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.

Admonishing the midwife for offering pain relief to a woman in pain even though they stipulated previously that they didn't want it is a bit like a person being angry at someone for offering them a cake when they were hungry, even though they'd said they were on a diet. There was the option to refuse as well as the possibility that her circumstances and feelings had changed.

I think to write off the opinions and decisions of a labouring woman as a delerious and unworthy is removing the woman's power from the situation, not the reverse. I think it's shocking that a woman should be held to her 'birth plan' - during labour your priority is just want to get through it and end up with a healthy baby - not to strive to get a nice little 'birth story' to regale after the event and to process and internalise afterwards. The perogatives of a pregnant woman and a labouring one might be totally different - they equally might not, hence the choice and option of pain relief.

" 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". "

We don't know if OP was there, and assuming the OP was the first midwife, then she was off to lunch so absent while this was going on.

I can understand what people are saying about a midwife undermining confidence by offering an epidural, but to give the benefit of the doubt - she possibly just thought she was helping.

I don't see that she had evil intent by suggesting an epi, which is is why I think FF's 'utterly fuming' comment is way over the top, and that unless she was the woman herself (who accepted ) then her reaction to all of this disproportionate.

Other than that - what mayorquimby said.

Sounds the same as my labour with dd2, spent hours in the bloody birthing pool with no joy, water kept getting cold so ended up having an epidural and dd2 came 20 minutes after. My choice though, i could have said 'no' and i'm sure this woman had the choice, she was not forced to have an epidural?

You can't have him - he's MINE!!!

gagamama Wed 10-Feb-10 11:31:36

"I think to write off the opinions and decisions of a labouring woman as a delerious and unworthy is removing the woman's power from the situation, not the reverse."

Yes!!! To me, empowering does not mean telling me what I ought to think; it means listening to what I do think.

Who actually says 'labouring bautifully' ?! Far too much of the candles and whale music rubbish for me.

If she didn't want the help she wouldn't have agreed! Myabe OP should stop judging and understand that it wasn't her decision to make.

I reckon FF is the beautifully labouring woman, and regrets accepting the epidural.

Will we ever know??

I'm pregnant with DC2 and having had a long, exhausting labour with DC1, eventually choosing to have an epidural which unfortunately I had a hugely bad reaction to, I'm keen to avoid an epidural this time round.

I was thinking of hiring a doula to assist me, but tbh if the OP turns out to be a doula then I'm not sure I would want someone so judgmental in the room with me.

"Labouring beautifully" despite it being long, painful and tiring? That sounds bloody patronising TBH and there's nothing 'feckin' beautiful about it when you have been labouring like that with Baby no 1 and have no clue what is to come or how long it is going on for. By your definition, I laboured 'beautifully' for 30 hours but ended up with an epidural because I was just so feckin exhausted. I was able to deal with the pain with the entonox but I could not cope with being knackered and only being 4cm dilated after those 30 hours and not knowing how long it would go on or if I would have the energy to push DS out so I chose the epidural. I don't even remember if I asked or they offered, but although it went wrong it was absolutely the right call in the circs. And actually I did deliver him myself in the end.

You know what, I'd rather have the same labour again than feeling there was someone in the room who was meant to be supporting me entirely who actually ended up feckin furious that I had ended up being monitored on a bed as you are. I don't want negative energy like that in the room while I'm labouring.

Get over yourself OP. Unless you are the mother (and it sounds like you are not) then it's not your birth, it's not your choice. I'm feckin furious that you think it is your place to be feckin furious.

And if you are a doula then I'd be very nervous of hiring one now.

If the OP is the mother, then I think she has to accept that, for better or worse, that was what she told the midwife at the time. If she feels she made the wrong choice, that is not an argument for denying other women their choice. Personally, I felt quite able to take responsibility for my own decisions in labour and would have resented deeply any suggestions that I needed somebody else to think for me.

FeckinFurious, YANBU.

OP, YANBU.

I would be furious too. Woman says she doesnt want an Epidural... Midwife gives, because woman is in slow labour ????
SO ?

Get her out of the pool, get her moving, then see if she is willing do these things before offering an Epidural.

What was on womans birth plan ?

Women do not nessceraily know what they want in the middle of labour, but if they were adamanant before hand that they did not want an Epidural, then other things should have been offered to help woman before offering the Epidural.

I got pulled onto the bed for delivery, by my midwife at birth of DC1 ! (6.5)

I was happily moving around the room before hand...
I wanted to squat.... you know what she said... ' That can make you tear at the front ' !

Its difficult to make any kind of meaningful comment without knowing all the facts OP.

Did the woman write in her birth plan that she didn't want to be offered an epidural/other forms of pain relief?

With DS I wrote in my birth plan (or birth preferences - as you can't really have a plan can you..?) that I didn't want to be offered any pain relief and if I wanted anything I would ask. Midwives respected that which was great. I asked for gas & air and I got it. I would have been mightily peed off if they had offered me an epidural as there were points where I may have accepted it and I really didn't want one. Knowing that they thought I could do it without kept me going.

However, if you haven't made feelings about pain relief known in advance I don't think it is wrong for a midwife to offer if she judges that a labouring woman is struggling to cope.

So whether YABU or NBU depends, IMHO, on whether the woman had made her preferences clear to the midwives in advance of her labour.

"Women do not nessceraily know what they want in the middle of labour"

So, the midwives should ignore a woman's request because she doesn't know what she wants? For every thread like this there is another from a woman complaining that she wasn't given an epidural because the midwives tried everything else first and then it was too late.

I would be utterly terrified to go into labour thinking that whatever I'd said beforehand would stand, no matter what.

I am all for natural childbirth but sometimes the obsession in the UK with having the exact birth you want drives me insane.

megonthemoon "Get over yourself OP. Unless you are the mother (and it sounds like you are not) then it's not your birth, it's not your choice. I'm feckin furious that you think it is your place to be feckin furious."

Well said!

Joanne - you are talking rubbish - the midwife did NOT give the woman an epidural without her consent and against her will. FFS, the woman climbed out of the waterpool and onto the bed - if she had been dragged there, forced into the position you have to adopt and hold whilst the epidural is placed, and then injected against her will, that would be very different.

If the midwife had given an epidural despite the woman saying 'No', that would be an assault, and that is not what the op describes.

What happened here, from the OP's account, is that the midwife offered an epidural, and the woman decided to accept voluntarily.

A birth plan is never set in stone - it cannot be because labour is different every time for every woman, and you cannot know in advance what is going to happen and how you are going to feel about it - and you might change your mind!! If a woman writes 'No caesarian section' on her birth plan, and the baby gets stuck and is in distress, and a cs is the only way to deliver the baby alive, should the woman be forced to stick to her birthplan? Of course she shouldn't!!

I don't know the details of your labour, but on the information you have given, I would say that the midwife was totally in the wrong when she pulled you onto the bed to deliver your child, and wouldnt' let you give birth squatting. If there was some actual reason why she thought squatting would be dangerous for you or the baby, she should have done a better job of explaining it, at the very least, so you could make an informed choice. If she wasn't experienced enough to deliver you that way, she should have said so ahead of time, and ensured you were delivered by someone who was. You have every right to be furious about what happened to you.

Hmmm. My post to this thread last night seems to have disappeared, got very strange page back after submitting it.

I'll try to be more concise this time round as typing out the differences in 1st and 2nd births made me realise I was still pretty angry about the first.

First time around - induced, very slow start. Eventually got really painful, was begging for an epidural and was told I had to wait. Turns out mw hadn't even gone to get my name on the list (I knew there was typically about an hours wait) for over an hour after I first asked. Kept being told it was going to get much more painful and so I didn't need epidural yet, had got at least 9 hours left until the baby popped out. I was in complete agony and couldn't bear the thought that it was going to get significantly worse and be going on for so long so was begging and begging for epidural.

Suddenly I started to push. mw freaks out, thinks I am nowhere near ready - but that would be because she hasn't bothered to check for several hours and had assumed she knew how I was progressing.

Turns out that whilst things had gone very slowly to start with, they they went very quickly and very painfully. To the point that the mw asked me why I hadn't said anything and that it must have been really painful as they very very fast strong contractions Not sure why screaming that I was in agony constant begging for an epidural counted as 'not telling' (and I hadn't ever said that I was against having an epidural so it wasn't that she was trying to protect me from myself and keep to a birth plan that stated no epidural).

So it ws too late for an epidural and ds1 came out fairly soon afterwards.

Second time around - different hospital - mw who knew me well. In the outpatients dept for a consultant's appt but contractions had started just before I got there. Consultant told me to go home and come back in a few hours when I'd been in labour for longer despite having 3 contractions back to back by that time and getting maybe 10-20 secs between a set of contractions

mws on the dept on the otherhand were digging out the birth kit as they weren't sure whether or not the wheelchair they had rung up to come and get me to take me to the delivery room would get there in time. I did just get to the delivery room - in extreme agony again but mw was able to say that I was only 10 mins away from giving birth so the end was in sight, not least as I was able to turn my tens machine up and up and up and not worry about keeping it down so there was still some for 8 hours later.

Same pain but completely different coping with it when you think you have 10 mins as being told that it is going to get much worse and take hours and hours more.

All came down to the way the mws treated me - first time they assumed they knew what was happening rather than checking what was really happening and second time, a very on the ball mw who was able to reassure through the pain made it so much more manageable.

In the op's post - she may well always assume that women will ask for epidural if they want it and know that that is ok. However if the woman labouring had seen a different mw who had said that not to worry, you'll always be offered pain relief when it looks like you need it, then she might have been waiting to be offered it - you just don't know.

If she didn't know she could always ask a more general question about whether or not she wanted to think about having more/different pain relief. That way, not directly offering it. But reminding woman in labour that there are options. Not like you are sitting there completely rational and able to have a sensible conversation if you are knackered from a long painful labour!

Does it cut the other way round too, I wonder. Supposing I had put on my birth plan that I wanted every kind of pain relief going and then when it got to the crucial moment decided I did not want the epidural- should the midwife still assume that the poor thing can't possibly know what she wants now, we'll have to stick to the birth plan?

A lot of these posts don't sound to me like it's really about doing what the woman wants but about following an agenda about what is the best birth.

Personally I feel a lot of the posters here are too harsh on OP.

Noone here knows the facts of the case better than OP. I'm therefore guessing that there was a reason why she was upset by it which is more than she felt that the woman went against her birth plan. I guess that if she'd just changed her mind then OP wouldn't have been so upset. That's perfectly reasonable.

"labouring beautifully" is a reasonable term. It's hard, it's painful but it's doing a job when it's going properly. OP implied that the woman was coping and in control, if tired, and who isn't. That's all good. Hard, but good.

Often women are pushed into interventions such as epidurals that they didn't want, but are not in a strong enough position at that time to refuse. Better support from the midwife MAY have avoided it. (Another poster said this where their husband was too upset at seeing her in pain - a very common thing for husbands to do).

That is not to say that the woman was not "empowered" (FFS). But that it's really hard to deal with outside stuff when you're inside yourself and labouring and to make decisions for yourself. Not impossible, hard.

I'm guessing that if the OP felt that this was the right thing for the woman from the woman's perspective, that she wouldn't have posted.

I'm furthermore guessing that this is an example of the problems caused by understaffing and overworked MWs who simply can't spend the time coaching and supporting women as they need.

Therefore I feel that as the OP knows the circumstances, chances are she's not BU.

I had ds1 without any pain relief & was keen to do the same with ds2 who's 10 weeks old. I'd always said I would never have an epidural & having given birth once assumed I knew what to expect. This time round my labour was much longer & really painful for a very long time. I was still only 2cms when I was in absolute agony where I was already 7 with ds1 by the time I was in that sort of pain. When I asked for pain relief I was offered an epidural which I turned down but having tried a pethidine equivalent which did nothing I asked for the epidural I'd previously refused. I was perfectly capable of refusing the first time the epidural was offered & the OP has given no reason to believe this wasn't the case for her 'beautifully labouring' woman. We all have limits & maybe the mw could see this woman had reached hers.

carrots, if the OP has access to information about the woman's perspective that she has not shared with us, then that is AIBU by stealth and really not our fault for not guessing at things she hasn't told us

I'm totally confused by this thread. One thing is clear - the midwife didn't force the woman to have an epidural,it was offered and the woman accepted.

Is the OP the labouring woman? Did she plan to have a natural birth but then ended up with an epidural for the pain and now regrets it? I can't work out where the OP is in all this!

One thing's for sure - no one is forced to have an epidural, which is a major medical intervention. It also increases the risk of further intervention. If you are determined not to have one, then don't have one. I made sure I wouldn't by booking into a MLU where they weren't available - I really didn't want to go down that route. Some women plan to do without, but when it comes to labour, change their mind. Each to their own. But I don't understand this apparent complaint that a woman labouring 'beautifully' was coerced into having a medically unecessary intervention she didn't want.

cory not unfair! But then it's often the case that the OP doesn't give enough info - not deliberately but because she doesn't realise that her original post wasn't detailed enough. I am not really making judgements one way or another, other than to give her the benefit of the doubt as opposed to berating her, understanding that MW support isn't how it should be. claire may be right that the MW had seen that this lady had reached her limit, although the OP implied that she didn't believe she had. If she's right, it was possible a shame. If not, it was probably the right thing to do. I don't know, I just feel that the OP didn't deserve to be slated for it - personally. 'tis all.

Sorry I so hate all this " you dont know all the information/facts" well of course we dont, we can only go by what information has been given by the OP, and can only wait more until she chooses to divulge more info. so posters will comment on the information given!

I find it all a bit pointless tbh, as its NOT the mother who has came on and gave her opinion of her situation, its all guess work, if it wre the mother who game on and was unhappy about the situation, then I could comment! but I refuse to comment from a supposedly "birth partner" or whomever this OP was to the birthing mother!

you are not to judge the mothers CHOICE! as simply she was offered a choice, and took it.

Why would it be in a hospital's interest to try to coerce a woman into an epidural anyway?

They are expensive.
They require an anaesthetist
They mean the woman has to be continuosly monitored.
They increase the likelihood of instrumental delivery (ie doctor needed, more expense, more risk of long term damage to the mother)

When I had my babies, the midwives prided themselves on being the experts in supporting the mother to give birth with as little intervention as was medically needed, through using all sorts of supportive methods. Midwives are the specialists in normal straightforward births. I don't get why a midwife would want a woman to have an epidural anyway, unless it was clear the woman was seriously not coping.

I am still confused. It was offered. The woman accepted. The woman could have said 'No thanks' and continues to labour beautifully.