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?

[Rooneyisalwaysmoaning]

With the gloating thing I think it's often insecurity.

I felt like I'd failed/cheated when I had ds1(8 hours) with an epidural - friends had had 30 hour labours, caesarean sections, etc and people just looked at me and said 'blimey you lucky cow' and I felt awful. Butthen I felt awful anyway as he was born to me on my own with no partner. So I already felt like I was cheating to have him. I hadn't donethe whole, be loved by someone, get married, have a baby together. I didn't deserve him. It as complicated.

So to have ds2 at home with nothing, not even G&A (which was available but I declined as I don't find it helpful) felt like an experience I was glad to have - in a way - though it bloody hurt, and was traumatising, I felt like I'd 'achieved' something, I knew what it really felt like and for once I had done something 'properly'.

That was my own, personal, screwed up self feeling that way. Six years on and having just had my third and final baby, I went for the epidural. I knew what the pain felt like and didn't want to have it again, and by the time they agreed to it I'd done most of it - he was born about half an hour later. But thank God for that epidural.

Now I've come full circle. I'd say unless you are a masochist with something to prove, like I was before, then take the pain relief - just blooming take it! It is not shameful, or wussing out, those are constructs we create in our own minds from our own feelings of inadequacy. Labour is horrifyingly painful, unless you're very lucky/know how to manage the pain (I didn't, at all) and I've hidden the conception topic on here because every time I see someone TTC, all I can think of is 'are you INSANE?!'

The only down sides I know, for me, are the side effects and the being strapped to a monitor when you want to be on all fours. Nothing else - in fact the improvement in the epidural in 10 years was astounding. I could feel everything.

[Rooneyisalwaysmoaning]

Oh and I haven't gloated btw. I don't think so anyway - tell me if I have! I kept all these feelings very much to myself IRL.

[Shagmundfreud]

"I'd say unless you are a masochist with something to prove, like I was before, then take the pain relief"

But what about those of us who don't want pain relief because we don't want our babies exposed to opioids?

Or don't want to risk needing instruments?

That was me - I didn't want to give birth to a sedated baby (as I did first time).

I also wanted to have a normal birth if it was possible for me to have one, and I knew that this was less likely if I went into an environment where epidurals were available.

As for labour being 'horrifyingly painful' - well yes, I found it to be the case. Not all the way through but for some of it. However, not everyone is traumatised by experiencing extreme pain. I wasn't. I know other people who will say that at times they wanted to die from the pain in labour, but chose to do the next one at home without an epidural. I don't know why one woman is traumatised by the pain of labour and another isn't. In my personal situation having a midwife look after me who I knew well and trusted made the difference to how I felt about the birth before, during and after.

[Shagmundfreud]

You might be interested in a book I've got, which is a study of women's expectations and experiences of childbirth. here

Two things that interest me from this study - the more painful women expected labour to be, the more painful they were likely to find it.

And that women who did not expect to have their preferences met in labour had consistently worse psychological outcomes for birth, independent of whether they got what they wanted or not.

[GoldenGreen]

katiemiddleton sounds like just how I went about things, and like you it worked out for me - and also like you, I know people for whom it didn't. I feel bad for them only because I care about them and I wish it had gone the way they wanted. Not because I think I am superior to them in any way!

Thingiebob I am curious - why slow labour down if the baby is in distress? What is the benefit of doing that? Genuine question - just not heard of that before.

[Shagmundfreud]

"I should add that women being pushed into pain relief they don't want is just as bad as women being denied it. Neither is acceptable!"

In countries where 95% of women are having epidurals I have NO DOUBT that there are women who will end up having one who would have had a better birth without one.

That said, if you watch 10 minutes of a US programme like 'maternity ward' you realise why so many Americans have epidurals. It's like the whole system of care in labour over there is designed to make the process unbearable:

• flat on your back in bed from the minute you arrive in hospital: check
  
• everyone induced within a week of their due date or earlier: check
  
• most women delivering in lithotomy position with half a dozen HCP's shouting at them: check
  
• most labours augmented by syntocinon: check
  
• people having their entire families/workmates/random strangers in the labour room while they give birth.
  
  It's seriously grim.

[PurpleStorm]

I think that you should get pain relief in labour if you need it. Having a baby isn't some kind of competition.

And I'd point out that not having an epidural isn't a guarantee that you'll avoid intervention.
I wanted to avoid epidurals because I was worried about the increased risk of needing forceps, managed on gas & air (and my labour progressed quickly, which helped with that) - but nearly ended up with forceps anyway because DS's heartrate started dropping with the contractions. Luckily the pushing went well enough for us to avoid that, but it was a close run thing.

[Shagmundfreud]

"Not sure I'd use the word 'grim' as a blanket term. If it's what the women concerned want, that's fine and dandy. It's only grim if it's been forced on them".



Very, very few women in the US have the option of a midwife led birth. Continuous monitoring, induction at term, routine augmentation - this is part of normal birth culture in the US. And it's not because women freely choose it. You can't choose anything freely if you're not actually given the option of any viable alternative.

"And I'd point out that not having an epidural isn't a guarantee that you'll avoid intervention."

Um, are we handing out awards today for stating the bleeding obvious? Because if we were, I think you'd have won with this comment.

[sayanything]

I had an epidural with both my children. I didn't wait to see if I could cope with the pain, I asked for one as soon as I was 4cm dilated. And lucky I did, as my labours progressed so fast I probably would have been too late had I waited. I wasn't immobile and I could feel each contraction very clearly, I knew exactly when and how to push - but there was no pain. And I was up and about after a couple of hours both times, after skin to skin. My entire experience was one of feeling in control, aware of what was happening to my body, I loved it.

I gave birth in Belgium, which has the same stats as France. I wasn't pushed either way with regard to the epidural, the hospital had birthing pools, balls etc, it was my choice to have an epidural and it was respected without comment. To me that's the ideal - give women a a true choice and respect their wishes. I would be interested to see the stats for countries such as France and Belgium with regard to the frequency of assisted labour and epidural use. Perhaps due to the notion in the UK that epidurals are best avoided, they are more likely to be called for in cases where assisted labout would happen anyway - but I've no idea if that's actually the case.

[sieglinde]

Some myths here, and some sense...

My first birth plan was 2.5 typed pages, about breathing and management and mobility and this and that.

However, Ds got completely stuck - part of it was that I had gas-and-air, and it made me spew in EVERY CONTRACTION thereafter, which made pushing very difficult. Eventually dh spotted that his heart rate was dropping and we had a crash instruments delivery. TBH I had PTSD afterwards - weeks of nightmares about the birth and the pain.

My second birth plan just said EPIDURAL in huge red caps.

Dd was btw born after a 2-minute second stage. I'd had the epidural, but I felt her crown. I was much MORE in the moment because the pain, though still noticeable, was moderate.

[Shagmundfreud]

"As I said, it's only grim if it isn't what they wanted, and no doubt some women prefer this and others don't. It is grim for the latter group, not the former."

I think what ALL women want is OPTIMAL care. That is care which gives them the best chance of a healthy and normal birth, and where their needs and wishes regarding pain management (which includes but doesn't stop at pain relief) are respected.

When care givers are routinely engaging in practices which are a) not evidence based and b) are known to increase the likelihood of complications without improving outcomes, then women are not getting optimal care.

And as someone who cares about what happens to women and babies in childbirth, I personally think it's grim.

[Shagmundfreud]

sayanything - France has better assisted delivery rates than the UK. Wonder if that's to do with the skill of midwives in delivering women with epidurals, or to do with the fact that your average French woman weighs about 2 stone less than your average UK mum (and interventions in birth are strongly linked with BMI at booking visit....)

[sayanything]

I don't know about France, but in Belgium most babies are delivered by a gynaecologist, there's almost no midwife-led care (and if you get an independent midwife the hospital may not allow her to be present at the birth anyway). You are allowed to have your kinisiotherapist with you though...

[Callycat]

"But what about those of us who don't want pain relief because we don't want our babies exposed to opioids?"

I've never been in labour, and of the do-whatever-works-for-you view! But wanted to say that opioids in single controlled doses will not harm you or the baby. Your child will probably take opioids (like codeine) on numerous occasions throughout her life, as will almost all of us.

[KatieMiddleton]

Yes anything that is blanket policy like that is grim. It shows no regard for clinical need and everything about making birth a profitable business.

I'm very much a hope for the best but plan for the worst kind of gal, but I like to plan using evidence and facts. Sometimes I have disagreed with a hcp because the risk assesment is horse shit not balancing the actual risks for me but based on several variables that did not apply.

Women who felt in control, respected and listened to in birth are proven to feel more positive about their birth experience regardless of pain relief and intervention options. I learnt that from NCT but I also double checked it for myself by looking at studies. I admit I'm a bit of a cynic but I'm one who felt informed and in control even when the mw went to bits with dc2!

[KatieMiddleton]

Callycat the issue with opioids is that they can make the baby drowsy and hard to feed in first few days. This is not always a problem but can be sometimes particularly when it is complicated by something like severe jaundice where fluids are essential to help flush out the bilirubin.

[noblegiraffe]

Some labours are more painful than others. My waters went early, my baby was extremely low in my pelvis (I could barely walk for the last few weeks). I went to hospital about my waters, they said to come back when I was having 3 contractions in 10 minutes, which I was already. I refused to go home and a few hours later was in intense pain and couldn't talk through contractions. They gave me paracetamol, I threw it up. They said that meant I was definitely in active labour, examined me and I was only 1cm dilated. No way could I have got to 10cm without proper pain relief if it was going to get progressively more painful.
As it was, I ended up being monitored, perched on the edge of a bed unable to move through pain, despite suggestions that I walk around. I'd only got to 4cm when they announced an EMCS due to foetal distress. My thought was 'thank fuck for that, I get an epidural'.

I know from talking to other mothers that their experiences were nothing like mine. They might not have needed an epidural but they're fucked if they're going to try to make me feel bad about wanting one.

[nailak]

I actively enjoyed my pain relief free home birth, i used only tens, sometimes i feel like getting pregnant again just so i can give birth again.

[Shagmundfreud]

"I find it exceptionally hard to believe that there isn't a single woman in the US who doesn't want the medicalised model"

Umm, I didn't imply that all women want a 'non-medicalised birth'. Or even that most women don't want a medicalised birth.

But ALL women want the best possible outcome for themselves and their baby surely?

And if the care they're being given is not based on good quality, up to date evidence, then they're not getting it, are they?

"But wanted to say that opioids in single controlled doses will not harm you or the baby."



If it creates a barrier to establishing breastfeeding (it does for some babies), is linked to higher rates of non-reassuring traces during labour, and results in more babies needing resuscitation after birth (it does), then I hardly think it can be described as 'harmless'.

And Callycat - my children have never had codeine, and they are 9, 7 and 13.

And I'm 46 and have only had codeine once. It made me very, very unwell and I've never taken it since.