Who had an epidural and could you have gone on without it?

[JeuxDEnfants]

On the back of news that epodurals are being rationed... I was in last star labour for 4 hours when contractions stalled and I needed oxytocin. Without an epidural... I think I would have experienced torture. I had to beg for one. What do you think? Aibu?

What concerns me is that the financial cost of epidurals (and maternal request caesareans for that matter) is being used to encourage hospitals to reduce their rates of each, when in fact the main reason organisations such as the RCM and NCT want these rates reduced is because of their fundamental belief that birth is a natural, physiological process, and that women should give birth with as little intervention as possible.

One way they can get the NHS (and government especially) to back their ideas for maternity care is to show how cost-effective they are, and how much money they could be saved by sharing their beliefs.

What this also does is (help) distance blame from the RCM and NCT (and in this case, the RCOG too, although RCOG has removed the document from its website at least and agreed to review the guidance). How?

Because when the story reaches the media, and the headlines talk about epidurals and caesareans being restricted to save the NHS money, people start arguing about (for example) cost-cutting in general, NHS management, other ways costs could be reduced or the fact that they'd happily pay the difference if that's what it takes.

Now I'm not saying cost is not an issue at all, but I do think that the far more worrying aspect in all of this is the attempt to force an ideology of birth upon all women, regardless of their own personal preferences. The attitude that 'normal' birth is something that can be defined for us and chosen for us, and if we want to make an informed choice to have an epidural or planned caesarean then we are somehow 'abnormal' or 'unnatural' mothers.

I'm lucky - I've never felt this way but I know for a fact that many women are made to feel this way, and that is nothing other than plain wrong.

(For those who have asked, original press release is available here here)

I hate that "women used to cope" bull shit line it infuriates me. I was talking to my dad about his mum's first birth the other day, she is 99 so it was a long time ago and she had a still birth at home (no hospitals for birth then and my grand parents are from Greece) anyway my point is that if I had a home birth with my first when it was the norm we probably would have both died. My son got stuck and there was no way he was coming out.
things have changed a great deal to 70 years ago. we have options now to avoid pts and pnd that probably costs the nhs less in the long run. I am sure my prescriptions, prolonged health visitor visits and the 12 sessions of counselling I needed cost a whole heap more than an epidural. My health visitor actually wanted me to complain officially over the way my sons birth was handled, she also thought it was barbaric.

My personal experience was this: I knew I couldn't have an epidural (bleeding disorder meant it was too risky) so once my haematologist and anaesthetist had made that decision I knew that I would either have to do it without or have a general anaesthetic. I found this out about 27 weeks. I put a huge amount of energy into researching natural birth and reading books such as ;birth skills' by Juju Sundin. In the end I didn't need one and have had two absolutely fantastic births with no pain relief other than paracetamol.

I know a huge amount is luck but I do think there is a little bit about attitude. If I knew I had the option of an epidural then I would not have bothered doing any work or preparation before the birth and I am sure I would have experienced it all differently.

I think that there is a lot to be said about giving women the opportunity to find out what other options are available (eg hypnobirthing, physio such as 'birth skills') and also giving realistic expectations. I

FWIW I also think it helped that I am an HCP and have seen quite a few births so knew what to expect. That experience allowed me to reflect on the attitudes that I had seen and which ones I would like to aspire to during my own experience.

tiara is it standard then for a woman to have an epidural if she is having forceps? I didn't know that. I have to admit, the forceps insertion really felt like my pelvis had been broken (in fact still convinced it was cracked)

bees i'm just lucky i suppose, that I don't feel traumatized by my births. I may feel differently about epidurals if I did. I also may feel differently if I had had an epidural.....

In response to posters who have commented that women "could go without pain relief" and do the world over - of course it's actually "possible".

In the same way, patients who are dying "could" easily die without pain relief. After all death is a "natural" process, isn't it? When cancer patients are dying in agony, what's the point in giving them them morphine to ease the pain? After all, they are already dying, they won't cause a fuss and complain about lack of pain relief later or even worse, start banging on about "human rights". Even better, we could organise for the dying to arrange special classes and teach them to embrace the natural process and let their bodies produce endorphins. If they buy into that and write on their notes that they will do it without pain relief, that will be fantastic and really empowering for them. Think of the money that the NHS will save!!

Or, moving away from the dying for a second and back to those entitled women who expect pain relief in labour.... They "could" have c-sections without a spinal block. It would save money because there wouldn't be an anaesthetist present in theatre. Instead, a couple of healthcare assistants on NMW could be employed just to hold the woman down and keep her still. After all, if she can't hack a natural labour or is simply "too posh to push" then she certainly doesn't have a right to complain.

As you can probably tell, some of the responses on this thread have annoyed me slightly. It's absolute bollocks that just because women "all over the world" do it, that women should be left screaming in agony and refused pain relief when IT IS AVAILABLE. Women "all over the world" still die in childbirth or lose babies because they are not lucky enough to have access to medical care that could save them and their babies. Since some of you are so holy about being "natural", maybe you think we should take the same approach to all health care in this country? Natural selection will soon soon the strong from the weak, don't you think?

Digestives...agreed! Anyway in terms of the 'natural' competition - sounds like many of those who didn't have epis had gas and air/pethidine etc..

And yes, it should be a right to have pain relief in labour. Absolutely.
elspeth: 'If I knew I had the option of an epidural then I would not have bothered doing any work or preparation before the birth'

That might have been your situation, but plenty of women prepare for the birth and decide beforehand that an epidural might be for them. It is not necessarily down to a lack of preparation or research.

Pain is subjective and personal, every birth is different, and as such nobody has a right to judge anyone for their choices. I remember asking one of our NCT group if she'd had an epidural and she remarked she was far too 'stoic' for one....puhlease!

Digestives, I just wanted to write something similar, but you've said it a lot better! There are a lot of "natural" but painful things, but oddly only women giving birth are expected to shut up and suffer.

Midwife suggested I had one when in labour with DS. They were adamant that I was in pre-labour and would need to be induced the following morning (was late in evening) so should have an epidural and sleep overnight. I was 9cm dilated when they gave it to me (they checked afterwards) though was very useful during the 2 hour pushing phase and later episiotomy and forceps delivery.

I was adamant that I did't want one with DS, but did ask for one when I wasn't progressing fast enough and they wanted to give me syntocinon.

The first epidural was a total block and I couldn't work out how to push properly as I couldn't feel anything and kept slipping down the bed. The second left me with enough sensation to feel pressure, though I did still need gas and air to cope with the pressure!

It must have been a man who came up with this idea, they wouldn't suggest that you didn't have pain relief to have teeth out or other medical procedures!

I never thought I would have to be cut and have my baby dragged out of me. had I known this and prepared myself I would have insisted on an epidural.
My 2nd baby was born in a birthing pool with just gas & air and I had a 1st degree tear. no pnd or pts afterwards so I am not a wuss who couldn't hack it, I had a really awful experience.
if a woman wants an epidural to save the aftermath I went through then its worth it and the individuals choice.

Great post Hull. I've got a lot of sympathy for the aim to keep down epidural rates as a means to reduce the number of EMCS and forceps births, but the ideological push for "natural" birth for its own sake is just vile.

...and also bravo Digestives

Well said, Digestives. And the thing is, I'm all in favour of women being supported to have a normal birth. Plenty of women have straightforward births that last eight hours, they manage their own pain, they push the baby out without intervention, and that's great. I'm very much in favour of that and wouldn't want a return to the bad old days where medical intervention was forced upon you whether you wanted it or not.

But. Things can go wrong in labour, it can be long and painful and the baby can be in an awkward position. Not every woman's physiology is the same, and not every woman can push a baby out in eight hours. Not because she's a wuss or she's got the wrong mental attitude, but because the baby's head is in the wrong place or her birth canal is too narrow or her uterus isn't contracting hard enough. And when she's been struggling for 15 or 20 hours and getting nowhere, that's usually when a woman wants an epidural. I can't see that saying "You can do it" at a point when a woman is exhausted and in agony is going to help anyone.

First birth had an epidural and had all the classic problems they cause ie slow down of labour and ended up in theatre for an emergency cs if forceps didn't work, thankfully the did but the whole thing was a nightmare.
Next birth no pain relief at all and everything over and done with in 4 hours.
I would never have an epidural again.

bravo, really? Comparing end stage cancer with giving birth?

pain relief is a whole different issue from intervention to save the lives of mothers and babies

We're talking about pain relief in both cases. In either case pain relief may have a downside, some cancer patients may choose clarity of mind over maximum pain relief. But there should not IMO be a moral value associated with the refusal of pain relief, not for cancer, not for dental work, and not for childbirth.

In terms of comparisons with the past and indeed other parts of the world, you need to consider a few additional factors.

Giving birth is both a physical and psychological process. If you focus just on the physical you forget about very real mental health issues. 20 years ago depression was treated with contempt and you'd be told to "get on with it" and that kind of attitude is completely unacceptable now and yet it is used when it comes to childbirth. I'd like to think that progress in recognising psychological problems, and differences between women was as important as the physical ones. Progress is generally a good thing not a bad one.

Not only that but British women giving birth in 2012 are different to their grandmothers. They are older, heavier and babies are bigger so physically there are differences too.

So how you compare the birth experience and expectations of a woman in 2012 to those of a woman in 1952 or even 1912 or before? The world has moved on. Thank goodness.

The important thing is that women get the best treatment FOR THEM and have the freedom to do so, rather than be treated as anonymous women in a production line where costs are the priority not the patient.

The two epidurals I did have I would have managed without but I was terrified of the pain. Dd1 I had without and she was stuck in my birthcanal for 3 hours, it was excruciating even with pethidine and gas. My next two were epidurals but my last baby was a four hour labour, born 30 minutes after arriving at the hospital without any pain relief and I managed the pain fine. I think fear plays a big part in the pain of labour.

Ive been doing the washing up and considering why I feel like I do about pain relief in child-birth;

for me, the pain of labour whilst gruesome, was an important part of the process (don't know why ). I would not want it to have been taken away from me. Im glad I didnt get the epidural i was screaming for!

I do concede that it is different for all women of course. And all individual labours too

What I feel VERY VERY strongly about,is the treatment of PSD. With dd1 I was unable to walk for 6 months upto and 6 months after the birth. I was sent for physio which was rubbish. With dc2 I got psd at 12 weeks and paid for a chiropractor thrice weekly (£100/week) which kept me pain free and mobile....

THAT should be available to everyone on the NHS....so many women suffer PSD...and an unaligned pelvis can REALLY affect the delivery and chiropractorary (?) can help prevent back to back

I think I feel money could be better spent on preventative measures...bbl

I had an epidural.

My (female) GP told me that if I didn't like a drunk / feeling out of control experience that pethidine wasn't for me as I would fight it and to ask for an epidural.

My midwife also recommended it as I was having contractions every 2 -3 minutes, but was only 4cms. she felt I would be too tired to push by the time I was 10cms. As it then took a further 11 hours to be ready to push I think she was right.

Only the lady in labour knows what she can and cannot take. The doctors should listen to them.

i needed and wanted and asked for an epidural 3 times. never got one.

so yes, you can carry on if you don't get on. you have to!

continued....i got PND after dd1, and I think that was down to my immobility. The pain of child birth, didnt really factor, ut could probably been improved with proper treatment of my PSD.......

I had one with DS1. Thought it was good at the time as I really did feel nothing, but it slowed things right down. I planned on having one with DD but things happened far too quickly with her for me to have one in the end! I felt absolutely 100% much better for not having one and my recovery after the birth was in the blink of an eye. So then by the time I had DS2 I was absolutely fine with the whole thing.

Funnily enough one of my main reasons for having an epidural was because I was scared the gas and air would make me feel sick! It didn't and it is of magical qualities. Turns out I spewed after each birth anyway.

Funny how they're saying they want to ration the epis, but now all women can have the choice of a c-section if they want one.

but now all women can have the choice of a c-section if they want one.

Except they don't at all.

^ they should do. According to NICE guidelines if a woman wants a c-section because they are worried about childbirth they should be reffered to someone for support. If that doesn't worth then they are given a c-section.

Elspeth i was SO well informed for my first it was untrue. I had read every book ever written about natural childbirth, homebirth, hypnobirth, had hired an independent midwife and TENS machine, bought a birth pool, etc etc.

After 22 hours of back to back labour at home, including several hours stalled at 10cm and pushing with no baby appearing I was bluelighted in and ended up with an epidural, an emergency section and a major haemorrhage.

I am curious. Which book in particular do you think I missed that would have tipped the balance?