Pain relief at 2cm. What happens if you just NEED it?

[StarlightMcKenzie]

I gave birth in an amazing unit last birth and my birth plan was agreed to say:

No internals. I'm in active labour when I say I am and require any pain relief/birth pool I say I do. Gas and air to be offered on arrival.

I've moved area since and can't get to amazing birth unit so am opting for a homebirth.

How can I ensure a similar arrangement? I know of many places that refuse pain relief if you refuse internals but an internal result has feck all to do with pain levels so it seems barbaric.

BTW. this is the discussion thread of midwives discussing mumsnet discussion:
www.studentmidwife.net/fob/mumsnet-and-the-promotion-of-medicalised-birth-thoughts.69784/

Some quotes:
"Women talking about how there's 'no way on earth' they'd ever consider the 'mental torture' of giving birth without an epidural, one woman saying her husband was offering to pay for an epidural as she was so afraid she wouldn't get one..."

"It could be me writing this post I've been browsing this exact same forum a particular thread about a lady expecting her first baby and demanding a section due to fear she'll have awful experiences like her mum and sister!

The advice she was given really broke my heart! In the end I had to stop reading because I just end up getting so ANGRY and frustrated!"

Yeah, right, it breaks the midwives' heart that she wanted to skip the midwife and take the direct route to ELCS. I wonder what somebody's choice has to do with her heart really.

Sorry, had to cut and paste in order to get link!

Lol at calling MNers DF readers.

There are a couple of sensible posts there though. About why should women trust midwives when there is no continuity of care or Time for antenatal education.

I am on my 3rd baby and about to pop and I have never in 3 pregnancies had an opportunity to discuss my birth plan though I really have tried.

Starlight,
yes, it is a valid point and I'm sure it could help to increase trust between midwives and birthing women.

However, I had to roll my eyes at the rest of the pro-natural-childbirth-with-no-pain-relief rhetoric. That's what I found truly sad. It's like a self-professed religion or something because it doesn't ever consider that there might be many women that actually DO NOT WANT to endure some ephemeral ritual of passage that they decided to impose on them by denying pain relief to them.

I decided long ago to not ever have a vaginal birth if I have children and this makes me want to avoid the "care" of midwives altogether. I don't need any amount of patronizing and humiliation in my quite advanced age. I react very impolitely to it.

I totally agree that those midwives often don't come across well on that message board. I'm not sure it's that representative of the profession though - certainly not those I came across. I saw far more 'oh you'll need the epidural' attitude than the reverse.

Mind you, I suspect that midwives are also generally comparatively pro-natural birth simply because they see the cascade of intervention so often. It's not as if you can simply choose to skip the pain and still have an uncomplicated vaginal birth (not that you are guaranteed to get one anyway, but you know what I mean, interventions skew the odds).

Denial of pain relief is unforgivable. Educating women about their choices (including the benefits of elective sections, the issues with early epidural etc etc) would be far more helpful.

It's also worth bearing in mind that, for some women, the non-medicated route isn't some right of passage. For some, it is the best, most logical choice. It was for me after the horrendous 'every drug going' experience with DD1. My second birth was painful through the contractions, but the sum total pain and ongoing discomfort was far less (if that makes sense).

If you give birth in the UK, you won't avoid midwives I'm afraid. Even if you go private they are likely to be involved in your post natal care. Many of them are lovely though!

ps just in case I don't come across clearly, I am totally pro women being able to choose (with informed choice) section if that is their wish.

Good luck Starlight.

I'm confused by a couple of things that have come up on this thread;

'Im in active labour when I say I am' - What if you're not and have had strong painkillers/ taken up rooms or staff that couldn't be with someone else?
We all know the units/PCT's are short staffed.

'Epidural on demand at the first contraction' - what if it was a false labour or very early labour that stopped - would the epidural be stopped so you could go home and come back?

YoulllaughAboutItOneDay,
valid points, but according to some very recent studies, epidural is not so evil as the midwives tend to paint it. And even if it did have side effects, it still doesn't give anyone right to deny it to anyone, just like any other pain medication most of which have bad side effects.

I'm not based in the UK, I'm following this discussion because it has many valid points for me regarding new research, discussions etc. I can more or less avoid midwife care if I'm able to persuade the head of the hospital ob/gyn to give me elcs. It is a very debated question in my country too, whether women have a right to elcs and unfortunately the same goes for the right for pain relief too, which sort of makes me want to puke because it is the midwives who try and deny it.

I've just had my 3rd baby in February, and was completely refused any pain relief apart from paracetamol until I was in 'established' labour at 4cm. My baby was back to back and at 2cm I was in agony,(pain felt similar to when I was around 6/7cms in previous labours) this went from 8pm till 2am when I finally reached the magic 4cms.
I had to beg them not to send me home at 11pm because I wasn't in established labour. I had to sit in a room by myself for 3 hours till they checked me again, crying in agony, because I was 'only' 2cms and they couldn't assign me a midwife.

No, absolutely. I said denial of pain relief is unforgivable. I 100% agree.

My personal view is probably coloured by my own vile experience of epidural, which I directly blame for the fact I needed forceps, but which was also vile in many other ways! I guess I was just trying to point out that not every woman who wants the whole 'natural, pool, dimmed lighting' birth sees it as a moral choice, or one others should also choose, or as in some way superior. I strongly feel every woman should do what is right for her (and, to a lesser extent, what is right for her partner and any existing children).

Finally- I see your point about resources, but why should we apportion resources based on a magic x cms rather than the level of pain the woman is in and the level of support she needs? Genuinely, I could have done with a midwife for the first few hours and could quite happily have sent her home for the later stages! I get quite annoyed at the medical view that your need for pain relief and/or support is directly related to a magic number. Especially since some woman spend (say) 10 hours in pain getting to 4cm, then half an hour finishing the job!

Midwife couldn't go away in later stages though.

In an ideal world all women who want whatever they want, whenever they want it would get it, but even in countries where women pay for their own OB/GYN they don't get that - they get what the OB/GYN decides is reaonable

Finally, active labour is an arbitrary medical term based on an internal examination plus some other numbers (frequency, duration, strength of contractions). Those numbers bear no relation to how much pain a woman is experiencing, how long she is going to labour for or how effective her contractions.

Active labour is at best, a guess. Pain relief should be given when a woman feels she cannot cope without it and not a moment later, otherwise you ar risking a traumatic experience that might damage her forever plus raising her adrenaline levels to those that will increase the chances of requiring more intervention later.

I'm a fan of early intervention and preventative actions rather than fire-fighting at the end.

Finally,
and that's simply WRONG. The woman should get anything she wants (any approved pain relief or even ELCS) unless she is deprived of her civil rights for being insane, which even in birth she isn't. And if she is denied pain relief, she should sue his/her ass off. I certainly would and the doctor would never practice in the same country again, I guarantee it.

Starlight,
I wholeheartedly agree.

Bill, that's a shocking story. I'm so sorry.

I am due with my first tomorrow. This thread is making me very nervous

I had my first at home and my mw wouldn't let me have g&a until she was convinced I was in active labour. She went home (it was 7pm) and got called back 3 hours later because I was in a lot of pain. After monitoring me for an hour she finally asked if I wanted an internal and declared "oh, you're 6cm, you can have g&a now". TBH I don't feel hard done by, I always assumed g&a slowed down labour?
This time round I'm in Australia where you have to pay for a homebirth, whereas going to the public hospital is free! But I am on a midwife led program and so far the care has been good, so fingers crossed!

Just had homebirth appointment. Midwife said I won't get any gas and air until I am in active labour around 5cm. I asked if she was saying I woukd be denied pain relief upon asking. She said if I needed pain relief before then I woukd have to transfer in for something stronger.

I said, 'what, and then come home again at 5 cm?'

She said no.

Grrr.

She then said that gas and air is on,y used when you really need it at the end. I told her I really need it at the beginning and not the end.

She said that I won't because it is my 3rd birth.

Fine. If that is true then fine, but what if I DO?

Is she likely to be the midwife you have on the day?

What did she say when you said you weren't having internals so they wouldn't know how dilated you are?

I think you need to find out if she is spouting her own personal breed of nonsense, or whether that actually is policy. If you can.

You have a doula don't you? What help is she being in all of this?

On a personal note, what a bitch. I absolutely detest with a passion the view some midwives have of labour as an escalating process of pain into which all women must fit. Like you, I find the first bit the hardest and could easily manage the later stages. why can't they accept that that might happen? I got so sick of the 'low pain threshold' sniping during my first labour.

Finallygot - They couldn't go away in the last stages, but actually in a hospital birth there is no reason they couldn't support you intensively through an intense latent phase, less so during active labour (returning to check on the baby etc) and intensively again at delivery. But actually that wasn't quite the point I was making. I was making the point that 'reasonable' care is arbitrarily based on a cm measurement. If a woman is dilating 1cm an hour, that might mean she gets 5-6 hours of intensive support. If she dilates very slowly, and then goes from 3cm to birth in half an hour it might mean that she is denied support (and possibly pain relief) for the vast majority of her labour. It doesn't mean that she was in any less pain, or that the need for care was any less. It just means that she didn't fit an arbitrary standard which is portrayed as 'objective' but is actually pretty random.

We didn't get as far as discussing internals. I kinda figured not to piss her off more by being argumentative.

On the day I'll just refuse them but start mooing. Luckily I've done it all before!

Oh and if pain relief is ever refused on asking I'll tell her to write it in my notes.

Seeing doula tonight.

I don't think mw was a bitch really. Just a bit - obstructive!?

A lot of discussion about how birth is, without consideration of how birth is for ME. I think it is cultural rather than personal.

Them on that student midwife site should take heed. This is why people prefer c/sections.

Yes, do an impression of someone in active labour. I love that idea. And if you can pull it off whilst in pain I shall be very impressed .

Sorry it didn't go well. Yes, make damn sure that if you ask for pain relief and it is refused your DH stands over whilst she clearly writes it in your notes (none of this 'pain relief discussed and agreed to wait' bollocks). That will probably put her off refusing in itself!

I really think you need your doula on side with all of this. Calm, professional reasoning, escalating to mild passive aggressive threats if necessary are easier pulled off if you are not contracting, or supporting a loved one to do so!

Well, maybe bitch was a bit strong , but I have very strong views on this. Very strong. Neither of my labours looks like the books, but I spent a lot of time being told by midwives before, during and after that I must be wrong because that was how it was and my interpretation and memories must be clouded.

Yes, I wonder if we could redirect those student midwives!

She told me a midwife would only come out to me when cx were 1.5 mins long.

I mentioned with my first they never got longer than 15 seconds (i have my notes to prove it if necessary) but she refused to acknowledge this stating instead that they were BH.

Well fine. In that case she needs to know that The head is likely to pop out after a few hours of BH then. You can't have it both ways and I really don't care what they are called.

Braxton Hicks leading straight up to delivery with no labour. Yeeeess. I can see that that is a more likely explanation than not all labours being alike!