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 can understand OP's pov. I have a friend who didn't want epidurral but wen she was 7 cm (and, she ays, coping quite well) the MWs came in and said if you want an epidural you need to have it now. Anesthetist (sp?) is outside the door. Last chance. So she had it becasue she suddenly started thinking 'what if I do need one? Maybe I won't cope'.
difficult to say without knowing how the labouiring mother felt.

Standanddeliver - for about an hour of the time I was pushing, I was on hands and knees. The midwife who had been caring for me that shift had got the senior midwife in because she hadn't delivered a baby like that, and needed supervision.

The senior midwife didn't suggest any other positions to me, and by that stage, I was very tired, so they didn't occur to me either. She did say that sometimes moving across from the bed to the table in the high risk room was enough to move the baby into a better position and get things going.

As I said, I think she was getting ready for more serious interventions, and until you asked the question, it hadn't occured to me that there were other things we could have tried. However, I had had a long, and rather inefficient labour, so possibly she decided that my body wasn't going to get the job done, and I needed more help.

I do remember her saying, when she came into the room, "If we were putting half the effort into pushing that we are putting into making THAT noise, we could push this baby out right now!'

By the end, I was grateful for the episiotomy, and I doubt I could have carried on pushing much longer. I shall always wonder, now, whether standing up or being on my side etc could have helped, but not in a sad or regretful way - at the end of the day (just for you, Reality ) I had a healthy baby boy, who is now nearly old enough for a provisional licence - now that IS traumatic!!

My other two labours were very long and somewhat inefficient too - 24 hours and 20 hours, but I was at home, not in hospital, and in both cases, second stage was very quick indeed - i.5 minutes with ds2, and two pushes with ds3 - both lying on my back in bed.

I see OP hasn't come back to explain her role in the birth nor how the actual Mother felt about things.

Ooh, that evil wench of a midwife - suggesting some means to help the (beautifully) labouring woman, should she want it....!!

FeckinFurious - 'utterly fuming'?? Really...? Isn't that just a tad over the top?

I'd be utterly fuming if a midwife refused me an epidural when I was desperate for one; not if she offered me one as possible helping hand.

I'd suggest trying to put things in perspective.

For what it's worth - I was induced and strapped to the table so had an epidural, an episiotomy and a ventouse delivery, but was up and at 'em that same day, a bit sore, but ditched the painkillers within a couple of days. Breatsfeeding took a while to establish, but it was a latch problem, most definitely not a supply problem!

I know people like to paint a doom and gloom picture of life post-intervention deliveries, but it's not a given.

Ok, I'm a doula and I can understand this.

The act of /offering/ an epidural actually does change things. It is a vote of no confidence from a midwife (or can be perceived as such). The woman thinks, "Shit, this midwife thinks I can't do it."

There is quite a lot written about this and I've been trained to talk to women about their wishes and to specify if they don't want to be /offered/ pain relief.

From a personal point of view, I've been in labour, begging for a C-Section when it was the last thing I wanted. On my birth plan, I put I absolutely didn't want a C-Section unless it was absolutely vital. I was really happy afterwards that my midwife reassured me through that dark period and didn't just take me at my word.

Bear in mind that just before and during transition in particular, most women have a moment where they say 'I can't do it' - it's perfectly normal to have this moment and if you can get through it, you CAN do it and do it well.

An epidural carries significant risks that many women would like to avoid for themselves or their babies. It sucks if a midwife undermines that wish by encouraging them to use one at a period where they are vulnerable.

(I'm not saying labouring women don't know their own minds, or that they're not allowed to change their minds, but your resolve can weaken during labour and you may regret that afterwards if you were very certain about your birth plan. One strategy doulas have is to say 'Ok, let's try two/three more contractions and see how you're doing' - if a woman agrees to it. These things aren't sprung on women, they're something that is discussed beforehand if she strongly wants to avoid epidural.)

I agree with StayingDavidTennantsGirl's thoughtful post.

FWIW, I had a birth which was in some ways opposite to the one she referred to. I had a wonderful midwife who supported me though a significant part of the labour, made me feel in control of the process, got me an epidural when I asked for one without judging me. For her entire shift I was having a great labour (by which I mean one that I will look back on with good memories). We hugged when her shift ended.

Then she went off shift. MW2 came on. I actually gave birth during her shift. It was awful. She spent a lot of time talking to the student midwife about how she hated the idea of the hospital birth centre and the lazy women having epidurals, and the "best birth" she had ever assisted at which was in a forest somewhere, completely without pain relief.

She ordered me not to touch the button which I had been given to allow me to give myself pain relief when I felt I needed it because she "wanted me to have a proper labour without pain relief", and I was in the position of having to wait until she was out of the room before pressing it like a naughty child in order to get the pain relief I wanted. I have no doubt that if she had been able to, she would have prevented me from getting the epidural at all. Thank goodness for MW1.

When MW2 stitched me up after giving birth without any pain relief (this had been taken away by then) and with frequent comments about me it felt as if she was trying to teach me a lesson.

I wonder if it was the too tired thing that was the issue. I was labouring with DD1 in a MLU and was very tired (long prelabour, long labour, vomiting a lot etc.), but I was coping by going into myself, using hypnobirthing techniques etc. It wasn't a bundle of laughs, but I was OK.

Until something happened. Maybe I had reached a certain level of dehydration, or my blood sugars were too low, or I just was too tired. But I had no resources left at all. Which meant that I wasn't able to use the calming techniques any more (because they require concentration and effort) and I panicked. The pain was like nothing on earth. I was hysterical. I would have done anything to stop it. In the end, I had a half dose of pethidine and passed out. That gave me enough resources to get to the second stage.

I think that it is possible for a midwife to convince a first time mother that she cannot cope and that she needs an epidural. But I don't think that you can deduce that that has happened just because the woman had been OK 30 minutes before. Particularly if the labour was "long and painful", just like mine.

Lisianthus - what a horrible midwife and a horrible experience for you! Bullying like that is utterly unacceptable - not to mention counter-productive - I doubt her comments made you feel more confident in your body and your judgements!!

I didn't get pain relief when my episiotomy was sutured either - and was so knackered it didn't occur to me to ask for the gas and air back - but at least I was spared the nasty comments you got. The one comment I do remember from the senior midwife, who did the suturing, was, "Just look what a lovely, natural-looking perineum I am giving your wife, MrSDTG!!' Poor dh wasn't good with hospitals and blood at the best of times, was having to hold up one of my legs as I'd got cramp in the stirrups, doesn't like blood or watching the gory bits of ER or Casualty, and went pea-green !!

Oh, stitching without pain relief is so nasty. I remember the MW with DC1 stitching the 2nd degree tear I had, and shouting at me to stop twitching becuase "it's all swollen and stretched, you can't feel anything anyway." Special.

Heh - My DH was like that too. I love your MW's attention to detail and way of thinking about it though!

I'd really like to hear more info about the situation in the OP and who the OP is in relation to the woman giving birth.

eep - I means SDTG's MW, not yours BigWeeHag (love those books btw).

Stitching without pain relief?! How can anyone think that is OK?

I can understand what you are saying, Carmen, particularly as I believe you are in a very epidural-intensive country. Must be quite difficult to know what to do on the day though: have to say, I would have found it hard to forgive a midwife who had denied me that episiotomy when I asked for it, so might well have felt the same about an epidural.

Have never been in the position when I have begged for extra pain relief: I suppose what I would have liked in a situation like that would have been a midwife who was sensitive enough to really hear whether this was a momentary blip of confidence or whether I really had changed my mind; who was perhaps able to encourage me to go through another few contractions, but who was not so committed to her own ideas that she could not then change her mind.

On the whole, I reckon I have probably heard about an equal number of women regretting that they did not stick to their birth plan and women regretting that the birth plan was not adapted to changing circumstances. And the majority seem to be like myself- look at the birth plan and shrug their shoulders with a wry smile, 'oh, was that what I thought I wanted'.

Hmm. I had a birth without medical pain relief, which was what I had hoped for. I believe I was 'labouring beautifully' (though bloody painful of course!) as in progressing through the natural stages well. Did the entire first stage at home.
I was totally knackered at one point (in hospital) and needing lots of support (which I got). No one suggested an epidural to me and I'm really glad they didn't because at the time I probably would have grabbed it! So very glad it wasn't even brought up, because I didn't fully understand at the time that I was just going with it, and actually doing fine.
Afterwards, I was mobile, pumped full of endorphins, sore but grinning from ear to ear (before I fell asleep).
Obviously, this is just my own experience of that birth, but I do think that women in labour may be very 'open to suggestion'.

Feeling very of these women who labour beautifully. I labour like an old hag.

Lisianthus, I think we had the same midwife.

jesus, how has there been so much debate over "adult woman offered something, adult woman chooses to accept"

cory
I don't think all women 'labour beautifully' every time... or maybe some do, the lucky things.

When I said that women in labour are open to suggestion, I meant that the midwives have to be so watchful of the particular woman, in what they suggest - be it epidural for someone who is beyond their limit, or just encouraging and praising through a few more contractions to help someone through a rough bit. I'm not convinced that this type of 'bespoke' care always happens.

I'm currently in the middle of requesting my maternity notes to go over why I ended up with an emergency c-section for my first (and only so far) birth and this thread has really made me think about how I thought was coping well until he midwife offered me: "pethidine or epidural".

She offered me pain relief because she said she could hear me from the other side of the corridor. I was making a lot of noise (mooing as opposed to screaming) because of the intense pressure and need to push but I wasn't in pain as such at that point and would not have asked for pain relief at that point.
Of course now I realise I didn't actually tell her I wasn't in pain (yet?). (I know it's obvious but I was very tired by that point and it just didn't occur to me to tell her).
I had "failed to progress" so they had started the drip.
The midwife did scare me off telling me that the drip was soon going to make the contractions a lot more intense, I asked for an epidural (not sure why I chose this one out of the two).

I don't know if I would have preferred that she didn't offer me pain relief, I do think that it was her job to offer it to me though and that it was my job to refuse it.
I think this is where the partner comes in and OP, if you feel she should not have been asked then maybe you should have asked "the woman", are you sure this is what you want, do you want to try this and that and the other first".

You see, June, I think that it's the midwives' job to be watching, waiting, encouraging, and then suggesting. But clearly I am talking about some utopia where midwives have time to stay with the labouring woman and get an understanding of their patient's experience.

My own experience of midwives was very positive. I remember when I was in advanced labour with DD1 (although I didn't know it was advanced) and I said I wasn't sure I could cope any more, she said "I've always found when women say that, it has got as bad as it's going to get". Even at the time I knew that was rubbish but it did give me the strength to carry on. As it did when they gave me time estimates of when the baby would be born - something to aim towards. And I remember the midwife with DD2 telling me that when you see me put an apron on, you know it's imminent. Basically they would just tell me I was doing really well, rub my back, help me try different positions. All this positive support and encouragement really helped me.

They did offer gas and air and I laboured and delivered in the pool with DD1, but they didn't offer anything else. Not sure how I would have felt if they'd offered an epidural. I think I'd have asked if they thought I needed one. To which I guess they would say something non-committal like only you know and we don't know if it'll get much worse etc. I may well have taken them up on it.

I love the way some people on here are so dismissive of "excruciating pain".

"Oh, it's only excruciating pain, man up, there's a love".

oh dear, slug. I'm so sorry. (Assuming it was the not-so-nice one, not the lovely MW1 one. If it was the lovely one then )

I am loving the phrase "labouring beautifully". Getting a mental picture of a woman with lovely hair and full makeup getting a shoulder massage from a david tennat lookalike DH, whereupon a beautifully dressed, gurgling happily DC suddenly appears in an antique crib by the side of the bed.

Sort of like "Birth by Vogue".

that was precisely the image I got lisianthus

David Tennant seems popular around these parts then