Pain relief - why is there stigma against using it?

[CalamityJ]

39+6 so seriously beginning to think about the actual birth process (probably about time!). A few NCT friends have given birth already and have a few RL friends who have also given birth in the last few months. The general gist has been that they've made it through childbirth with as little pain relief as possible. One posted on Facebook that he was 'really proud of his wife as she'd done it all without pain relief'. And that made me feel a bit as before then I hadn't thought that people would think worse of me if I went for whatever pain relief I felt was necessary. Speaking to the midwife last week she mentioned the birth plan which has that I want to know when it's becoming too late for an epidural so I can make a decision about if I need it. She basically tried to say I should not bother with one and I should just try for gas and air. I'm not sure why I should feel the need to be a hero and go without pain relief? Would it make me a 'better' mum? Why wouldn't I want to make it as easy as possible on me?

FWIW - midwives working on maternity wards don't give a shit about the cost of epidurals. Neither do anaesthetists or doctors. Hospital managers and politicians care. People who're in charge of how the NHS buck is spent care. Midwives generally want women to have uncomplicated births if at all possible, which is why they have concerns about epidurals.

"Depending on who you speak to you will always get a different opionon on whether they do actually slow down labour."

Which is why it's not a good idea to ask individual opinions about whether they slow labour down, but to look at what good quality medical studies have to say on the subject, particularly REVIEWS of the evidence, which take lots of studies into account and not just one.

If you're interested, this is the evidence that NHS patient advice is based on: here

"The review identified 38 randomised controlled studies involving 9658 women. All but five studies compared epidural analgesia with opiates. Epidurals relieved labour pain better than other types of pain medication but led to more use of instruments to assist with the birth. Caesarean delivery rates did not differ overall and nor were there effects of the epidural on the baby soon after birth; fewer babies needed a drug (naloxone) to counter opiate use by the mother for pain relief. The risk of caesarean section for fetal distress was increased. Women who used epidurals were more likely to have a longer delivery (second stage of labour), needed their labour contractions stimulated with oxytocin, experienced very low blood pressure, were unable to move for a period of time after the birth (motor blockage), had problems passing urine (fluid retention) and suffered fever. Long-term backache was no different. Further research on reducing the adverse outcomes with epidurals would be helpful."

Mydarlingclementine - sorry but it's not bollocks at all. Have a look at cochrane (gold standard research in healthcare) epidurals increase the risk of assisted delivery by 38%.
They relax the pelvic floor muscles and hinder rotation of the baby into an optimal position for birth. They also reduce the urge to push thus increasing rates of assisted delivery. The research is quite clear.
Having said that I don't think I dont think anyone should stop someone having an epidural if they want one.

MyDarlingClementine & others. So true regarding why people think you're a hero if you don't have pain relief in labour when you would for a tooth extraction. Men get pain relief for vasectomies & that's fiddling with their most intimate part! I've read the Marie Mongan Hypnobirthing book. Listened to 3 different natal hypnotherapy CDs & whilst they've calmed me down a bit they haven't 'worked' in the sense that the last 2 times I tried listening to them I had to stop as my back ached so much just from sitting down! I think labour's going to be a bit more painful than that!

Because some people treat it as a competition? I had an induced (pessaries then syntocin drip) back to back 24 hour+ labour with no pain relief whatsoever. This was in a bloody Catholic country that believes women should suffer. Thequacks doctors were quite happy to make references to 'natural' birth being the be all and end all whilst conveniently forgetting that an induced, augmented labour is anything but natural! I ended up with a section after failing miserably to progress.

I was a fucking mess to be honest. Don't think there's anything to be proud of about refusing pain relief. If go as far as saying that if it's available and you're suffering you'd be a fool not to take it. Had a lovely elcs for the second dc as was not risking vbac, despite the fact I'd be in a lovely compassionate nhs hospital.

My SIL bangs on about her lovely natural waterbirth at every good given opportunity and BIL writers on about what a bonding experience or was. I just grit my teeth, smile, nod and remember that every birth is different.

My section was a wonderfully bonding experience because I hadnt had to go through labour.

It was bliss to just have the baby there and out, and not have had three days of tiredness and torture to get through.

I loved every minuete of being in hospital with her - feeding, cuddling...gazing.

It was bliss.

Have you ever gone through labour Clementine?

Meeting your baby is the best thing in the world (as long as you feel well enough to enjoy it) however they've arrived.

Signora - I suppose it depends whether you think there's any benefit to you or your baby from going without drugs in labour.

Given that some people won't have a single glass of wine in pregnancy, it does strike me as odd that so many people have absolutely no misgivings about exposing their baby to a fairly large dose of opioids just before they're born. In the long distant past women would drink alcohol in labour to help with labour pains. We'd be appalled at the thought of a baby being drunk at birth, but we think nothing of babies being so heaving sedated with pethidine at birth that they can't breastfeed, or that they risk needing naloxone because their breathing is depressed.

Also - babies born by ventouse and forceps are more likely to have seizures, scalp abrasions, bruising, cephalhaematoma. All more likely for mums having an epidural because of the higher rates of assisted delivery.

I'm not saying that people shouldn't have pain relief in labour - god knows I've needed it myself - but can we all stop comparing it to having a tooth out? Using pain relief in labour may have implications for mums AND babies.

Yes. Because the 'natural birth brigade' (whoever they are) really WANT women to suffer as much as possible, because they're basically sadists.

Any pregnant woman reading this thread and worrying - find out here what percentage of women at your local hospital get the pain relief they request: here (click on main index of national statistics, then go right to the bottom of the page and click on 'Survey of what women thought of their maternity care'.

There's a question 'During your labour and birth, did you feel you got the pain relief you wanted'. On average 1 in 8 women in the UK said 'no'. The lowest percentage of women saying 'no' was 0% at the Wrightington, Wigan and Leigh NHS Trust. There were loads of others where only 1 in 20 said that they didn't get the pain relief they wanted in labour. The highest by a long way was 22% at Ashford and St Peter?s Hospitals NHS Trust.

I quite fancied the idea of a low intervention labour and considered spending some of it in water and then delivering on dry land... trying to stay mobile throughout.

What I got was slow labour for days, a distressed baby from the start and an induction where they didn't bother with gels or pessaries- they put me straight on the synto drip which took no time at all to get me into full blown labour with contractions on top of eachother.

Any thoughts of staying mobile/getting in water had to be forgotten as I spent the rest of the labour and delivery on constant monitoring stuck to the bed.

I worked my way through all the pain relief options and can honestly say I loved the epidural. It was the last thing I said I wanted in my birth plan but my God it works! The pain went from unbearable to non existent and I had a little nap! When I woke the mw examined me and it was time to start pushing.

It was so far from the hippy birth I wanted but at the end of the day they did what they had to to get baby here safely and I did what I had to to deal with the pain. I don't regret a thing.

Good luck for the birth, you'll be fine. If you're getting on well you may not need much pain relief but it's there if you need it.

I can categorically say I could absolutely not care less what anyone else chooses to do (though I do care, very much, that women get what they want during labour and birth - that's different).

I refuse to believe that anyone goes without pain relief in order to win some kind of competition. Does anyone here seriously believe that a woman would go through an extremely painful and frightening experience just to be able to gloat that they did it? Or might it just be possible that those women who prepared for and managed without pharmacological help (and yes,of course luck is a part of it) might have had some other motivation to do so?

What hospital is this Miaow?

If you feel you're being 'fobbed off', then ask to see the midwife who's in charge of the shift. Ask for it to be written in your notes that you've requested an epidural.

Re: competitive birthing, the aspect of this that affected me was women competing to tell the worst birth stories.

Who denies that birth trauma exists by the way? I don't know anyone who's had a baby or who works with women who have babies who doesn't acknowledge that some women are traumatised by the experience of labour.

I don't get it either. Would you feel proud of having a wisdom tooth out without pain relief?

"Does anyone here seriously believe that a woman would go through an extremely painful and frightening experience just to be able to gloat"

Agree.

It's very unsisterly to ridicule someone's motives for wanting to go without pain relief, just as it's unsisterly to ridicule someone for wanting an epidural.

Women generally have very sound reasons for wanting a particular type of birth, and we ought to show some respect for this.

"I don't get it either. Would you feel proud of having a wisdom tooth out without pain relief?"

There are no benefits to going without pain relief to have a tooth out, other than not being dribbly afterwards.

But there may be benefits for some women and babies in not using pain relief in labour.

It's just another stick to beat women with, and often it is other women doing the beating.

Personally I think if you managed without pain relief and claim afterwards you found it 'easy' then clearly you were lucky enough to have a straightforward birth which wasn't very painful in the first place.

Lucky you.

"Does anyone here seriously believe that a woman would go through an extremely painful and frightening experience just to be able to gloat"

Erm... Yes. I know of two in particular.

I agree with what MyDarlingClementine says.

The link between the increased risk of assisted delivery and epidural is there but it's not necessarily a cause. Labours that require more pain relief are all too likely to be ones that need assisted delivery - back to back, suspected abruption, foetal distress that requires continuous monitoring. In other words, you need an epidural because of the type of labour you are having, not the other way round.

Let's not forget there are also advantages of epidurals - lower risk of postnatal incontinence and prolapse being two. The risk of an epidural not working is significant but possible paralysis is absolutely tiny and it is pure scare mongering to keep telling pregnant women about that risk without context. Epidural might slow labour down but it can also calm things down and give you some rest and thinking time.

If I ever met again the Anaesthetist who did my epidural I would give her a hug. It is shameful that the Anaesthetists were excluded from the recent consultation on childbirth and pain relief.

In France epidurals are standard - they are surprised when women don't want one. Means the OBEM equivalent on French TV is a far more peaceful and quiet programme to watch than OBEM in the UK.

I was coping with a tens machine, then DD got into v scary fetal distress. I had no choice but to have an epidural to slow labour down. So sometimes it is not always the woman's choice.

Tonde - I have rarely seen the risk of paralysis mentioned anywhere in relation to epidural use, except in passing when pointing out how very rare it is. It's really not something that's commonly mentioned in the UK to dissuade women from using pain relief.

Thingie - I managed without pain relief (which was what I wanted to do - I had good personal and clinical reasons not to have it) during two difficult and in one case exceptionally long and augmented labour. It was having brilliant care that made it doable, not luck or a stiff upper lip.

I've not heard of an epidural being used to resolve fetal distress. Epidurals are more likely to cause fetal distress than resolve it AFAIK.

I think like all things you take a pragmatic approach. For me, I decided to aim for a birth without interventions because of the greater potential for complications but I decided that if, when I was actually giving birth, I decided I needed pain relief I would take it. Gladly.

So, I planned to be at home because it's a less stressful environment and I thought that might help make labour a bit easier if I was tense from being in an unknown environment.

I did a bit of natal hypnotherapy. Not because I really thought it would work, but on the off chance it might it wouldn't do any harm.

I got a birthing pool because there is strong evidence it helps with pain.

I got a TENS machine (because everyone else did).

I bounced on a ball prior to labour to help get the baby in an optimum position.

I looked at birthing positions and decided it would make sense to use gravity to help so I'd try to be upright as much as possible.

I didn't know any of this would work. How could i? So I also had a plan for what would happen if I went to hospital or had to be induced (although I wanted to avoid induction as much as I could):

If I needed to be induced I would want an anaesthetist on stand by for an epidural. If there was unlikely to be an anaesthetist available i would want to wait until there was. Nobody else is having potentially painful procedures without anaesthetic so neither am I. I would also expect to be catheterised and have continuous monitoring plus a cannula in my hand and other wires trailing off me - that's ok. I would knew that just having an epidural would mean I was at greater risk of other intervention. For me, that's ok too.

If I had a c-section or ventouse or forceps I would be accepting serious pain relief afterwards. Demanding if necessary.

If my baby was breech I would have an elective c-section.

Only a sadist would deny a woman pain relief and only an idiot would criticise somebody for how they had their baby. Natural is not easy and neither is a birth with intervention of any kind. I was lucky I was physically healthy, baby was healthy and my body is the right size and shape to give birth under my own steam and my babies were not too big and in a good position at point of delivery (second was back to back so labour took a bit longer while she turned). I had a much easier time than my friend who tried to do it the "natural" way, had every intervention attempted and ended up with an emergency section. Not that it ever feels easy at the time!

Any woman who gives birth deserves respect and awe. She is amazing.

oh and I'm a big fan of NCT I feel empowered by the information they provide and I had great antenatal classes

Shag
The OP mentioned risk of paralysis. This was also a risk that was discussed in my NCT & NHS classes.

I've not heard of an epidural being used to resolve fetal distress.
Me neither and that's not what i said. 'foetal distress that requires continuous monitoring' means that the mother can't move freely during labour and manage her own pain through labour positions - so epidurals are more commonly required.