing' an epidural?

In the 1960's and 1970's the vast, vast majority of women laboured without one. Even with having long and difficult labours. Are women today any less likely to be traumatised by childbirth, or feel more satisfied about their births given that so many of them have epidurals? I sometimes feel, reading the childbirth boards here, that there are just as many women now coming away from their births feeling bad about what happened to them as there were when our mums were having babies.

are you deliberately missing my point? I said the women could need the MW to ask if she would like an epidural as she feels she can't ask for one.

"All those I have met have had the best interests of mother and baby at heart. Saying that the midwife had her own agenda for the labour is, frankly, offensive."

Ah well. Scenes I've seen in hospital: two midwives standing outside a door on the labour ward pissing their pants at the noises a terrified and hysterical mother is making inside the room; a midwife coming out of a room where she had been assessing a homeless woman brought in in labour, turning to me and saying 'some men will dip their wick in anything. Disgusting'. And other stuff which is positively chilling.

I've also met some positively saintly midwives, but I can tell you - the profession is a very difficult one right now and there is an epidemic of bullying and work related stress in maternity units at the moment. Midwives DO sometimes have their own agendas - sometimes to undermine a colleague or to prove a point. They don't always have the best interests of women and their babies at heart, sadly. They may think they do, but their actions sometimes suggest they have other priorities.

Hi ff
I am inclined to aggree with you

With my first I was induced and experienced contractions within 30minutes, came on very suddenly.
Annoying midwife trying to be helpful offered me diamorphine - I accepted it not because I really wanted the painrelief but because I wanted a room!
I was on my own (dh had been told to go home) it was 10:30pm, I was pacing the corridor - the midwife didnt like that!
I thought if I agreed to something she would let me have the room! - she didnt but obviously I got the pain relief as well

Baby2 - delivered within 4 hours of contractions starting - midwife kept telling me to push. I repeatedly informed her there was no need, baby was coming out all on her own - pushing was pointless, I did try to appease silly midwife (who was clearly in a rush) - eventually dh told her to leave me alone, but had I been on my own I might have been bullied into something simply because I wasnt in a fit state to argue my case (as with baby1)

So I can understand how you feel - just because labouring woman says yes to something it doesnt necessarily mean she wants it, it might just mean she wants to shut the midwife up!

I wonder how the woman in the case you refer too feels about her birth experience now it is over???

If someone had offered me an epidural in my long and extremely painful first labour, which ended with the last four most painful hours in a birthing pool, I would have declined.

It took the midwife several offers of gas and air until I eventually decided that it would do no harm, 20 mins before I started to push.

Offering is not a problem. Yes, it is better, in most cases, if the mother labours without epidural given complications that can arise, but to offer, is not an issue imo. If the woman does not want it, she will refuse. If she has changed her mind, she will take it. Her choice.

'tired but coping' - thats how it appeared to op. Perhaps, inside, the woman was dying and praying for a way out. In agony but not wanting to let on.

Personally I think it's marvellous to read a story where someone is offered an epidural and gets one as opposed to all the stories I've heard of people begging for them and not getting them.

I know which scenario makes me more furious.

Stand - your post rings SO true with my experience that I wrote about a few minutes ago
Both the midwives I referred to in that post definitely had their own agenda for the birth of my children

As a m/w I never offer women an epidural. When I firt meet them I tell them that I won't offer them any pain relief at any point. I make sure they know what's available and tell them if at any time they want anything to tell me.

I do think that offering an epidural to a labouring woman can perhaps make her have doubts about her ability to do it without one/doubts about how she's coping.

IME a woman who wants one will tell you fairly quickly.

I'd have been annoyed if I was MW 1.

"but to offer, is not an issue imo. If the woman does not want it, she will refuse"

But many women lose all their self-confidence and their faith in their bodies in labour. That was me in my first birth. If, instead of offering me an epidural the midwife had said 'you're doing ok - come on, let's get you off the bed, and I'll rub your back for you/talk you through a few contractions', or explained to me why my labour might be taking longer than I'd expected (baby was OP), well then I might have not wanted an epidural.

I took her up on her offer of an epidural because she simply had nothing else to offer me - not her sympathy, her skills or even her focused attention. As soon as she offered me the epidural I felt the labour was 'doomed' - thought 'Oh this must be a really bad labour, and I should take everything that's going'.

"As a m/w I never offer women an epidural. When I firt meet them I tell them that I won't offer them any pain relief at any point. I make sure they know what's available and tell them if at any time they want anything to tell me."

Such a good strategy and so simple to do. Why don't all midwives do this?

StayingDavidTennantsGirl - I can't say anything more to defend my position that StandandDeliver has not said so eloquently already.

Sorry if can't see this midwife as a wonderful angel of pain relief swooping in to save this mother from her normal birth.

I see your point standanddeliver, but this cannot be seen in the same light as those totally unprofessional midwives you described. If you know you are not going to be capable of giving enough emotional support to a woman, isn't pain relief the next best thing? I guess you could say if you can't give the support don't become a midwife, but there is a shortage..

Giving emotional support to women in labour should be a basic midwifery skill surely?

standanddeliver - I do understand your point, about not offering and offering additional support instead. However, I don't think in all cases it is wrong for a midwife to offer pain relief as the mother may be too shy/scared/intimidated by partner etc. to ask for relief or to admit that they have changed their mind. It is a catch 22 imo.

I think it is very difficult to say this midwife was wrong without being there or at least having more answers from the op.

GothDetective - why was it midwife 1's prerogative to be annoyed that midwife 2 had offered an epidural and the woman had decided to have one? That would sound to me as if midwife 1 had an agenda for the birth, that midwife 2 had changed. Is it OK for a midwife to have an agenda, if it is for a birth with no interventions/pain relief?

By handing the labouring mother over to her colleague, she was showing her belief that midwife 2 was up to the responsibility, and therefore midwife 1 should accept the actions of her fellow professional, unless they hurt or otherwise adversely affected the mother or baby.

The OP hasn't said that the mother was pressurised into accepting the epidural, or that she was unhappy afterwards that she had accepted it, nor has she said that the mother or baby suffered any problems as a result of the epidural.

It is your practice not to offer pain relief to a mother in labour - that is fine, but I believe that it is equally fine to ask a woman in labour if she would like to consider some form of pain relief - some women will respond better to the first approach and some will respond better to the second. As long as the midwife is sensitive to the woman and her needs, and is listening to her, either approach should work well.

OP - I would like to know what you role was in the birth of this baby, what relation the mother is to you and what your problem is.

Only read first post.

I say it's fine. Not offering pain relief is like not offering a cup of tea, and waiting for someone to ask. If she hadn't wanted the epidural, she'd have said no, like I did with Ds2. She did want it, and it clearly worked at relieving her pain. It's a good thing.