Opinion from my friend the doctor!

[ohthegoats]

I have a friend who is a high up anaesthetist. We were just out for lunch with her and a group of others, most of whom have kids already.

The doctor's advice on birth is:

If things go early and seem easy, then all is fine - go for the natural option. If you are overdue and they start talking about induction, then do the following: don't turn it down, they are suggesting it for a reason. Go in for the induction sooner rather than later, have an epidural as soon as they will let you. If things work OK for you at this point, then go for the 'natural' option. The minute they start talking about interventions because something has slowed it down, or you're not progressing etc, refuse the drip to speed you up, refuse forceps or ventouse and just ask straight away for a C-section, before things get too far along. Put your foot down on the issue. The epidural is already in, you're not already massively knackered, and often a calm, non emergency C-section is easier to recover from than a failed induction/ natural birth/ forceps tear/ cut. That's what all doctors would do.

So... what do you reckon to that suggestion? Oddly, as she was telling this story I remembered another friend's birth story - she's in obstetrics somewhere, not sure detail of her job, and that was her exact situation.

I think that is reasonable. i was adamant that i wanted a straight out section if there were any complications with dds birth. She has a heart condition and i wanted no risks.
Besides anything else, nobody can make you do anything you don't want to. Make sure your birth partner is aware if your choices.

Not sure about the induction is offered for a reason - some hospitals have nearly double the induction rates of others, even when they're serving a similar demographic. The induction rates in some hospitals are over one in four labours. I am damn sure that one in four women doesn't 'need' induction.

The only bit I would not agree with is to accept induction. I do not agree that it is always being offered 'for a reason'.

i wouldn't think that an anaesthetist knew anything more about giving birth than anyone else tbh!

if you said a midwife of many years had made the suggestions then i'd say you may be onto something lol

An anaesthetist will know a huge amount about giving birth. Obstetric anaesthesia involves placing all the epidurals and spinals and being present for all the instrumental deliveries and sections, as well as coming to sort out patients when things go a bit wrong, like post partum haemorrhage! They are a very important part of the obstetric team!

I wouldn't agree though that "That's what all doctors would do."

(I'm a doctor but not an anaesthetist!)

All I would say based on my experience is induction doesn't instantly = I want an epidural mow. I have heard it advised prior to the drip as things apparently get very intense quickly then, but if I've understood correctly your friend's advice is to decline the drip and go straight to C section.

My induction worked following the pessaries and I found the pain levels v similar to the spontaneous labour I went on to have with DC2. Was fine on gas and air. Obviously it's different for everyone but from the ridiculously extensive reading I did around induction prior to DC1's birth it seemed ti be the drip rather than the earlier stages of induction that was the big difference.

She has a point. I had a horrible labour with DS1 (waters breaking, intermittent contractions, augmentation of labour, eventual EMCS). With DS2, I planned a VBAC, once in labour nothing happened, consultant suggested augmenting again - I refused and requested a section.
As it turned out, DS2 became distressed as they were getting organised for the section so it did turn out to be more emergency-ish, but I did appreciate not having had to labour futilely for hours and hours.

Not all doctors would have this plan. And anaesthetists never see calm, normal births to be able to make a proper balanced judgement. It is just another opinion. Inductions are not always necessary. Epidurals aren't always necessary with inductions. And if the induction route has been agreed and started, sometimes a bit of syntocinon drip can nudge things along successfully. I do get the point about a calm C/S being preferable to lots of complications and interventions leading to a difficult forceps or something, but making the decision at the optimal time would not be easy.

As others have said, I agree with everything apart from the induction part.

(I'm also a doctor though not anything to do with OB/GYN)

I had one birth after induction and massive episiotomy. That wasn't fun.

Second time around, I asked for, insisted on, and got an elective CS. One of the best decisions of my life.

I'd agree with your friend and go even further to say I'd take elCS over 'normal' vaginal birth every time.

"anaesthetists never see calm, normal births to be able to make a proper balanced judgement"

Who puts in the epidural in your part of the world?

It's not advice I would take and I don't think any doctor can offer a one-size fits all birth plan.

CoteDAzur- Exactly, the anaesthetist puts the epidural in. An intervention in itself. Even if you still class the labour and birth following an epidural as completely normal ( which i don't) the anaesthetist would not be hanging around to witness it. She would be too busy dealing with another complication. So, as i said, not in a position to make a balanced judgement.

Oh come on. Anaesthetist puts the epidural in during perfectly normal births and then follows them throughout. Of course those are normal births that they see.

Around these parts, birth without epidural is very very rare.

Really? ...the anaesthetist is present at vaginal births with no complications whatsoever? For what purpose?

I think it is a good plan, but I have disproportionate fear for tearing or cut and the problems they can cause long term that a c section would always be preferable to me than forceps.

I'm not a doctor (but am.married.to one!) and had an induction which proceeded to the drip. I wish wish wish I'd insisted on a c section. I was induced for prolonged rupture of membranes. my dad was born 56 hours after my waters broke in the end. Third degree tear, pph, I had a slow recovery in terms of pain and comfortable sitting for me though no infections and an excellent recovery according to the mw/Drs who all thought why scar very neat . I had an elective c section next birth. lovely. I had been offered a c section earlier in the whole hideous induction and pushed for a normal delivery which I regret in hindsight.

I'd agree with the anaesthetist

dad being dd of course, thanks autocorrect!

I wish I'd known this. I had a Keillands forceps delivery which left me with a fourth degree tear. Yes, a C-section would have been risky, but as it was I had to have four surgical procedures under general anaesthetic to sort out the mess. And my pelvic floor is shot.

Havibg being given the drip last time round and it spiralling into a night of intervention and drama, I am doing the following:

Labour in the pool, birth in there if possible, if my labour slows, sunroof it is.

I know ots not a given but that drip.will never enter my body again.

I had a forceps delivery which was nearly an emcs. I'm happy i didn't need an emcs as from friends who have had them i know the recovery is normally harder and it reduces your chance of a natural birth next time.

however i have been lucky enough not to have suffered from any long term complications from the forceps touch wood

The anaethetist who gave my epidural for DS2 was present during the fairly uneventful, though admittedly very quick birth. Not sure why but he was lovely and the only person who seemed to care how much pain I was in (2nd dose didnt kick in til after the birth) - everyone else just told me to stop screaming

"Really? ...the anaesthetist is present at vaginal births with no complications whatsoever? For what purpose?"

For The Epidural.

To put in the needle and then supplement as necessary.

What is it you find confusing, martha?

Please stop the sarcastic tone in every one of your posts.
An epidural is not sited at the time of birth. If not in theatre, the epidural is sited and the anaesthetist goes away, only coming back occasionally ( perhaps) to check it is working well. She is not witness to normal vaginal births without intervention or complication. So, for the third time, is not in a position to make a BALANCED judgement.