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!)

Sorry Anagram - point taken.

I was 3 weeks overdue and was in to be induced. Before hooking the IV up they offered me an epidural straight away as apparently it is more painful than a natural labor. I managed 3 hours before saying "you were right! Gimme that beautiful epidural!" And she went running off to organise! So my midwife was very pro epidural in my case!

I repeat:
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?

Fwiw I am far scareder of the needle in the spine than the labour pain

CatPussinacrownofthorns, obviously that's not what I'm talking about. My post is about midwives discouraging epidurals, nothing to do with resources (although it seems a good few people think resources are the reason for the attitude)

Every woman deals with labour differently, many women can handle labour with no pain relief. I think a lot of women ask for an epidural early because they are scared of the pain later, midwives want you to wait until you see how you are handling it. Although, maybe if you felt that you would be given the epidural as soon as you asked for it you would be more willing to wait and see!

And minimising interventions is better for the baby and makes recovery easier (in general)

But how do you know its not about the resources? Surely "you can do this" or "Its too late" or "come on now, you can cope" is more acceptable than "You cant have one because theres no anaesthetist" or "we cant afford to give you one"? Or even "you cant have one because we dont have enough midwives to give you one to one care"
And there are lots of MLU and delivery wards that just dont offer them. IT's not feasible to just get one because you decide you want one.

Does a midwife have to stay with the mother once the epidural is in?

I didnt get an epidural because the anaesthetist was dealing with an emergency.

I was under the impression that once you get an epidural they have to stay with you. possibly regional or just wrong

I thought you had to have one to one care on gas and air as well, though?

I don't know it's not all about the resources! That was the point, I was curious as to why they seem so anti them. If resources is the reason then that's my answer!

I agree with skibunny it seems some people ask really early instead of trying to cope a bit longer, and maybe surprising themselves. Of course women who've been labouring for hours/ days should get epidural. No questions asked.
The problem with epidurals is increased interventions, therefore more complications for mum and baby. It's not purely about money but also outcomes and it therefore makes sense for midwives to encourage women to try to continue without (within reason)

I don't think everyone should be offered one as a matter of course, nor do I think you're mental if you don't want one.

My labour was painful (I wanted to die), but I really really didn't want an epidural as I knew it could mean a cascade of intervention, forceps? EEK!

However - if you want one, you should be able to have one, no questions asked. If you were in an horrific road accident and having your leg amputated, they wouldn't think twice about giving you pain relief. Childbirth should be no different.

I was given an epidural with my DS2, almost as soon as I asked for it, despite not really needing one and being so far progressed with a quick labour, that it made almost no difference at all. I was fed up because I couldn't go in the birth centre and thought as he was my last baby, I'd 'treat' myself to the epidural, despite a previous quick birth on G & A. I still wish I hadn't had one, two years later. The needle was horrible, I was terrified that I couldn't stay still long enough for them to stick the needle in my back because my contractions were coming in waves and he was born 30 minutes later. I felt everything and just ended up with a backache for 2 days after he was born. I think at the time, midwives were under mounting criticism from people re epidurals, so they just gave them out. I don't think that just handing out epidurals without question is the right way to go, just because thats the way it's done in other countries.

MWs don't like epidurals because the woman has to be kept under closer observation- more work basically

I never wanted one, then I had to be induced and was hooked up to some kind of drip to help my contractions along. The midwives tried talking me into it, saying the contractions were much more painful with the drip. I said no.

I don't know how long exactly I lasted, but I still remember the pain now. I could cope with gas and air for a bit, but they just didn't go away. I had no let up between each contraction. It was just the worse thing ever.

Then I had an epidural, the relief was immense. However, babies heart beat started dropping and they rushed me off for a EMCS.

Its so difficult. I don't think people have any idea what it may be like. The option should be there for everyone, regardless of circumstance. However, I don't think its the best thing to just ask for one straight away, you should see how it progresses.

WRT The midwife on OBEM I saw her comment as being about being able to go home to her family. The mother was on her own because the father was looking after their toddler, instead of being able to go home and rest in comfort she'd have had a night on the postnatal word (or hell on earth as I like to think of it).

I know doctors who say they can often tell how well a patient is likely to cope with pain (not just childbirth, any pain) and MWs encouraging people to see how it goes is part of that, plus of course people often ask for pain relief as they go into transition so it makes sense to check it's not just that. Obviously they won't always get it wrong, and our personal perception of pain varies so much anyway. I quite enjoy natural labour (got 3DC) but hated my root canal treatment! So a doc might think 'oh, she'll be a stoic one' (based on how I am in labour) and then I'll stub my toe and scream the building down.

I must watch the wrong OBEM episodes - practically every one I see has the mum labouring flat on her back and ending up with an epidural.

MrsJLS85 Sorry to hear about your tear but there is no evidence that epidurals do increase the chance of tearing overall. Epidurals may slightly increase instrumental deliveries (by about 1 in 20) but they also reduce the risk of tears caused by uncontrollable pushing. Tears can be horrible but despite what some midwives say, epidurals do not increase their incidence.
It isn't just the issue of putting women off epidurals, it is also that many midwives will blame everything that goes wrong in childbirth on the epidural.

I really do believe giving birth is more painful for some women than it is for others. With DD1 I was contracting and when I got to hospital (after waters went), I was 3cm and it was a doddle. However, fearing the pain, I asked for an epidural and got one. I progressed very quickly (3-10 in 5 hours) but did require forceps, although I'm not entirely convinced that's because of the epidural.

With DD2 I was induced (never doing that avian!) and the consultant said I should have one as he wanted to break my waters and he knew I wanted one. I was 4cm when my waters were broken and Ive had period pains worse than those contractions. She was also born via forceps, though came out much faster than DD1.

I would still opt to have an epidural. I think my body doesn't register the pain until after my waters have broken. It doesn't slow my labour down at all and makes things much more bearable for me.

I do think its extremely barbaric to give a woman syntocin without an epidural. In the US you are given an epidural before syntocin but not here which I really don't understand!

I had an epidural and the midwife did not stop with me the whole time which was just as well as she was a right moody cow although I had DH there, perhaps if you are labouring without a birth partner htey have to stay with you once it's in...

The reason they tried to encourage her to go without was because they believed that she would labour faster and be able to go home to her husband and little girl. I agreed with them actually and felt really sad for her being by herself as clearly they didn't have anyone to watch their daughter. I think they were being really caring. And there is nothing wrong with trying to encourage women to give an epidural free birth a go. Jeez, some of you need to wind your necks in.

Midwives' whole ethos is to promote normal birth. Epidurals do disrupt the normal physiology of birth and necessitate syntocinon augmentation, and often catheterisation, continuous monitoring, higher rates of episiotomy. Mothers who have one have a radically different postnatal hormonal profile in the hours after birth from women who've had an unmedicated labour. I appreciate that most people don't think that's important, but midwives study the minutae of birth - the finer points of mother and baby interaction in the hours after labour and how these are subtly influenced by hormonal physiology, hence many of them seeing epidurals as a complex intervention.

"Epidurals may slightly increase instrumental deliveries (by about 1 in 20) but they also reduce the risk of tears caused by uncontrollable pushing.@

As for the view that epidurals are not linked with higher rates of c/s, instrumental births etc (except slightly, for first time mothers), which is the advice given in the NICE guidelines, this is based on a meta-analysis of studies almost all of which compare women who are giving birth with epidurals with women who have been sedated with pethidine or other opioids. There are only a TINY number of studies that compare women labouring with epidurals with women having unmedicated labours.

In other words you are comparing outcomes for women having epidurals, with women who are having supine labours, who have been given a drug which is KNOWN to be associated with non-reassuring fetal heart rate traces in labour, and with a group where the majority of women will be having their labours monitored with CTG, something also associated with higher rates of emergency c/s in low risk mothers.

I personally think the evidence from the Place of Birth study is very interesting - that it shows low risk, healthy mums who opt to labour in a setting where epidurals are generally the most accessible (consultant led units) have double the rates of emergency c/s than women who have opted to labour in settings (home or midwife led unit) where an epidural requires transfer and is therefore less accessible.

FWIW I haven't seen the episode of OBEM from the other night. Will watch it this weekend. IMO the conditions women are subjected to in in big, busy consultant led units like the one in the programme generally necessitate epidurals except in the situation where the mothers labour is completely straightforward and quick. Labour is hard enough for most people without syntocinon/being expected to lie on your back/continuous monitoring.