Hospital putting me in midwife led unit so no epi available-worried!

[Manc451]

Hi, I found out this week that I'm low risk so going into the midwife led unit rather than the consultant led bit. They slipped in that that unit doesn't offer an epidural, which I was determined to have (my sister had a horrendous time and I'm terrified!). I'd at least like the option? They said that if I said so on the day they could then move me to the consultancy led bit and try to get me one then. But what if a bed isn't available at that late stage, or they try to convince me to leave it? Maybe im being a fuss and it will be easier than i think? What do people think?

Ginderella I think Ushy was saying that the behaviour of midwives doing this was completely unacceptable. Which it is.

And I do think it happens sometimes as midwives think they know best in some cases...

Even if you're in a consultant-led place there is no guarantee of an epidural. My best advice is to plan as best as you can for a birth without one.

Not getting one when I needed one has meant I have and continue to suffer from PTSD. I had no alternative plans and suffered terrible.

My subsequent two births didn't feature any drug pain relief at all as I was no longer under any illusion that the MWs would do fuck all to help and took it upon myself to research and practice ensuring I could cope.

"Your body, your choice and your right to choose where you want to give birth"

More than 90% of women in the UK give birth in consultant led units. Many women who want a birth centre birth or a water birth are disappointed because of lack of capacity and end up on the labour ward, so women not getting the birth environment they choose is commonplace in the NHS.

It's just much more unusual that it's a place in a CLU which appears to be being denied in your case, rather than the other way around.

If you are very keen to go to a CLU then you should have a right to choose it as your birth place.

That said, it's worth keeping in mind two things:

• low risk mums who choose birth centres tend to have a more positive experience of birth, even when you factor in those who transfer in labour
• low risk mums who choose consultant led units as a birth setting are signficantly more likely to have a complicated birth and need pain relief.

Would add, just to put a figure on it - epidurals generally work and are very, very effective but 1 in 8 women has incomplete pain relief with an epidural.

Handmini - women who opt for birth centre births also have the option of an epidural. They just need to transfer to the labour ward for it.

Minifingers - there no point in trying to persaude the OP to opt for natural birth. Her chances of complicaitons may well be higher if she has an epidural, but lots of women have normal delivery with an epidural.

I suggest the OP asks for mobile epidural rather than a traditional epidural if possible. The pain relief with a mobile epidural is less good, but I didn't need a catheder and I was not completely paralysed.

And what percentage of women who ask for an epidural do not get one?

"And what percentage of women who ask for an epidural do not get one?"

I imagine that a lot depends on the day of the week, time of day and what the woman has written on her birth plan. Sadly it also depends on how assertive she is and how busy the midwives are.

Mini fingers, I know that, but I think the perception you give to MWs makes a difference - turn up at a MLU, they will assume that your preference is for a non-epi birth and they will persuade/encourage you in that direction. I think your chances of getting an epi if you ask for one are higher on a labour ward.

'Sadly it also depends on how assertive she is and how busy the midwives are.'

Yes. But Pethedine can sort out both of those, alas, regardless of the woman's wishes .

Just wanted to add - our local MLU have cot beds for husbands to stay with you from the time you arrive to the time you go home (3 days in our case, wanted to get BFing established and didn't feel confident at the time). Not sure if this is the case with all MLUs but I wouldn't underestimate the moral support that gives you in the first days.

In our area that is the only place you can have your DP with you, and now I couldn't imagine not having him there for those midnight/2am/4am/6am moments we shared

This time we're opting for home birth, otherwise I'd go MLU in a heartbeat, these MWs are used to treating pain in different ways and are probably better trained in many ways, knowing they don't have a doctor/anaesthetist down the corridor.

Do you want to go in and ask for an epidural as soon as you are in established labour or do you want the option of an epidural if it all gets too much for you? If the former then tell them you want to be in the CLU, if the later then MLU will give you that option. Does your trust run antenatal classes? Go to them and research the different pain relief options.

You will always find positive and negative views about all options. I liked the TENs machine and got within half an hour of birth with it with DS (and that was an induced birth that was hard and fast). My Mum hated gas & air (she felt sick), I thought it was fantastic (for me it was like the perfect drunk stage and completely removed the pain of contractions); I hated pethidine (it was like the worst drunk stage when you've vomitted and just want to sober up but can't and made me unable to control the G&A so I actually felt worse), my friend loved it; you have positive and negative stories about epidurals as well. A friend had a VBAC and said she thought a planned CS (she had pre-eclampsia) was easier to recover from than a 'natural' birth (she had an epidural in both cases) but she felt she got her 'I've given birth properly' award after the VB.

I am all for having all pain relief options available (I work in the pharmaceutical industry so have no hippy notions as far as birth goes) but personally I never felt the way you sometimes see women on OBEM where they feel out of control with the pain and need an epidural to become themselves again. So I would say you have to wait and see how YOU (not your sister) cope with your birth experience but feel happy to ask for pain relief if you need it, you need to specifically ask what happens in the MLU if people want an epidural, how long does it take to transfer etc before making a decision. If they are telling you you have to go to the MLU then hopefully they have good procedures for transferring you to the CLU.

You will hear good and bad experiences of both, I have nothing but praise for my local obstetrics department after having 3 births (including a dramatic preemie birth that involved a pushing stage with no pain relief as I was being pushed along a corridor for a CS, he arrived before they could give me a GA) but I have a work colleague who complained about it so even the best department will have some detractors. You need to assess yourself how things work in your department and do you feel confident.

I don't think the point is how many women here are against epidurals and how many had a lovely time without one.

Nobody can give OP a guarantee which way her labour will go in terms of pain levels. Some of us don't even want to bother trying to experience the pain of childbirth and denying someone an epidural is absolutely outrageous.

OP, do not let them send you to a MLU.This should be your choice entirely. Tell them firmly that you do want an epidural and will not accept being denied one.

Minifingers, I honestly don't know what part of UK you're in but I don't think OP's experience is an outlier.

I have been hearing about this increasingly in and around where I stay- women are being pressured into opting for MLU and they are being pressured or even tricked out of epidurals.

If you want a MLU or a home birth, there is very little chance that anyone will stop you because it suits them much better anyway (cheaper). On the other hand, if you want consultant led care and/or an epidural, then you will most likely have to fight for it.

I don't agree with PeaceandHope saying if you want consultant led care and/or an epidural, then you will most likely have to fight for it.

You just need to clarify that from the start, insist on giving birth in a labour ward, discuss epi in advance with midwives and write it clearly on your birth plan.

If you go into a MLU, HCPs will try and persuade you against an epi because its assumed that's why you've gone into a MLU - to be supported in a non-medical birth.

HandMini, there is nothing to disagree with here. I had to fight for it, my colleagues had to fight for it, my neighbour had to fight for it- OP will have to fight for it. This is part of a cost-cutting drive to encourage what the NHS defines as a "normal birth".

Maybe in some areas (like parts of London) you'll get an epidural etc without a fight, but in many parts of the country you honestly won't.

OP, if I were you I would want the option. I laboured for 25 hours with no epidural but had pool, pethidine, birth balls, a doula, breathing exercises the lot. The epidural finally helped me not lose my reason. There are no medals handed out for so called 'natural births'.

Where is your midwifery led unit? half the time the midwifery led unit is next to the consultant led unit, to the extent that there is a set of double doors between them. If there is a reason to transfer or you want an epidural, you walk though the doors.

In many hospitals now all women with a low risk pregnancy/labour go to the midwifery led unit unless they want an epidural the minute they arrive. A large number transfer to the consultant led unit for more pain relief or because of an issue that makes them high risk. Often the midwife goes with them. If you think you are likely to want an epidural, I wouldn't suggest you go to a midwifery led unit off the main hospital site but one which is a midwifery led unit pretty much in name only is unlikely to be a problem. Just expect to change rooms at some point during labour.

Peace, that may have been the experience of you, your colleagues and your neighbour, but I think it's unfair to the medical profession to state that. See NICE guideline 55, which specifically states women have the choice of MLU, home or labour ward, and specifically states labour ward should include access to epidural anaesthesia. I feel sorry for anyone who wants an epidural and isn't given one (for whatever reason, it's too late, the anaesthetist is not available etc) but its scaremongering to suggest that it would be withheld for no reason.

Handmini have you seen the joint statement that was put out by the RCOG, NCT and RCM last year on the subject and the national drive they are actively making to promote (or enforce) low risk mothers into MLUs?

The reality is that choice is only choice if its free and there isn't this 'encouragement' or policy to do one thing or another on the part of professional bodies.

If the evidence points to one place of birth being better, then let the stats and experience of others speak for themselves, rather than setting policies (and targets) about this.

HandMini - I agree with Peace. If you want an epidural you must state this from the beginning of your labour. Before you take any other drugs, whilst you are still lucid, before you are so stunned with pain that you will do anything the doctors or midwives tell you. There is no point going to a MLU if this is the case.

OP, make sure your DH or birthing partner is on your side. Otherwise, (in my experience), when I was begging for an epidural, the midwife tried to get my DH to talk me out of it. You have to fight and stand your ground. The midwives will use every emotional trick in the book to dissuade you. Show them you mean business. They are not your friends.

Don't waste your time writing a birth plan stating you want an epidural. The midwives don't read them. My plan stayed in my bag.

Every hospital has targets set to reduce costs. Cutting back on epidurals is one way to save money.

I think you are naive if you think that NICE guidelines are being followed in every case.

Hmmm, clarity up front required I think then! I can imagine asking for one and it not being possible at that point (and the midwife i asked said as much when i asked her). There are a few good points about the benefits of the midwife led unit though, so I will have a look into it before making a decision, thanks again

Agree about getting DH onside to know exactly what you want beforehand. Hospital staff don't even bother to read the care notes written by consultants ime, given they wanted to give me pethadine and discharge in less than 24 hrs (consultant instructions - no pethadine, must stay in for at least 72!)

Ginderella, I agree you need to state it up front to have the best chance if getting an epi (see my comment up thread). It will be easier to get an epi if you start off in a labours ward with a clear plan to have an epi, rather than start in a MLU with a plan to have a drug free birth.

I'm not naive and I don't quote NICE guidelines because I think they're followed in every case. I quote them to give the OP back up to ask for what she wants. And if necessary to stick these in front of a midwife/doctor.

But crucially, do all this BEFORE you're at the moment of feeling in pain/out of control.

I would write a birth plan if I were you. It is not the case that these are routinely ignored.

And by the way I do think there are LOADS of benefits to being in a MLU, so I hope you don't find all this epidural/no epidural thing takes your focus off these other things.

I had an epidural for all 3 of my previous births - at the last minute with the most recent. When I did a bit of digging afterwards I discovered that there's no such thing as 'too late' - only their (hospital staff's) decision that it isn't worth it now. Which is not very reassuring - if you were having surgery without anasthetic would you ever think, 'oh, it's not worth it now? My arm's nearly off....'
I'm firmly in favour of putting your foot down - you want pain relief, you should get it. What's the point of suffering needlessly? If you lived in France...but that's another story.
Tell your birth partner when you first start wanting the epidural, and let them do the insisting on our behalf. Give them instructions to nag & nag & nag if need be - it's the wheel that squeaks the loudest etc...
The relief when it first starts to work is unbelievable. You feel human again.