OBEM - why are they so anti-epidural?

[babyblabber]

Just watching OBEM and I've been wondering every time I watch it, why are the midwives so anti epidurals? Is it the same all over England? There was another episode recently where a girl was practically begging for one and they talked her out of it (at 3cm) & I just don't know why. I know there are risks but they are minimal and thousands of women give birth every day with epidurals but watching that show would make you think they're a last resort.

I'm just curious really. I'm from Ireland where it's more normal for first time mums to have an epidural than not and it's almost presumed you will. Having had two kids I am a big fan of epidurals and secretly think giving birth without one is a bit mental!

(ps don't want to start a big debate, just wondering!)

[badguider]

lillian - they have the statistics. there are over 800,000 births in a year in the uk and for every single one they know if the woman had an epidural or not. So it is possible to know if women who have them generally have longer labours, it then takes more detailed studies to try to work out if the epidural causes the labour to lengthen or the long labour causes an epidural to be requested... but that's what researchers do, they study these questions carefully and try to allow for all compounding factors and variables. Same goes for studies of interventions.... lots and lots of researchers working to try to answer these questions... because it's important to try to understand and that's what medical researchers do.

[Cantbelieveitsnotbutter]

I think it slows it down as you end up stuck in a rubbish position. But I do agree I'm not sure how statistics can prove it

[Thurlow]

It's not always simply about the pain, though, and that's what frustrates me. Like other women on this thread I had a ridiculously long early labour, active contractions, very regular, very painful but it still took a day and a half to get to 4cm and be considered for any pain relief or to be allowed near a pool or bath. A day and a half of standing up, walking around, not being able to sit or lie because it was too painful, not eating, not really drinking - I wasn't in a position to carry on.

I remember being aware that the pain, while very bad, wasn't screamingly hideous, and maybe if it had only taken a few hours to get to that stage I would have carried on with G&A or maybe pethidine to get through the next few hours of dilation. But I was beyond exhausted, so I asked for an epidural because I knew I needed some rest before coping with birth itself (though in the end I had a emcs because my baby was ill). I honestly think that if I didn't have an epidural and had progressed on to vb, there would have been more intervention because I wouldn't have had any reserves to draw on to actively push.

There is a need for guidelines and for the majority of women, 4/5cm dilation before being eligible for serious pain relief is probably ok. But I really believe that the length of time women have been in pain for should be taken in to consideration as well.

[RooneyMara]

I asked this a while ago, ds3 is 11 weeks old. I had a quick labour and was desperate for an epidural when I got to the hospital, I was 6cm or so - kept being fobbed off, Oh I just have to fill in this form, Oh I've got to do this, Oh your baby will be here very soon, etc etc

FINALLY I got one about 20 minutes before he was born
I had to beg, literally

At one point she even gave me a bloody sweep which I hadn't wanted and told me afterwards

I presume to speed things up, when all I wanted was to slow them down and get some pain relief.

I have no idea why they didn't want me to have one. I gave birth 6 years ago with nothing and I didn't get a medal that time. I had nothing to prove to her or to myself.

[RooneyMara]

oh yes I had the 'you can do it without' implied over and over...yes I know I can, I've done it before without any pain relief. That's how I know I want one!!!

[OneLittleToddleTerror]

rooneymara my even classier NHS hospital refused to examine me even. They told me they were too busy so they can't escalate my case. I was left in the antenatal ward with my DH, no midwife for 2.5 days in labour. Because I wasn't in 'active' labour, all I got was codeine, my tens machine and a birth ball.

So no guideline is going to help just because it says women after 4/5 cm dilated are to get x&y pain relief. All they have to do is not put you into the system by not examining you.

I was finally attended to at fully dilated after 2.5 days. That's when I was moved to the delivery room to push for an hour.

Thank god I have a high pain threshold. All through those 2 days I can hear the cries of the women in the rooms next to me. They sounded really really awful.

[OneLittleToddleTerror]

I saw the dinner ladies more than midwives during my stay. They were lovely getting my meals to my room, and popping in to refill my tea etc. I can't help but think they felt sorry for us.

[CatPussInACrownOfThorns]

I dont think midwives can win. They're damned if they do and damned if they dont. They are in a very difficult position. Every decision they make directly affects the womans experience, and could well come back to bite themon the arse. How many women would regret an epidural? How many women would have serious intervention because they had an epidural?
There are arguments for and against epidurals, I ended up asking for one when in labour, but in hindsight Im glad I didnt.
I'll seriously try to avoid any kind of pain relief next time. Even Entonox makes me lose long periods of time, Pethedine put me completely out of my skull for hours. I missed the entire birth. Next time, I want to be mobile and hopefully be in a position other than on my back.
I watched OBEM last night and IMO the midwife said what she did about the epidural because the parents had a small child hanging around, and not having one would have meant a quicker discharge and less childcare issues. I dont think she was being funny at all. It was just her opinion.

[Panzee]

Yes, the midwife who tried to put me off having codeine after my section had an opinion too. But it was not her call to make. It was mine. As it should be. I am not five and she's not my mum!

[babyblabber]

But whether they 'know' you can do it or not is irrelevant. Of course I could give birth without an epidural as millions of women have before me but I don't ever want to. Each to their own & brill if you want to do it without but if you want one I think you should get it as soon as you ask (so long as you're in labour!)

I also disagree with the use of the term natural birth, now that I think about it. If we went with nature we'd still have a life expectancy of 50, women would frequently die in childbirth and we wouldn't use contraception. An epidural, like chemotherapy, heart stents, the pill etc is something that we've developed to improve our lives so I just don't get why those midwives see it as a bad thing.

[Thurlow]

I also HATE the term 'natural labour'. And 'failure to fucking progress'.

Just explain to the person who is actually suffering from the pain what the pros and cons of each type of pain relief is, and let them make the decision.

[LillianGish]

It does seem to be a cultural thing. That's how we do it in the UK - there is an entire industry in the form of the NCT to brainwash us into believing that this is the best way. I realised that I had been slightly brainwashed when attending ante natal classes in France and I was the only one asking "What if you don't want an epidural". The other women in the class couldn't think why you wouldn't want one. The default position in France seems to be that you can have one - it's not obligatory, but it is a perfectly normal and acceptable request. The midwife's line was that the length and progress of your labour was pretty much genetically predetermined and an epidural wouldn't make any difference - no doubt they have their own statistics to back this up.

[CatPussInACrownOfThorns]

but that midwife was just filmed voicing her opinion. She didnt inflict it on the mother.
Dont forget OBEM is edited. Its not an impartial view.

[CatPussInACrownOfThorns]

Each to their own & brill if you want to do it without but if you want one I think you should get it as soon as you ask (so long as you're in labour!)
And what about when there just arent the resources in the NHS? Or you book yourself into a birthing unit that doesn't offer epidurals, but you change your mind half way through?

[LillianGish]

I also think it is interesting that the woman insisting on an epidural, not being swayed by any guff about waiting to see what happened, was not British. Her birth looked pretty straightforward to me - the only downside (as far as the midwife was concerned) was that they couldn't boot her out after six hours.

[PandaWatch]

"An epidural, like chemotherapy, heart stents, the pill etc is something that we've developed to improve our lives so I just don't get why those midwives see it as a bad thing."

Childbirth isn't an illness or disease. You cannot compare the use of pain relief in labour to chemotherapy. Taking the pill is for convenience, just like driving rather than walking everywhere, but that doesn't neccessarily mean it's good for you.

The reasoning behind not giving an epidural on the basis that it can slow labour down isn't just because the hospitals want to get rid of your as quickly as possible, it's because a baby is more likely to become distressed if labour is slowed down.

I absolutely agree that women should be given the pain relief they need but it's so important to remember that the NHS aren't the enemy and maybe the reasoning behind the stance taken in respect of pain relief is more sound than some seem to realise.

[LeBFG]

Interesting LillianGish. I've just given birth in France too except all your positives are my negatives: I hated the expectation I would have an epi and that I would have an extended break in hospital. In fact, I did neither . Having argued here about my distaste in general for epidurals, I do also accept OP's issue with UK MWs. I think pain sensation and reaction to pain is so individual that it's patronising of anyone to think they can gauge someone else's suffering. Epis have upsides too - less tearing as the push reflex is reduced/absent so the final stage is more controlled, more relaxed perineum etc. Who could possibly stand by watching an extented labour and not want to relieve someone's pain so they can rest a little ?

I had, fortunately, a quick labour but if, at its most painful point, I didn't progress and I had to feel that pain for an hour or more, I would've been crying out for that bloody epi for sure!

[CatPussInACrownOfThorns]

Ive just watched it again. I still dont think the midwife was after an empty bed. She said "If she hadn't have had the epidural, she would have probably delivered, and got a six hour discharge" Given that at the time the epidural was put in the father was at home minding the toddler, the midwife didnt say "we could have sent her home on a six hour discharge" or the like, and you only heard one sentence of what could have been an extensive conversation, IMO she wasnt being at all 'off' or insensitive.

[treaclesoda]

I feel that I was treated well in labour with regard to pain relief, but I did spend a lot of time in hospital with gallstones during one pregnancy, which were every bit as painful as labour, if not moreso. In my experience, midwives were very anti pain relief. I was being prescribed pain relief by the consultant, who had talked to me about pros and cons, and about side effects, and about how they wouldn't suggest pain relief if they didn't believe it to be safe. Then he wrote it in my notes, disappeared, and the midwives gave me paracetamol instead, supposedly on the grounds that I would need to learn to tolerate more pain in anticipation of the upcoming birth .

My experience in hospitals at every stage was that doctors were much much more compassionate than the midwives, although I'm not of the opinion that all midwives are nasty and sadistic, just that their training seems to somehow make them immune to other people's pain.

[FairPhyllis]

I think midwives have a vested interest in protecting their own professional turf, and that is why so many of them seem to be resistant to medical management of pain. Women should be trusted to make their own decisions.

[MyNameIsAnAnagram]

My experience was the opposite, they mws kept pushing me to have an epidural (back to back baby) and I kept refusing. I didn't want one, I don't want one this time either, and not I'm not "mental"

[LillianGish]

Then you got what you wanted MyNameIsAnAnagram. Imagine if they'd just ignored you and forced one on you anyway - that's what it's like for women who really want one, but can't have one. Surely it's a question of choice - and women should be allowed to make up their own minds.

[MyNameIsAnAnagram]

Sorry, I must have missed the bit in my post where I said I didn't think women should be allowed them if they asked for one.

My point was that not all mws are anti epidural.

[hazeyjane]

secretly think giving birth without one is a bit mental!

I had an epidural with dd2, and spent the next 2 hours slipping in and out of conciousness, bloody terrifying!

I also have a friend who ended up with permanent damage following a bodged epidural, leading to leaking of spinal fluid, and a chronic headache which lasted a year!

Comparing it to chemo is daft, chemo is a poison with awful side effects, honestly not something you would choose to have, unless the consuequences of not having it, weren't pretty dire.