Anyone else 'tricked' out of epidural? (part 2)

[Chynah]

For those that feel the discussion still had some way to go........... please continue.....

I'm sure the lack of care in early labour AND pain relief culture is related to the fact that the NHS has a handy, cheap, and convenient get-out clause with this 'er it's physiological pain, so suffer, bitch' thing.

That and the fact that if you skimped on care and pain relief with any other patient, it would have much more obvious and immediate repercussions. For example, if you refused pain relief to someone having an ingrown toenail removed, the patient wouldn't hold their foot still to have the toenail removed, so you'd end up with a frustrated surgeon and a waste of operating theatre resources.

But a woman giving birth doesn't have to hold anything still. So conveniently for the system, she can just scream away on a bed (or car park) on her own, and hopefully sort herself out before either she or her baby are in imminent danger of actual death.

I think we women are our own worst enemies sometimes. We need to be supporting each other, whatever sort of birth we had, into improving the system that enables traumatic births to happen in the first place.

Instead many posters on here seem to be belittling others birth experiences just for being different.

Whatever sort of labour and birth you have, you are performing a wonderful, vital task of creating a human being. A baby. We all need to congratulate ourselves on this a little more, instead of denigrating others experiences for either being 'natural hippy pain-is-good indoctrination' or 'too posh to push, just get on with it'. We mothers have so much guilt and pressure put on our shoulders by society anyway why are we doing this to each other?

For the amount of time many people have spent posting on this thread, why not join your hospital MSLC and try and make an active change to maternity services? Or join other hopsital/health user groups (eg RCOG)? Set up a forum for parents in your area to discuss experiences and present this to the hospital? Nothing is going to change if we just bitch at each other.

Well done on getting on the news - although I fear (as usual with the media) the message may have got a bit lost in translation...

DrMcDreamy - I have skimmed through that article (and will read it properly tomorrow) - it looks very interesting, especially the parts about the stress hormones.

A few thoughts after reading the general discussion.

1. Epidurals can or can't prevent an obstructed labour. It depends on the reason for the obstruction. An epidural isn't going to stop a baby that is always headed for a deep transverse arrest (although it may make it easier to cope with and can be topped up fast for the inevitable C section). However, with a poorly positioned OP baby there is often a deep need to push felt prior to full dilatation of the cervix. If someone tries to push a baby out through a cervix that isn't ready, they end up with the cervix swelling and thickening instead of thinning and dilating - and a C section. If you put an epidural into these women and take away their urge to push, there is a more likely chance of the cervix dilating and the baby coming out vaginally. That's not to say that they won't have to have a C section, but they definitely would have to if they didn't have the epidural.

2. Doctors and delivery training. Not that it has anything to do with the discussion, but every medical student has to deliver 10 babies during their O&G attachment so I find it insulting to suggest that SHOs (who are 2 years out of training) don't know which end of a pregnant woman a baby comes out of. Consultants in O&G have had 7-8 years post-graduation specialist training. Registrars anything from 2-7 depending on how far along the line they are.

Ok, I've read the article now. I disagree with most of it! But it did ring true on a couple of points.

I think women who are scared at any point during their labour - because they don't know what's happening, because the pain is worse than they thought it would be, because they aren't in control - for whatever reason, if they are scared the pain will be worse. Which makes them more scared which ramps up the cycle which then becomes extremely difficult to break. If we can find a way to address that fear - then maybe fewer women would need an epidural to help break the cycle.

The second point is that by taking birth out of the home and moving it into hospital, we've taken the experience of birth away from other women so now really unless you've given birth before or have been in the delivery room with a relative or friend, you have absolutely no idea of what is going to happen. I do think that we've made it safer (as shown by the fact that maternal and infant mortality rates are so much lower) but I also agree that we've made it scarier (going back to the point above).

one of the side effects of hospital being a place of healing, is that they are therefore associated with sickness and death. It's hard to rewire the part of the brain that tells you hospital is not a healthy place. Having home like birth suites, home type comforts (music players, cushions, etc) can help reduce the fear that women understandably feel when stepping into a hospital to give birth.

Women not feeling like they will have to fight to get what they want in labour is another major factor. Knowing that an epidural is only a request away could reduce the need to request one. Equally knowing that a pool birth will not require an argument or stamping of feet will reduce fear in a labouring woman.

But more midwives is surely the main factor, as being left alone in a strange place must be the scariest thing of all when in labour.

And I loved that article BTW, and agree with most of it. However I also support hospital births because as well as being mammals who require a dark place to birth, we are also thinking women who are reassured by qualifications and a machine that goes ping.

"No. I think the deep meaningful event to a lot of women (myself included) is the baby not the birth."

You call for understanding and tolerance but I think your comments reveal a deep contempt and lack of understanding for women whose attitude to birth is different from your own. Do you honestly think that those of us who don't want pain relief think that the experience of coping with pain in labour is more meaningful than meeting their baby?

"I do not see suffering a lot of pain as being empowering - in fact I think it is a lot of mysogynist bull!t and entirely cultural in its origin"

It's not the suffering of the pain that's the point - it's the responding to it and getting through it that can be empowering for some women. And most women (myself included) have very practical, real reasons for doing without pain relief - they think they'll get the birth over and done with quicker and in better shape (and with a healthier baby) without than with. Many of us have also experienced birth with an epidural and birth without and know that we FEEL differently after a pain-relief free birth that is well managed: physically intact, more alive, 'higher', more confident. In other words - there can be a huge reward, physiologically and emotionally. So it's not all about being masochistic and macho - it's about trying to have the most positive birth for ourselves and our babies.

"Natural isn't actually best. A large number of natural births result in death."

What rubbish! I have never heard a health professional say 'natural is better no matter what the situation'. All midwives and doctors acknowledge that vaginal birth without instruments, when it can be achieved safely, is generally the best outcome for women. But they also acknowledge that some women will need medical help to safely deliver their babies.

"She made this statement I found astounding: "I feel as though I've missed out on the full experience of childbirth somehow - like I haven't done it properly". I looked at her and answered "It's pain. Trust me. You haven't missed much. You have three healthy boys. You've done very well."

How utterly 'right on of you'.

Reducing it to 'you haven't missed much' and 'it's pain' is a patronising and dishonest summary of the HUGE range of experiences and responses to both normal birth and c/s.

"However, with a poorly positioned OP baby there is often a deep need to push felt prior to full dilatation of the cervix. If someone tries to push a baby out through a cervix that isn't ready, they end up with the cervix swelling and thickening instead of thinning and dilating - and a C section. If you put an epidural into these women and take away their urge to push, there is a more likely chance of the cervix dilating and the baby coming out vaginally. That's not to say that they won't have to have a C section, but they definitely would have to if they didn't have the epidural."

Not so SouthoftheThames there is a lot of research out there at the moment that says that the early pushing urge is the bodies way of correcting the 'malposition'. By pressing the presenting part onto the pelvic floor it is encouraging the baby to rotate into a more favourable OA position for birth. Of course that is not to say that is the case on every occasion but it is true for many and it does make sense to me.

Another musing I had whilst reading this thread was I find it interesting that the word competeition has been bandied about with regards to acheiving a 'natural' childbirth. In my experience - and this is my experience as a woman of childbearing age as opposed to a midwife, the 'competition' I have encountered is of a different nature, ie who had the most 'dramatic birth' "I 'had' to have a section because the baby was in danger", "If the doctor hadn't come in when he did we could have died". Normal birth is actually sneered on quite a bit, DrMcDreamy remenisces on the time that she spectacularly lost it in the pub one night after what felt like the hundreth time her BIL (whose wife had a very 'managed labour', epidural, EMCS and other complications) said "Oh DrMcDreamy just opened her legs and the baby fell out, it was like shelling peas" - "Um no you fucking idiot, I had to work just as hard as anyone else, it fucking hurt and just because it didn't end with a dramatic trip to theatre and a Dr saving the day does not make my experience any less valid".

Ahem. Slightly off topic there

I would like to point out though my last 'rant' was not directed at any of the experiences shared on this thread, just in general.

I felt the urge to push with DD2 when i was only 5cm. The anaesthetist about to my epidural was horrified but assured by the midwife I wasnt about to deliver. It hurt like hell though and whe she was born she had a red cap like my previous ventouse baby where I'd been pushing but not dilated enough.

Cleo I am banging my head in despair!!!!

You said of my comments "You call for understanding and tolerance but I think your comments reveal a deep contempt and lack of understanding for women whose attitude to birth is different from your own. Do you honestly think that those of us who don't want pain relief think that the experience of coping with pain in labour is more meaningful than meeting their baby?"

NO! NO! NO! Cleo, Please listen!!! Your views are totally and perfectly valid. I completely accept them. I absolutely do not have contempt for your views. I do not agree with them but they are of exactly equal value to mine but DIFFERENT. When you have a baby, the midwife should respect YOUR views.

When I have a baby the midwife should respect mine.

Good gracious - so many angry people on this thread in Mumsnet ...... many of whom aren't even bothering to read posts correctly before having a go at a fellow user. And so people disagreeing vehemently and agreeing wholeheartedly with the same view in the same sentence. (not referring to the last couple of posts before this one).

Not much chance of a meaningful discussion here when people are just disgruntled and want to take pot shots at others - including even those with whom they agree.

I think the original question posted has been answered.

cleofartra - on the other thread (where you ask for experiences from women who have not had epidurals but don't feel they suffered as a result) - you describe your own attitude towards birth without epidural/anaesthesia: -

"For me it was a bit of an experiment. I wanted to see how it was to be pushed to the limits of my endurance - to see what emotional and spiritual resources I could call on to help me. Only time in my life I've ever had to tolerate something intolerable - it was very interesting."

Now, please, please, don't accuse me of making some women's attitude towards birth sound like some 'masochistic cult' (YOUR words, not mine, I would never ever describle someone else's attitude in that belittling way).

It is worth hearing your attitude towards your birth. You are entitled to every opinion you have about it.

My point was that I don't share that attitude, and I don't want to have my births or maternal care influenced by anyone who does. I have had times in my life where I've had to endure a few awful situations, physically and mentally. For a number of reasons, I don't feel chilbirth is an area where I want to be pushed to my limits, to see if I can tolerate the 'intolerable.'

Different people, different perspectives. I really genuinely feel you don't listen or respond to what is being said on these matters.

DrMcDreamy, I have also heard the 'competitive birth' experience expressed in the 'who's had the most dramatic birth'. It's complicated, though - I don't think it's just a matter of competition, I think there is often some genuine need to share bad experiences there. Just to pick up on something you say too - I feel sometimes that women whose emphasis is on the 'I HAD to have a Csection because the baby was in danger' is a defensive measure. If a woman feels that she 'wasn't doing birth properly' or missed out on a birth experience she wanted because of a Csection - or, feels she is going to be judged for having one - then she will want to stress the necessity of it. Which I think is a bit miserable, really, not a competitive mum thing.

I've never heard normal birth 'sneered on', but I'm sorry if someone did that to you, I can see how that would be very annoying and upsetting.

I know this thread is just so far off topic now...

however, with regards to the comment of who has the worst story to tell...

when I tell people about my job - they always feel compelled to tell me their birth story - and generally it is the people with the 'oh mine was the worst' type of attitude who shout the loudest.
The people who have 'normal' no drama type of stories tend to sit quietly in the corner - as if its of no interest to anyone, compared to the shock, horror story being discussed, which is sad as re-telling the story can be a cathartic experience regardless of mode/type of delivery.

so, I suppose in a roundabout way - bad news always travels faster than good news.

Good gracious - so many angry people on this thread in Mumsnet ...... many of whom aren't even bothering to read posts correctly before having a go at a fellow user. And so people disagreeing vehemently and agreeing wholeheartedly with the same view in the same sentence. (not referring to the last couple of posts before this one)......I think the original question has been answered.....

I think actually we are just managing to get a good debate off the ground and the original question has evolved somewhat.

I know exactly what you mean DrMcDreamy. My first birth was very long and very hard but it didn't end dramatically - thanks entirely to a brilliant MW who somehow enabled me to deliver naturally - and I sometimes feel that it is not appreciated what a bloody awful experience it was. People do like a drama. I would never think anything of a woman with a straightforward birth except jealousy (especially if it was their first). Now I've had one too so that jealousy has gone away. Any sneering I've come across has been in the opposite direction and not normally from the women themselves as it happens, usually via relatives who really do engage in competitive birth stories about their daughters.

Sorry posted too early. Competitive as in implying to my mum that I was a bit pathetic as their daughter only felt period pain and coughed the baby out. /you know the type.

"My point was that I don't share that attitude, and I don't want to have my births or maternal care influenced by anyone who does"

What - the attitude that some women find the experience of labour emotionally and intellectually satisfying?

Does believing that labour can be a positive experience automatically make you unable to understand women who are deeply fearful of it and want to birth without pain?

Well - maybe I understand. I would hate to be looked after in labour by someone who couldn't understand why anyone would want to give birth without a regional analgesia. Which is the case for many women giving birth in cultures where epidurals are the norm.

But I think most midwives are aware of the wide range of opinions and needs different women have when it comes to pain relief. Thankfully....

How is it intellectually satisfying?

Sigh. No, cleofartra.....

What I actually said, and please do check below, was that I didn't share your attitude, as stated by you, that during birth I wanted "to be pushed to the limits of my endurance", or that I would find it 'interesting' to 'tolerate the intolerable.'

THAT is the attitude I say I don't share, and that I don't want to anyone looking after me during birth to share.

How on earth do you reinterpret that to mean that I don't get "the attitude that some women find the experience of labour emotionally and intellectually satisfying?"

Oh, I do. I do, I do, I do, I do. And that's FINE. That is SO FINE, it is FINE that they find satisfaction in a DIFFERENT EXPERIENCE to me. I have NO PROBLEM with that.

Talking to you is like having all of my words fed through a bad translation programme. You just don't listen.

Some women CAN find the experience of labour emotionally and intellectually satisfying. Some women will find that NOT in being "pushed to the limits" of their endurance, or aiming to "tolerate the intolerable" - which is what you say YOU wanted.

"Talking to you is like having all of my words fed through a bad translation programme. You just don't listen".

It's a bit ironic you saying this following on from:

"I didn't share your attitude, as stated by you, that during birth I wanted "to be pushed to the limits of my endurance"

.. where you are subtly distorting what I actually said, and then using it as a stick to bash me with.

I didn't say that I wanted to be pushed to the limits of endurance. I said I wanted to see what it was like to be pushed to the limits of endurance - knowing that being pushed to the limits was the likely outcome with an unmedicated labour.

I chose to go without an epidural for a whole host of reasons - the main ones being a lack of confidence in my ability to push a very large baby out with an epidural in place. A sound physiological reason. Plus the fact that I didn't want to have my baby in hospital. Plus the fact that I wanted to meet my baby and experience the first 24/48 hours of motherhood with high levels of oxytocin and endorphins in my body - as nature intended, and which I didn't get after my epidural birth.

"Some women will find that NOT in being "pushed to the limits" of their endurance, or aiming to "tolerate the intolerable" - which is what you say YOU wanted."

Yes - I have acknowledged that women want different things. Here:

"I do appreciate some women will feel the need for an epidural even with optimal care, a good birth environment and a normal labour. Fine - they should have access to this".

and here:

"Different women want different things. Some will want the maximum amount of pain relief. Some are more preoccupied with having a birth which isn't interfered with".

and here:

"What all women want is to be listened to, and to be given the best opportunity to have the birth they want - with pain relief or without".

All of which comments you've chosen to ignore.

As well as, confusingly, interpreting everything I say about my own choices as a clear statement of my opinion about what you and everyone else should want when it comes to labour.

I'm really not up for an argument about attitudes I don't have, or about things I haven't said.

BTW, the majority of midwives I know share my attitude towards labour when it comes to THEIR OWN BIRTHS - ie, they want to get through it with the minimum of interference, and approach the pain of labour in a spirit of positivity and acceptance. However - this doesn't mean they expect everyone to feel the same.

Oh, cleofartra....

In the interests of fairness and accuracy, here is what YOU said about wanting to give birth without pain relief.

"For me it was a bit of an experiment. I wanted to see how it was to be pushed to the limits of my endurance - to see what emotional and spiritual resources I could call on to help me. Only time in my life I've ever had to tolerate something intolerable - it was very interesting."

I absolutely don't want to misquote or misrepresent anyone's views here.

By ALL MEANS argue the semantics of wanting to be pushed to the limits of your endurance versus wanting to 'see what it was like.' Up to you.

Only a few posts ago, you were accusing me of making some women's attitude towards sound like 'some masochistic cult.' Very, very rude and dismissive of you to do that. Very misleading, too. You really do have a habit of not listening, and of distorting other's views. Also of making extreme statements, and then retreating from them afterwards.

You used to do this a lot when you posted as tittybangbang, I remember.

This thread deserves better.

I joined Mumsnet following Lucy's appearance on morning TV and have been following with great interest because I've been researching women's experience of birth ever since I had my own babies. I think if you get the birth 'right' - with the mother feeling in control - it can be really empowering and can set you up for all the turmoil of new motherhood. If you get it wrong it can lead to traumatic stress, postnatal depression - not a good start for the new family.

Thinking aloud really ... I think we need to distinguish between two sorts of pain, the first sort that doesn't need an epidural or drugs (other than gas and air perhaps) is perhaps more accurately described as acute discomfort of your body doing something you can't control. We're just not used to feeling what's happening inside our bodies. Labour contractions are a completely new sensation, they can be huge and can be shocking from this point of view. We can't control them, they just happen. We're just not used to feeling like that, not being able to control our own bodies.

The good news is that - usually - they are self limiting, they come in waves. Also - usually - they build up so you have time to get used to them when they are relatively mild and you learn how to cope with them, to let them happen, to 'allow' your body to do its job. This is where relaxation and breathing techniques for childbirth come into their own. I think gas and air works partly as a distraction, to give you something to DO. For me these sensations were not something that pain relief would have helped. I don't think I was stoic, I think I learned how to cope and I remember my husband reminding me to breathe through them. (Certainly I could have done without the sensations but it wasn't really pain as such - First labour, induced by waters being broken, back to back, 7 hours hard labour but only two actually painful contractions when I lay down on the bed for some respite - I soon got up again. I could cope with them sitting bolt upright, I couldn't cope lying on the bed) Epidurals take away sensation so you don't need to learn to cope with the sensations - this removes the psychological discomfort and breaks the link between tension and pain.

For me the most painful bits were the pushing out, I just didn't want to do it, wanted to go home, wanted my mother, but at least then you do have to do something you sort of know how to do (i.e. push.

The second sort of pain is your body screaming at you to do something, anything, to take the pain away. I think contractions do become really painful if you don't learn how to accept them and cope with them and fight them instead. The fear tension pain cycle is spot on. But the pain is real, it's not in the mind, and it's not just about failing to relax and accepting contractions. The pain makes the contractions less productive so you have to go through more of them. I also think that labour contractions that become screamingly painful are a signal that something is wrong, and I think often this is because women are in the wrong position to the uterus to do its work effectively. I think the uterus needs to be as 'free' as possible to contract where and when it wants, and I think this is why labouring in water so often helps. I just don't understand why we put women on beds for labour, I think being on one's back is just the worst position possible.

It's a question of whether the pain is productive or not, whether you feel you are getting somewhere. And when it's not productive (hours of no change in dilatation) that the pain becomes intolerable.

What makes me so angry is that most women have to go through labour in one of the most unrelaxing of places possible, with strangers telling them what to do. The NHS could provide a far better service by giving each woman her own midwife for the whole of pregnancy and labour, the mother and midwife could get to know each other and trust each other during pregnancy and the midwife could go into hospital with the mother in labour, supporting her as a friend, knowing that when she says she wants an epidural - she wants an epidural - and getting it arranged for her.

I really hate the current factory system, it does untold harm to mothers and families. It turns midwives into factory hands working on a conveyor belt. It is as difficult being a midwife in the system, having to spend valuable time in early labour building a relationship with a woman you are supporting. All that could have been done beforehand if you knew your midwife and she knew you.

It wouldn't need any more midwives, just using them differently. Our system allows for something like 30 births a year per full time midwife. It could be managed. I think the current system has evolved as a way of keeping women (mothers and midwives) under control - being good little girls doing as they are told. It is deeply misogynistic.

Gulp, my very first post to Mumsnet. Hope it makes sense...

good points glowglitch.

The only thing I would query is having a one to one midwife through your ante natal/ labour and postnatal.
If it is only one midwife, then that would involve her/him being on-call for possibly 5 weeks at a time (37weeks to 42weeks). That is alot to ask of someone.
multipy that by 30 women - and the midwife is run down and as stressed as ever, only unable to drink copious alcohol as she is permanently on call for her case load.

It does happen in some areas where they have team midwifery. It was trialled local to myself and it didnt work due to the on-call factor and not enough midwives in the team.
The midwives each had a caseload of around 90 women - and 5 midwives in the team - just too many women to cope with, although the idea of it is good, it still needs more midwives.