They can't make you have pain relief, can they?

[ardenbird]

I get worried when I read things like women being pressured into pethidine or gas & air when they don't want it. I'm hoping that if you really don't want particular things they wouldn't do something like jab you with analgesic when you don't want it, right? And you'd have to breath in the gas & air, right? Is it more being badgered into agreeing to something someone would have not agreed to if they were in less pain and able to think more clearly?

I'm concerned because I know I have bad reactions to pethidine and gas & air (got pethidine at an outpatient procedure and ended hospitalised for the dehydration brought on by constant vomiting, when I got home I was incapable for 3 more days; gas & air produced immediate vomiting, never got enough of it to tell how bad it could be!). I'm pretty sure I'd have to be in awful lot of pain before I agreed to go through something like the pethidine experience again (and it's not like one's abdominal muscles are all peachy-fine after vomiting for four days).

I'm prepared for medically necessary things, but for just pure pain relief, I hope that as long as you continue to say "no", they can't force it on you? I have no idea how much a wimp about pain I'll be, but I already know I'm a super-wimp about feeling nauseated (I moaned throughout the first trimester, although I know mine wasn't nearly as bad as some), and am absolutely terrified of being as ill as I was with pethidine ever again.

No they can;t make you have it. Put in your notes in BIG letters that you don;t want pethidine. I had it in my first birth and it made me violently sick, so in my second it was one of the only actual demands on my birth plan that I didn't even want to be offered it. Not a problem.

No. They can't make you.

Make sure they know how you feel and the problems you have had.

However, it's a good idea to find out what else might be available - you don't know how you're going to feel or what you're going to feel you need when you're actually IN labour.

No they can't make you. But I would consider giving gas and air another try- the effects wear off pretty quickly if it doesn't suit you, and I thought it was bloody amazing!

Oh, and if you don't want pain relief, definitely consider a water birth.

No they can't make you. But I would consider giving gas and air another try- the effects wear off pretty quickly if it doesn't suit you, and I thought it was bloody amazing!

Oh, and if you don't want pain relief, definitely consider a water birth.

No they can't. And if you are in the SE, which I read somewhere has a midwife shortage, you might be lucky to actually get pethidine or G&A. I know it's ridiculous, but I was just left in a labour room, and never got examined for 2 days. (I went in after my water broke). Because I wasn't examined, and I wasn't screaming like a banshee, I wasn't deemed to be in established labour. So no pain relief available. By the time they got around to examine me, I was already fully dilated.

So most likely, they won't even have enough staff to force you to take pain relief.

have you considered epidural? The main side-effects tend to be a headache in some people (and of course reduced mobility for a day or so, and sometimes a lazy bladder for a few days!)

I imagine there could also be a strong medical reason for an epidural - I was told I had to have one with pre-eclampsia that degenerated v. quickly during the birth as the doctor saw it as the most effective way of lowering blood pressure at that point. I probably could have still refused but it really didn't seem wise based on his advice at the time.

I had home births, used TENS machine for pain relief (although G&A was there if I'd wanted it). For first birth I was in the bath a lot too.

I wasn't keen on having pethedine as I'd had it for something non-labour related previously and felt really out of it and frightened and so put this on my birth plan. I also put that I'd prefer to have to ask for G&A rather than have it offered to me. In the end I felt so sick that I couldn't face putting anything in my mouth, let alone sucking on a gas tube.

I kept upright and active as much as possible. It did hurt a lot, but was only at the end that it felt unmanageable (which both times turned out to be transition, and would have been too late for pain relief even if I'd been in hospital).

They won't force you. IME you're more likely to have to beg for the pain relief you want/need. Do make sure you've researched what you want to happen if you find you can't manage without pain relief though, just in case.

I agree with others who have said no pethidine. I didn't find it affected me too badly, but DS1 slept for the first 3 days!

Technically, no they can't make you. You are vulnerable in labour tho, and they could pressure you into doing things "their way" :-/ Important to feel safe and comfy wherever you are, so if you are not happy with the hosp you are with, maybe you could change? Having good support independant of the hospital should help! Whoever is going to be with you (your partner or your mum or whoever) make sure they are well prepared and up to the job of advocating for you if needed.... Sometimes, when you're tired or frightened, they feel that way too!

Have you spoken to your midwife about your earlier reaction to pethidine? I am hypersensitive to opiates (discovered this following a knee op, awful experience) and it sounds from your post that you may have the same.

my midwife arranged a meeting with the anaesthetist at the hospital about 2 month before my due date and I got a big yellow sticker put on the front of my notes. Meant that the anaestheic team were notified as soon as I arrived and everyone knew not to give me opiates.

I was told that the standard epidural also contains an opiate- it is possible to get one without, but they need to know about you before the event iyswim? For me it was brought to the room as soon ad I arrived to make sure I got the right one if needed. (wasn't used, but was nice to know it was there!)

It may also be worth you discussing what sort of post- op pain relief you will want if you end up needing a cs. Again, opiates are the normal thing you'd be offered, but alternatives are available.

I also had it put in my notes that if I were given any opiates I would not be able to be responsible for the baby- that was one of my biggest concerns and it was reassuring to know that the staff would be aware.

I managed with some lovely aromatherapy oils the midwives gave me and just a tiny bit of G&A at the very end (which was horrid and didn't help the pain). It's amazing what you can put up with when you have to!

Bear in mind that codeine is also an opiate, so avoid that too!

Best of luck, I am sure you will be fine.

I had g&a which worked a treat for me. I did also use tens, hypnotherapy and aromatherapy which were all amazing IME - even with a painful back to back laboy

Sorry - darn phone! ... Even with a painful back to back labour that failed to progress. There are other options that could work well for you. Good luck.

No they can't and it is doable without. Have you considered Hypno birthing? Think if you are planning on heading down what is effectively a non standard route you need to do a heck of a lot of research.

Thanks! I'm feeling better now about it. I'm wondering if I could do something like try gas & air early on and see how I react -- the response was so immediate that I'm pretty sure I'll get a quick yes or no, and if I try earlier when I'm not in terrible pain and it's okay, I could use it later.

I had been thinking an epidural should be fine, as they are local anaesthetics but I didn't know they could have opiates (it's terribly hard to find out what is in them, and the MW at the labour antenatal class didn't know -- searching online suggested they were cocaine-derived, like the shots the dentists give, which I'm fine with). Although I am hoping to avoid an epidural because of SPD, but was thinking it could be an option if I was desperate.

kernowmissvyghen, how did they determine you were sensitive to all opiates? Was there some sort of test, or did they extrapolate from one drug? We also have diamorphine available, but I think that's an opiate too? Didn't know that codeine was! I've actually got some cocodamil on the shelf for my SPD, but haven't touched it yet. I suppose I could try a pill (on a weekend) and see if I get ill -- if I don't, maybe diamorphine is an option. But that could be dangerous if I react as badly as I did to pethidine...

I told them about the pethidine and it says "? Pethidine" on my notes in the allergies box. It seems rather low-key, and I wonder if there should be something more yellow-stickery somewhere?

Is there ever a moment when you sit down with someone and go through your birth plan, or is it all when you show up in labour? I've got an appointment with the consultant next week (I'm under shared care due to a chronic condition for which I'm medicated, but I hope to give birth in the MW-led unit as it shouldn't have an effect on labour) -- would it be appropriate to ask him some of these questions? Hopefully he knows more about what drugs are actually in an epidural! Or should I be talking to my community MW? Except I barely see her, as they keep sending me to the hospital for consultant appointments, and she won't be around at the birth, it will be the MWs in the hospital.

That's one of the reasons why a birthing partner is there, to represent you when you're fragile and tell the midwife that you don't want pain relief. Your birthing partner needs to be well aware of you birth plan though, so that within reason, you'll be able to have the birth that you want, not the one that you've subjected to.

I think you should ask your MW if it would be possible to chat to someone with specialist knowledge before you go in. I had a meeting with the anaesthetist a couple of weeks before my due date, and it was well worth it, especially as the birth didn't go quite to plan and I needed the information from the meeting to support my case to a badly-informed midwife.

There may be alternatives available to pethidine that aren't readily available but could be if asked for.

They can advise and offer but they can't make you have it. Worth being clear though about why you don't want pethidine at the start of labour (you will do a birth plan in your notes with your MW around 36 weeks).

Make sure you look at all pain relief options though - until you are in labour, it is difficult to be sure what/how much you will want and need. Some of the options aren't just about pain relief either - I didn't want pethidine before hand either but ended up with half a dose, which meant that my labour progressed and I didn't need further intervention.

What everyone else said. I had gas an air and was grateful for it, but my labours were too quick for anything else (I'd said I didnt want pethadine and they noted that)

Ardenbird, yes, diamorphine is an opiate too - all morphine based drugs are. There are also synthetic opiates, which I personally react to even worse than the "natural" forms, unfortunately. However, cocaine based painkillers are totally fine and very effective for me, same as you!

I don't know if there are any tests to see how you will react to opiates - I was just given lots of different types of painkillers to try to control pain after a knee operation. Over the course of around 5 months I went through quite a few different types and reacted to all the opiates - the reactions varied from terrible sickness and nausea to hallucinations, delusions and paranoia, with the symptoms lasting around 3-5 days each time.

The absolute worst was a synthetic opiate that the GP said "this is the one we give to people who react to opiates, this one will be fine"!

For me (and I suspect you will understand!) no pain in the world could be worse than the awfulness of several days of opiate "hangover" and I could not imagine meeting my baby in that sort of state. I found it really helpful to meet the anaesthetist and make it clear that I didn't want to withhold consent if they needed to give something to keep me and the baby alive, but I DID withhold consent for any opiate given just for pain relief, at any stage during labour or postnatally. The consultant then raised the question of what I may want / need if I had a CS, told me about the opiate in the standard epidural and said that if I did have a ceaserean he would make sure I got an epidural without opiate and the line would be left in as long as was safe after the operation to give me post-op analgesia by topping up the epidural. He did say that the normal thing would then be to get co-codamol or similar postnatally, and they would need to discuss what to prescribe in that case.

I found the midwives didn't really know much about the drugs side of things, sounds like it would be a good idea to raise it when you next see your consultant.

I've had 3 children and have been lucky to find that each time the staff have been entirely respectful of my wishes throughout, but nonetheless I would run through it all with the consultant.

No one is going to jab you with anything against your will. (If they do, it's assault, so they tend not to for that reason alone). Also write a birth plan, and put SEVERE PREVIOUS REACTION TO PETHIDINE AND GAS AND AIR across the top.

Make sure your birth partner is briefed and understands. Maybe consider a doula, too, in my experience they can support you through the pain.

No they cannot make you have it. However I woudl make sure it is wrtten on my notes along with the reasons why and make them aware of this when you first get there (or whenever a new HP pops up).
If you have had bad reactions to these before perhaps you should talk to you mw about other forms of pain relief, and think about if there is anythign you coudl do to aid pain relief -hypnobirthing classes, getting birth partner to practise massageing your lower back, etc.

ardenbird If you have an allergy then you will be given a red wristband to wear (instead of a white one) upon admission to hospital anyway - I am allergic to nickel and was still given one - it alerts the staff straight away to the fact that you react to something so it isn't just in your notes.

In my experience I couldn't get them to GIVE me any never mind force it on me! Just be assertive and make your choices clear, nobody will pressure you into doing anything you're uncomfortable with.

ardenbird I'm rubbish on opiate based pain relief, I go quiet a bit crazy and really wanted to be able to remember the birth of my baby. It was at the top of my birth plan and highlighted by my MW in my notes. On admission for my induction I explained my reactions slightly to the MW and they put it on my allergy band, DP was also fully briefed that regardless of how I gave birth absolutely no pethidine or morphine. Sometimes morphine is automatically prescribed as pain relief after a CS and I thought I could be too out of it to refuse.

When I decided I wanted an epidural the Dr questioned me for a while over the reaction as apparently there is some opiate type drugs within the epidural. I was really impressed by how seriously they took my preference. Ultimately if you have an adverse reaction to anything they won't want you to have it as your health is their priority. I think they only push women into pain relief when they feel they aren't coping and need some relief to be able to labour effectively.

What a very very strange question. IME it was being allowed to HAVE pain relief that was the problem, at a point in labour when I wasn't supposed to need it. Mentally scarred me for life, and I'm not joking.