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.

How did the mother feel about happened? Isn't that what matters?

I was offered an epidural (which I refused) on meeting the midwife in the hospital before she even examined me. Ds was born 5 minutes later.

Doesn't an epidural add some elements of risk to the situation that weren't there before? Not the best course of action I would have thought unless the situation was going tits because mother not coping... but then, in that situation, if I was said mother I would have been grateful for emotional support and encouragement rather than a lazy offer of anaesthesia.

Ahem, "going tits up" that should be.

"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?
"

I said I'd be annoyed if I was m/w 1 for the reasons I stated that I don't think its a good idea to ask but to wait until the woman states she wants whatever. I think I made my reasons for this thinking quite clear.

I don't have an agenda for birth without pain relief at all. Maybe some midwives do, but if a woman tells me she wants an epidural I'll go and sort one out for her. We have a co-ordinator at work who if I come out a room and say "x wants an epidural" she'll say "well have you tried supporting her though other methods?" Which I'm always a bit about. Sometimes it may be appropriate to do that but some women just want an epidural without trying massage/water/breathing/etc and whatever they want is fine by me. The only agenda I have is to do everything I can to make sure the woman I'm looking after gets the birth she wants. Not always possible but I do the best I can.

Anyway I'd never be in m/w's 1 position as I don't go for a break when looking after a labouring woman. If she's delivered and is fine then I'll have a break but otherwise I don't.

I think it's blatently obvious how much of an agenda that others have regarding the birth choices of another woman -looking for validation of your feelings on a forum like this is a pretty big indicator of that surely.

Standanddeliver - I was so bloody scared of asking for pain relief in my second labour because it was drummed into me how 'marvellous' and 'brave' and 'incredible' I was to have coped without any analgesia first time round. I continually denied that I was in as much pain as I was in because I was scared of being seen as a wimp or a failure. When the MW left the room I was hysterical on DHs shoulder and he was begging me to ask for help but I wouldn't. It was ONLY when another midwife came on duty, with a fresh assessment of the situation, a fresh assessment of my pain levels, that she suggested an epidural. As it turned out baby was OP and some other bizarre presentation. if that second midwife hadn't taken 'control' to some degree of the situation,
I'm not quite sure what would have happened. I think it's absolutely essentail to be informed and aware before you go into labour, but it would concern me slightly that you refuse to suggest or offer an epidural. Are there any circumstances under which you would digress from that ? (Sassybeast who wants another but keeps getting cold feet )

I think the Midwife should have offered encouragement rather than an epidural. I know it helped me through my first labour, being told I was doing well. If I had wanted any help, I would have asked.

Hmmm Sassy your post makes me think... I was in a similar situation with DD2, who was breech, and it hurt much much more and I felt like a total wimp begging for someone to get me some sort of relief. FWIW the midwives also thought I was being a wimp. But I digress.

Unless you were the woman and feel pressured, I don't think it is your place to get that bothered about it.

Was the mother that bothered?

I really don't understand why people get taht bothered about how babies come out. I wanted a home birth but had an emergency c section, so what? At least me and baby were fine.

I specifically asked not to be offered any pain relief that I hadn't requested myself during my one and only labour so far. I did have gas and air as I knew that it would not affect my baby but I had it in my mind that maybe I might have pethidine if things got bad (they did, as they always do, but not bad enough for me to want it). I knew I didn't want an epidural and would not have accepted one, but then I was lucky enough to have a relatively swift and painless labour. It all depends on what the mother had said before labour started and in early labour. If she didn't want people suggesting pain relief then it was not right of the midwife to offer it IMO unless she thought there was a specific clinical reason for it, like maybe suspecting that the mother would need a forceps delivery and wanting to protect her from unnecessary pain. But if the mother was open to the idea of an epidural, well, it's up to her. Personally, I do think maybe some, not all, women have them when they could have coped without and that they do seem to lead to further interventions which can't be a good thing. But I have only had one baby and I don't know how I might feel next time. I would expect any midwives attending me during labour to adhere to my birth plan and try to follow it as far as possible (and mine wasn't exclusively all about no pain relief and natural birth etc, it also detailed stuff like if I had to have a GA I wanted DC to be handed to my partner asap and allowed to have skin to skin with him if I wasn't available and what was to happen if I had a CS under local etc).

"Personally, I do think maybe some, not all, women have them when they could have coped without"

I know, those fuckers, having epidurals just for fun.

"As it turned out baby was OP and some other bizarre presentation. if that second midwife hadn't taken 'control' to some degree of the situation,
I'm not quite sure what would have happened."

Well - as there's no evidence yet that having an epidural improves your chances of having a healthy birth I imagine you would have gone on to have your baby anyway. Did you have a vaginal birth? If the labour hadn't progressed and a c-section became an issue you would have had a spinal at that point I suppose. You can't know how your labour would have progressed had you NOT had the epidural. I had an epidural at 6cm dilated with my first, who was OP. Afterwards I said for quite a few years - 'thank goodness for epidurals - couldn't have coped with another 12 hours of labour at that intensity without one'. After a while though I started wondering how the labour might have been different without the epidural. Would it have gone on at that intensity for another
12 hours? Don't know. All I do know is

that the support I had in my third birth, which was a much longer labour - just as painful - enabled me to cope without an epidural. And I'm not brave at all - as my DH was happy to tell everyone after the birth.

Can't imagine a situation where the midwife has had a chance to discuss pain relief with a mum - where she'd made it clear that the mother could ask her at any point for pain relief - where suggesting pain relief would be appropriate - unless the mother was going to have a procedure which might cause the additional pain (eg assisted birth) and you wanted to make clear the options for pain relief in that particular situation.

"I really don't understand why people get taht bothered about how babies come out"

Possibly because some of us feel it's a bit shite that loads of new mothers end up having unnecessary major surgery, postnatal infections, babies in SCBU, breastfeeding traumas etc, etc, just some of the things that go hand in hand with labours which involve what is sometimes avoidable and heavy handed intervention.

I'm sure some women do have epidurals who could have coped without them. But thats up to them, maybe they didn't want to cope. Some women don't want to feel any contractions even if they are able to cope with them. If thats what they want then thats fine.

I had a friend who was adament throughout her pregnancy that she would have an epidural. She didn't want to cope, she didn't want to see how she "got on". She just didn't want any pain whatsoever. Her choice.

Actually I have once and only once suggested an epidural to a lady. It was her first baby and baby was OP. She had a very strong urge to push at 6cm dilated, I tried all sorts of different positions and she was still involuntary pushing. I was very newly qualified at the time and worried as I'd always been told that someone having their first baby should never push until fully dilated as it can cause the cervix to swell (I've since read more reserach on this but thats a whole other thread).

Anyway the co-ordinator said I ought to offer the woman an epidural. So I did and she had one. She had a raised BMI as well and even with position changes (as much as you can with an epidural and a raised BMI) she got a bad pressure sore. She sued.

feckin i think you ned to debrief this with your mentor really.

(am assun=ming you are a Doula, could be wrong)

Am also assuming you were very thorough in your antenatal sessions with your couple and had discussed what kind of pain relief mum had wanted. Am also assuming she had a partner dp/h (am assuming alot I know)

Unless mw2 forced epi on lady then I'm afraid it's not really your place to be feckinfurious really As others have said even if not in her original birth pan, we all know how labour can change a woman's outlook on things, and maybe the epi was just what she needed to help her relax and progress, they are not always the spawn of the devil

You haven't said outcome of baby and mum, you left it at mum on bed, managed labour. Was mum happy after this? Was a healthy baby birthed by a healthy mum?

Also speak to your couple after the even, (if you haven't already). How do they feel about it, then lay it to rest.

It's not about us, it's all about supporting couple's choice.

If you are not a Doula, ignore debriefinf stuff but if you were just a birthing partner, the all about the couple still stands. (did that make sense? )

"If thats what they want then thats fine"

Agree. But the voices which are often so loud in support of choices in childbirth when it comes to women having the freedom to choose an elective epidural are very quiet when it comes to arguing for the radical change in maternity care we need for more women to realise their choice for an epidural free birth.

Women have a right to make an informed choice. But if you know you don't want an epidural you also need to know that it's quite likely you're going to need one if you give birth in your average NHS consultant led unit. Particularly as a first time mum.

To be honest so far it sounds to me like the only person who had an agenda as to how the birth should go is the OP.

Have you ever been through labour OP?

Are you going to come clean about what your role was in this?

Oh feck off. She was tired - women having first children have no idea how badly it will hurt or how long it will last and she had some pain relief - noone would have handed her a well done medal at the end and the baby was born healthy so get over yourself. Honestly birth nazis drive me mental.

On paper I wanted no drugs and a water birth and that is what I discussed with dh before going into labour. When it came to the actual delivery I desperately wanted (and am very glad I had...) an epidural. In my view there are no prizes for pain and it should be the person who is in labour who decides. I would have been absolutely furious if someone had stopped me having the epidural. What is your connection to the birth you are talking about?

Fecking hell. Nobody gets a medal for having teeth pulled without anaesthetic, but when it comes to giving birth, it's back to the middle ages.

Fwiw, I thought I wanted to have a pain relief free (maybe a bit of G&A for the giggles) birth. That was before the actual birthing bit started.

All the natural birth lobby propaganda had me terrified of asking for and accepting pain relief, giving myself much more pain, stress and feeling sick as a result. I had my husband and a midwife almost getting angry with me because I was so stubborn.

In my opinion you cannot make the decision to do it without pain relief just from theory. And women should not be bullied into sticking to their original birth plans when they notice that it doesn't work that way.

I find the whole mythology around the tree-hugging whalesong waterbirth with no analgesic or anaesthetic deeply misogynist nowadays.

There's no need to be a martyr to be a good mother.

Well, it's HER choice, NOT yours! The midwife made an offer and she accepted it. There's nothing wrong with having an epidural!!

The labouring mum could have said no to the epidural!?

I'm with FeckinFurioua.- this almost describes my labour with DD.

I had lovely midwife all throughout my pregnancy and labour- encouraging, supportive, everything you could ask for. I was 8cms dilated and starting to panic but I trusted her when she said I could cope and that I'd soon be meeting my baby.

Well she went away and another midwife was with me, started shouting at me that I was doing it all wrong and that I must have an epidural- I was 8 centimetres dilated! Well I assumed obviously that she was right and I needed the epidural and so took it. Ended up with forceps delivery 8 hours later and regretted it ever since.

Im sure my midwife No1 was furious too because she knew me and knew what I was capable of.

This was the reason I was adamant that I had DS in a midwife led birth centre- so no pushy horrible midwives forcing all sorts on me to make their jobs easier!

Having read the whole thread I think that the only person who is in a position to make a decision about pain relief is the mother. All options should be available to her. No-one but the mother alone knows her pain threshold so the OP is making a very subjective judgement about the labour being "painful... but mum coping well". what were her actual words?

From personal experience, the MW totally underestimated the pain I was in after the prostin gel made contractions start within about 15mins. I had a hypersensitivity reaction and was offered 2 paracetamol & a hot bath. Thankfully the consultant heard me and i was given pethadine. He wanted me straight into theatre but because they were too busy, he suggested an epidural and see if labour could progress naturally. I could have hugged him as I was able to have a vaginal birth with DS1

Morloth i think your post of 17:31 is actually quite rude. Your are obviously naive about the role and responsibilities of a student midwife and the fact that you obviously know better than they do and btw you have to be over 18 to train and of a group of 50 std mws there will be an average of half being older than you probably are.

And I would agree with you OP, I wouldnt be happy about mw no2 saying what she did, it totally undermines the womens confidence and sense of coping. Although I wouldnt be utterly fuming as unfortunatley its just one of those things-you will get mws that will think as we do and you will get mws that are all to quick to offer pain relief when its not neccessarily needed.