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?

Being a woman doesn't exempt anyone from being called out for chauvinistic behaviour.

If you think a woman is behaving in a chauvinistic manner, then call her out for it. I have no problem with that, whether I agree with you or not.

I object to your use of the word 'bitch' as an insult. It's demeaning and offensive (to the point that yourself and RalukaV felt the need to self-censor with asterixes) and highly gendered.

It's been successfully reappropriated by feminists, who can self-identify as a bitch. "A Bitch takes shit from no one. You may not like her, but you cannot ignore her....Bitches have loud voices and often use them." (Jo Freeman, 'The Bitch Manifesto')

By using the word in a derogatory way against another woman you're essentially stripping it back from its reappropriated context and placing it firmly back into the hands of its original misogynistic owners. You're doing a disservice to feminism which has worked hard to take it back.

I have to say to hell with the debate about whether its anti-feminist or not or whether its misogynistic.

I don't actually buy into that. I do think there are some militant natural birthers who are so for reasons to 'empower' women and its not misogynistic per sa in nature.

What I do think its about, is power and control, and having an agenda thats your own, rather than listening to a patient. Which is unacceptable whatever the motivation behind it.

As for all this bollocks about the semantics of the word bitch... Meh.

I do think the feminist angle is something of a red herring, because I believe that patients being disregarded and ignored is endemic throughout healthcare, and certainly not restricted to just women. I think its more staff thinking they can get away with it, because others allow them to. This covers the elderly or the disabled as much as it covers women. Basically anyone more vulnerable or less able to speak up.

I also think there is a feminist aspect to pro-natural birth that actively ignores the full picture as part of all the bollocks about reclaiming women's bodies or whatever else they are trying to 'reclaim.

Its shouldn't be about reclaiming anything. Reclaiming isn't reclaiming. Instead it draws attention back to the old associations anyway, rather than moving forward.

Its an approach that looks backwards rather than looking forward to new ways unconnected with the old. And frequently in doing so completely misses the point, because its so busy trying to fight back and disprove something, instead of getting to the real heart of issues and getting on with things for the benefit of all groups (which may include other groups who aren't women).

It is not acceptable, for any healthcare provider to deliberately ignore appeals from a patient for assistance. If midwives are more guilty of this than other healthcare providers than others, then the problem isn't necessarily about misogyny; its about a lack of empathy and understanding about people being individuals.

Of course this is a feminist issue! I don't see any pain being trivialised and being called "good" other than the pain of childbirth.

Childbirth is a feminist issue. The appalling way in which women are treated on maternity wards is a feminist issue. In every other sphere of medicine patient autonomy is mostly respected, but pregnant women are treated like incubators. Only on a maternity ward does it become acceptable to force unwanted procedures on a patient or to refuse pain relief.

kittenmittens

You think women should be denied pain relief, but you want to argue with me about the so-called feminist issue of reclaiming "b*tch"?

You don't understand feminism.

Wow. At what point did I say women should be denied pain relief?

I'm not even commenting on the issue at hand. I actually happen to agree with you. If women want pain relief then they have a right to get it.

I'm taking issue with your use of sexist language. But you seem not to be able to understand that.

Kitten,

I was first to use it and I censored it because this is a public forum and I don't use offensive language in public if not necessary. The word expresses exactly my feelings about it and it was supposed to be superoffensive on purpose. I would use much stronger language in real life towards such midwives.
When I wrote it, I didn't care much wheather it was reclaimed by feminists or not, in fact I use the word in boht senses when I use it. However, I meant it to be offensive, yes, and as I've said above, it's still very weak for such a person.

I am afraid of needles and also wanted a natural birth. Was pretty nazi about it, went for the hypnobirthing course, practiced the techniques religiously every night and day for three months.
When I went to the hospital I had been in labour for 28 hours, all bearable until the 25th, then I was struggling and the contractions were frequent so I thought I'd go. There they told me that I was very little dilated and the consultant broke my waters. The pain became unbearable. The rest of the story does not matter here, my point is that it is great to hear positive stories and I hope that you will experience a beautiful birth. However, what I learned about my experience is:

1- once you are in labour it is quite difficult to concentrate on what other people tell you/have a discussion with others, so make sure that everyone knows what you want beforehand. Do not leave it to the last minute to discuss with the staff how and when you can get an epidural, as you will be busy doing other things.

2- As others have already said above, make sure that your birthing partner knows exactly what you want and when to intervene, so that s/he can fight for you if necessary when you will be too busy.

3- Hypnobirthing did not work for me. However, hypnobirthing websites and books are quite good on information on pain relief. So when the consultant told me that he thought I needed an epidural and maybe forceps, I knew that that would mean my baby's birth would become someone else's business, for often one step into a medicalised birth then means another, and possibly another and so on. I learned that from the hypnobirthing book I read, and so I decided to go for a c-section. It was the best decision I have ever made, and I am sure that I would not have been in control of my birth experience so much had I had an epidural.

So at the end of the day I moved from no needles to a c-section. This taught me that until you are there, you cannot really know what it is going to happen. Other people's stories, good and bad, will be useless on the day. I would make sure that all my options are open, and then see what happens when it happens.

Have a beautiful birth.

Great post Redtoothbrush and I certainly second PeaceandHope as well
"The appalling way in which women are treated on maternity wards is a feminist issue. In every other sphere of medicine patient autonomy is mostly respected, but pregnant women are treated like incubators. Only on a maternity ward does it become acceptable to force unwanted procedures on a patient or to refuse pain relief."

We're in the dark ages aren't we? In a hundred years time, hopefully, historians will look back at the evil treatment dished out to women in labour - a completely shameful chapter in our social history.

Great post mpac298 as well - my post crossed

Women's empowerment in terms of childbirth rights has a long, long, long way to go Ushy. We haven't got anywhere near where we should be.

Women are still forced into treatment they don't want and denied treatment they do want. Everyone seems to have more rights than the woman herself- the doctor has a right to prevent malpractice, to protect his religious and moral beliefs, to deny treatment etc., the fetus has the right to be born safely.... the list goes on. What gets lost in this debate is the right of the woman to make decisions about her own body.

The scary part is that most women themselves don't understand the injustice of what is happening to them.

Hi OP

I haven't read the thread but wanted to share my experience with DC1. I went to a midwife led unit when I arrived at the hospital at around 11pm. I was 5cm dilated at that point. I laboured there for 15 hours with gas and air, then decided I wanted an epidural and transferred to the labour ward. DC1 was born 6 hours later.

It was a really positive birth experience for me. The MLU had a nice relaxed atmosphere for the earlier stages of labour, but I was grateful for the constant monitoring in the labour ward by the time I transferred there. I felt that I was listened to and allowed to make my own decisions. I hope you have a similarly good birth experience.

I'm wondering if those of you (Redtoothbrush, Ushy and PeaceAndHope) who feel very concerned about women's autonomy in labour (which is obviously something of importance to everyone who is concerned about women's emotional and physical well being in labour) feel about the large amount of avoidable surgery which is being done on healthy young mothers in this country and around the world?

Is this something you're concerned about, or not? I don't know a single midwife who doesn't think there is a huge amount of iatrogenic damage being done to women in our hospitals. Why do you think as a society we're so accepting of high rates of avoidable emergency surgery in this particular demographic? Do you think this is part of the misogyny that you think is endemic in maternity services? A sort of 'as long as we get the baby out and don't get sued, bugger the fact that we are inflicting tens of thousands of avoidable surgeries on women's bodies' attitude?

"and has notions of pain being "good"

But in relation to childbirth experiencing pain DOES sometimes serve a useful function. It provides a sort of bio-feedback system, and if women are given freedom of movement to respond to what they're feeling in their bodies, it can help them work out how to move to birth their babies more easily. I appreciate that some women would prefer not to have pain in labour no matter what, but it's not sensible to ignore the physiology of birth when you're trying to understand the way midwives work. There are very midwives who are genuine woman hating sadists in my experience!

Minifingers,

"But in relation to childbirth experiencing pain DOES sometimes serve a useful function."

Any notion of "good pain" makes me want to inflict pain on the person saying it. It's as simple as that. How come that pain isn't so good in any other area of healthcare? Huh? Because this bullshit theory was invented by men to safe on anestheatics and it is very sad that so many women (midwives being the most arduous acolytes) buy into this. It says a lot about their self-respect.

And no, I'm not as much concerned about the rate of the so called unnecessary surgery in general as much as I'm concerned about not respecting woman's wishes about pain relief or CS on request. I think that in fact if women were to really choose, CS rate would be much higher about 50%.

"Any notion of "good pain" makes me want to inflict pain on the person saying it. It's as simple as that. How come that pain isn't so good in any other area of healthcare?"

Because pain in childbirth, while being as or more severe than pain involved in serious accidents or illnesses, is in every other way different, being a) episodic b) limited in duration and c) not usually pathological. Pain serves no purpose whatsoever in relation to other situations, other than to alert someone to get help as something is wrong. Once its served that function there is no value to it. However, pain IS part of a bio-feedback system in labour - like it or not! Mothers will tell you this. Midwives who understand the physiology of labour will tell you this. It doesn't mean you SHOULD experience pain in labour if you would rather medicate it away, but it's an undeniable truth for many women.

There are plenty of good reasons not to have pain relief in labour. I personally didn't want to give myself or my baby a large dose of opioids, and in any case, they don't work that well as an analgesic for most people. And I didn't want an epidural as I have large babies and wanted to do everything possible to avoid having to have my baby pulled out of my vagina with instruments, plus not wanting to have loads of syntocinon in labour as I have concerns about its long term effects on the baby. Some of us weigh it up, and feel that we'd rather put up with severe pain for a few hours in exchange for not having more medical interventions, and there's nothing silly, unreasonable or unrealistic about that. Denying these things is about as short sighted as denying the fact that some women can't manage labour without pain relief.

"I think that in fact if women were to really choose, CS rate would be much higher about 50%."

Where is your evidence for this? Even in the US where people have private healthcare it's only 33%.

"I'm not as much concerned about the rate of the so called unnecessary surgery in general"

Every year, hundreds of thousands of women are coming out of hospital with full-thickness abdominal wounds, which put their next pregnancy and birth at additional risk, wounds which they might have avoided with better care, and you don't think this is a problem? Why? Just like 'pain is pain is pain' - 'a wound is a wound is a wound'. A c-section wound is a birth injury. A serious one. Why do you not care that thousands of women are being unnecessarily injured in this way every year because of the way care is organised in hospital?

Mini,

do you really know that for a fact that those "injured" women really feel it was unnecessary?

As for countries where there is real choice, look at Brazil and look at France for real choice of epidural etc. In France they offer it to you right when you enter the hospital, which is how it should be. You still can say know if you want, whereas when someone is denying it to you, what can you do? Scream some more?

Minifingers Mon 01-Jul-13 10:43:19
I'm wondering if those of you (Redtoothbrush, Ushy and PeaceAndHope) who feel very concerned about women's autonomy in labour (which is obviously something of importance to everyone who is concerned about women's emotional and physical well being in labour) feel about the large amount of avoidable surgery which is being done on healthy young mothers in this country and around the world?

You make it sound like I'm pro-surgery. I'm pro-choice and autonomy for women in childbirth. And there are plenty of examples where things are clearly not right in respecting women wanting a more intervention free birth.

But thats the point, trying to get the balance right can only be done if the information being given out is free from agenda and politics. Which it currently isn't. Throughout the world there are groups taking advantage of this.

However we are talking about the UK and the relevance of the situation in this country. And we are talking about when women are choosing surgery for certain reason thats based on a degree of data in the interests of their health. We are not talking about opinions that are being made because of some dubious information without foundation in a degree of research. We are talking about an area where the balance of information really does suggest that there is a case to be made for both approaches and as such women should have the freedom to explore this and decide what they think is best for their own personal circumstances.

And yes I really do think it works both ways. I would support any woman who wanted to avoid interventions and feel they should not be pressured by words like 'have to' or 'not allowed' or 'you must' or worse still 'I'm just going to'. I think there are women who are being persuaded to have invasive treatment which is totally unnecessary and for the benefit of others and not themselves (and thats not just restricted to maternity). Which is going on, across the board, because women are mere spectators to whats happening to them, and are actively being taught not to question or challenge what doctors/midwives say.

I'd highly recommend Margaret McCartney's book, "The Patient Paradox".

So yeah, if its what you are getting at, I support women who want to have a homebirth as much as I would support them wanting to have a CS. Provided they are given information about the risks (and maybe benefits of both) and not being given biased info.

There is soooo much that needs to be done, you have to start somewhere. I think starting with whats closest to your heart is perhaps the most natural. It certainly does not mean you don't support other connected and differing approaches.

"the OP is however the opposite as she wishes for epidural to be available to her and she is pushed into the MLU. This goes against what you are saying is the reality nowadays."

Well it's not me saying it - it's there in the national statistics: 90% of babies in the UK are born in an obstetric led unit, so it is unusual for a mother to feel pushed towards a birth centre. If she has stated clearly that she wants to go to the labour ward and she is denied this wish, then it's a job for the supervisor of midwives at the hospital, and PALS to sort out.

And fewer than 1 in 10 women in the UK say answer 'no' to the question 'Did you feel you got the pain relief you wanted in labour'.

These statistics come from the Royal College of Midwives and from BirthChoiceUK.

Incidentally - you are right that midwives DO have an agenda: which is for you to have your baby without needing surgery or instruments, and for your baby to be born in good health. Google 'normal birth agenda' and you'll see how preoccupied midwives are with the issue of the rising tide of interventions in birth. The negativity midwives feel about epidurals is linked to this agenda: they believe that epidurals can and often do complicate labour and make a normal birth less likely. They still don't have a right to refuse a mother's request for an epidural if it is safe to site one, but it is fair to acknowledge that they are not generally doing this out of simple sadism.

"An epidural should be a human right"

Should access to a birth pool also be 'a human right'? Or the right to be cared for by a midwife you know in labour? Or the right to one to one care? All of these things, like epidural, make a huge difference to women's ability to cope with labour and to have a birth experience that leaves them happy and untraumatised.

The trouble I have about this pushing of a normal birth agenda is exactly that. Pushing it. It need to be made freely available and if women actually don't want to go down that route, back off.

Instead it ends up about being 'proving' they have achieved this goal by having targets on the number of interventions going on, rather than actually bother to ask women whether the birth they wanted, was the birth they got and if it wasn't, was this preventable or beyond anyones control.

"The trouble I have about this pushing of a normal birth agenda is exactly that. Pushing it. It need to be made freely available and if women actually don't want to go down that route, back off."

Ummm - I don't think there are many women out there who would actually WANT a forceps/ventouse/emergency cs/episiotomy if they thought they could push a healthy baby out without having these things!

Because that's what a 'normal birth' is. It's birth without artificial augmentation, one that starts spontaneously, one that doesn't involve instruments or a cut to the perineum. Most women want this - no matter what their feelings about pain relief..

The issue about planned c/s for healthy women is a different issue. Midwives are NOT currently 'pushing' any agenda which seeks to deny women access to planned c/s, although there is concern in midwifery circles about the impact of a large increase in numbers opting for surgery in the context of a rising birth rate, stagnant midwife numbers, and no increase in consultant cover in OU's.

Minifingers

Read every word of this post before responding and think deeply about what I'm writing.

I am concerned about any procedure being done on women without their consent and approval- not just c-sections but also forceps and ventouse.

If a c-section is performed on a woman without her consent, then I am against it.

However, I am equally, if not more, concerned about the fact that tokophobic and well-informed women are being denied caesarians on request in this country and being forced into birth experiences that leave them with PTSD.

Autonomy isn't just about refusing treatment, it is also about being able to choose and request suitable treatment.

I have no doubt that midwives are concerned about women being forced into surgery. I wish they were equally concerned about women being denied pain relief and caesarians on request. Unfortunately, they aren't.

Could you please tell me how you have become an authority on "unnecessary" surgery? The only time one can be 100% certain that a caesarian was required is when it is too late. I would personally prefer to have a surgery that may be potentially unnecessary, than end up with a brain damaged or dead baby. HOWEVER, I support any woman's right to refuse a caesarian and I think most women are aware that they have this right. If they don't want the surgery, they can simply refuse. Nobody can be forced into a caesarian. The law in this country protects a woman's right to refuse any treatment even if it kills her or the baby.

Why aren't you equally concerned that UK is one of the only countries remaining to still use the deadly Kiellands forceps? Why aren't you and other midwives raising the same kind of hell about outdated forceps as you do about caesarians? I would argue that forceps are much riskier than a caesarian in most circumstances, but I don't hear the same outrage from you people about the 10-15% forceps delivery rate in certain parts of the UK. Why?

Yes, I think an epidural is a human right and it disgusts me that you placed human right in quotes when you referred to this statement of mine. It just shows the disdain you harbour for pain relief and that to me is horrifying.

To clarify, I think any form of pain relief is a basic human right of a labouring woman- be it a birthing pool, gas and air, or an epidural. There is no excuse for denying a woman her choice of pain relief and comfort in a developed nation. None whatsoever.

To add to some of the points that have been made, I object to the term "normal" birth because it has associations of guilt and judgement. Are you saying that women who have assisted births or caesarians are "abnormal"? There are 2 types of births- vaginal and caesarian. Vaginal can be medicated or unmedicated, assisted or unassisted. The caesarian can be planned or emergency. Those are all the classifications we need.

I would like to point out here that UK currently has around a 25% c-section rate. Given the fact that c-sections are recommended for a variety of medical reasons including breech babies, triplets, some twin presentations, transverse babies, some cases of pre-eclampsia, in women with more than 1-2 prior c-sections, some women with heart disease, some overweight or older women (although certainly not all), placenta previa and a variety of other emergencies that might occur in labour, I don't think that 25% is an unreasonable percentage. If the c-section rate has risen over the years, then so has the safety associated with the surgery. So have levels of obesity, the number of multiple births and the instances of GD resulting in bigger babies. So have interracial marriages which may result in CPD. So has the evidence which recommends caesarians in certain situations that weren't included 40 years ago.

You might be interested to know that the WHO withdrew its recommendation for a 15% caesarian rate in 2009, and has now stated that the overall rate is irrelevant as long as the maternal and perinatal mortality rates are within acceptable levels.
It might also interest you to know that Greece has a c-section rate of almost 50% and the lowest maternal mortality rate in the world at less than 2 per 100,000.

I am not saying it is OK to force women to have a caesarian- it is never OK to do that. But if the 25% of women who had caesarians consented to the surgery due to medical or personal reasons, then what is your problem? Why are you assuming that all 25% of these women were forced into unnecessary procedures that they had refused?

And for the last time Minifingers there is nothing called good pain. Pain is pain and it is unpleasant. You either tolerate it or get pain relief. Glorifying that pain of childbirth (and none other) is misogyny of the worst kind.

If someone wants to have an all-natural birth with no pain relief- fantastic for her and I would hope she had one-to-one support to be able to do that. However, kindly do not insinuate that every woman needs to be lectured on the so-called "benefits" of labour pain so that she might change her mind about needing pain relief.

Would you argue with someone who wanted pain relief in any circumstance other than childbirth? NO. There! That's why this is a feminist issue.

You are so concerned about women with abdominal "wounds". Why aren't you equally concerned about the hundreds of women seeking treatment for pelvic organ prolapse and incontinence caused as a result of severe damage during a vaginal birth? Why aren't you equally concerned about women who end up with severe tears that take months or even a year to fully heal?

The problem with you is that you are obsessed with the drawbacks of a caesarian. So obsessed that you fail to see how horrifying the risks of a vaginal birth can also be. I know someone with a permanent colostomy as a result of an all-natural, unmedicated birth that went seriously wrong. It isn't just caesarians that can cause catastrophic damage.

If midwives were really concerned about women and their well-being, they would pay equal attention to the risks of BOTH modes of delivery- they wouldn't live in denial about the very real risks of a vaginal birth.

Every word you type has a subtle undertone of disdain for pain relief and caesarians. You are biased and unhelpful to this debate.

"You are so concerned about women with abdominal "wounds". Why aren't you equally concerned about the hundreds of women seeking treatment for pelvic organ prolapse and incontinence caused as a result of severe damage during a vaginal birth? Why aren't you equally concerned about women who end up with severe tears that take months or even a year to fully heal?"

I am PeaceAndLove. I am.

5% of vaginal births end with the mother experiencing a third degree tear or worse. Of course most of these tears will not cause any further problems, but some will. One of the most significant risk factors for problematic tears are forceps and ventouse deliveries, and as you know from reading my posts on this board, I am very keen for the NHS to do all it can to help women who wish it to avoid the use of epidurals, which are associated with higher rates of assisted delivery. That's why I strongly support the opening of new birth centres, one to one care in labour, case loading care, access to water birth facilities, and access to home birth services. All these things help women have straightforward births and avoid complications which increase their chance of problematic tears.

"The problem with you is that you are obsessed with the drawbacks of a caesarian. So obsessed that you fail to see how horrifying the risks of a vaginal birth can also be."

I'm not 'obsessed' at all! I myself have ongoing issues with my pelvic floor from a forceps delivery followed by a shoulder dystocia with an 11lb baby, so I know how a difficult vaginal birth can impact on genito-urinary health in the medium and long term.

You write as though I'm arguing that women shouldn't be entitled to a planned c/s - I'm not arguing that or minimising the risks of vaginal birth. (although elsewhere I've raised concerns about widening access to elective surgery in the context of a rising birth rate and decreasing midwife numbers/consultant cover). You are reading things into my posts which are not there - but that's probably because you are biased. I have had an epidural myself and feel very strongly that can be a very useful tool for labour and what many women need to have a reasonable birth experience. I have said this on many occasions on this board and you have chosen to ignore it.

"I am not saying it is OK to force women to have a caesarian- it is never OK to do that. But if the 25% of women who had caesarians consented to the surgery due to medical or personal reasons, then what is your problem? Why are you assuming that all 25% of these women were forced into unnecessary procedures that they had refused?"

No - in the UK about 12% of women consent to a c-section prior to labour. They make (hopefully) in informed decision to have their baby surgically, in consultation with their doctor.

The rest - the majority, have an unplanned c-section. Most after a diagnosis of 'fetal distress'. The next largest group will have a c-section in labour for 'failure to progress'. The likelihood of a healthy woman needing emergency surgery in labour is most influenced by one thing: where she has chosen to have her baby. Healthy women going to obstetric led units to have their babies have more than double the risk of needing emergency surgery, and a nearly double the risk of needing forceps. Now I am all for surgery if it is a) consented to b) unavoidable. The stats from the Birthchoice UK study show that a large number of emergency c-sections ARE probably avoidable. And women who have been in labour for hours and have been presented with a diagnosis of fetal distress and/or failure to progress are not able to make any sort of informed choice: their hand is forced. They are not in any position to turn down a c/s and neither (in that context) would anyone encourage them to do so.

"And for the last time Minifingers there is nothing called good pain. Pain is pain and it is unpleasant. You either tolerate it or get pain relief. Glorifying that pain of childbirth (and none other) is misogyny of the worst kind."

Sorry - but I myself have experienced very major benefits from going without pain relief in labour, and I know many other women who say the same. Yes it's bloody unpleasant at the time. But then so is exercise (at least for me!). Doesn't mean you don't benefit from it. It's worth pointing out that some of us experience fucking horrible side effects from sedation (pethidine) and have sound physiological reasons for not wanting an epidural. I actually felt quite exhilerated in strong labour. Probably like you do when you're climbing a mountain or running a marathon, and your legs are on fire and your lungs feel like they're about to burst. I times I enjoyed trying to find ways to respond to the challenge of each contraction, I felt strong and I appreciated not having to just passively wait for the labour to be over. And I enjoyed the huge hormonal surge that I got after labour as well, which I didn't experience after my labour with an epidural. Why can't you accept that some women do have amazingly positive experiences of coping with pain in labour, and feel that they benefit from having an unmedicated birth? There is plenty of research out there to confirm that births without an epidural do tend to be more straightforward, and babies thrive better in the first few days of life if they've not been sedated with opioids in labour. And nobody is arguing that everyone should opt to go without pain relief. It really is horses for courses. Pain can be experienced positively. Though we all accept it doesn't have to be!

Minifingers

Are you honestly comparing exercise to the pain of childbirth?? It's people like yourself who have succeeded in trivialising childbirth and the associated pain. If you found it "useful" in some way to suffer in agony, then good for you. If you didn't really find it agonising, again, good for you. However, a woman who requests pain relief is probably doing so because quite obviously she either can't cope with the pain or doesn't want to. Either reason should be respected without question.

I am confused about your analysis of emergency c-sections. First you implied that they were all mostly avoidable (something that I would challenge and disagree with strongly). Now you are asserting that women are not advised to turn down advice for emergency surgery. What exactly do you want??

Let me educate you- the law in this country makes it possible for any pregnant woman to refuse even life-saving treatment. Nobody has to have a c-section that they don't consent to. However, like you yourself have rightly pointed out, most women will not want to take a risk in an emergency and will likely consent. Where is the problem then?
No doctor's diagnosis is perfect, but I am sure that they recommend a c-section only when it is needed. IME they have been all too eager to avoid c-sections. They usually try to talk the lady into a trial of forceps or ventouse wherever possible. In ante-natal discussions as well, they are hesitant to offer a c-section even when there is evidence that it may be advisable (such as a big baby, previous c-section, twins etc.)

Your problem is imaginary. There is literally no doctor (at least on the cash-strapped, midwife dominated NHS) who is keen to section women without a reason. If OBs loved c-sections as much as you claim they do, they'd jump up to grant requests for c-sections on request and we know that is far from the case.

I am further sickened by your subtle implication that it is in fact epidurals that are to blame for severe tears and complications such as forceps.

May I point out that the epidural rate in the USA is almost 70% and their national forceps delivery rate is 0.08%? The ventouse delivery rate is 2-4%. Their c-section rate isn't all that higher than many EU countries. Here in the UK, no more than 30-40% of women probably get epidurals and the forceps delivery rate is still between 10-15%. Epidurals are associated with higher rates of delivery in hospitals that insist on using outdated interventions such as forceps. It doesn't have to be that way at all. Look at the data from France- almost all women there have epidurals and their rate of assisted births and even c-sections is much lower than ours. So please don't try to guilt trip women who desire pain relief by implying that they are signing up for a complicated birth.

Epidurals can prolong labour by about 30 minutes and can lead to longer pushing ( a risk many women are happy to take for a pain-free labour). However, there is no connection between an epidural and severe tears or pelvic organ prolapse as you have implied.

Severe tears affect around 5-10% of women (depending on the area) and when you factor in the number of women who give birth, this is quite a high percentage. I hope you realise that these figures are not entirely accurate because many times third degree tears are mistaken for second degree and are only discovered much later on when it is too late.Furthermore, you don't need to have had a third/fourth degree tear to experience pelvic organ prolapse or incontinence.