What's the bottom line - is giving birth without chemical pain relief manageable? Yes or No!

[Baretoes]

If you could answer either 'yes' or 'no' ONLY - what would your answer be?

not first time for me.

Yes - 2nd time (although i did cry towards the end just before i started pushing)

Oh, and fortyplus - I did ask for my leg to be re-set without pain relief after I broke it! I'm not mad, I just react really badly to opiate pain relief

me too and anaesthetics.

I read this thread with some interest as I have been doing some research for my post-grad on attitudes to birthing and the communication of science knowledge (I know I know I have a thrilling life!). What is interesting is that what is actual known about effects of drugs (and when I say known, I mean known from a peer reviewed paper in which subjects are compared against controlled conditions and measures are taken quantitivly) is not terribly well communicated to women about to give birth. Not sure why this is- maybe due to cost, midwifes attitudes/perception etc. Take for example the oft quoted idea that an epidural will slow labour down and increase the risk of intervention. A recent meta-analysis (basically an analysis of all the studies so far undertaken) analysed all the statistics and came to the conclusion that they don?t (either slow labour down or increase risk interventions). Now before I am shot down in flames by midwifes- that?s not to say you don?t have experiences of women in labour who have an epidural ending up with a forceps delivery more than women who don?t, but that perhaps its not the epidural that causes this (a long labour may make someone more likely to chose an epidural, and then the long labour makes the forceps delivery more likely). I get the impression from this thread that lots of people are put off by side effects. There are side effects (the correlation between pethadine and increased drowsiness of newborns for example) but they tend to be small (eg in pethadine- it effects a small % of newborns and causes them on average to be a bit more drowsy for a few hours- hardly a huge negative side effect) or actually misreported (as in the case of epidurals above). All of this is all very well (and before I bore you all with more science) my actual point is this- we all have choice, but we are not making the choices (in my opinion) with all the correct unbiased information to hand. If you choose not to have pain relief because you don?t want it/like it/hate needles etc the great- but if you choose not to have pain relief because someone with misinformation/ some kind of agenda has told you that you are increasing you risk of x or y then your putting yourself through pain for no good reason.
I have also found (thorough my research) that this is for some reason, a hugely political issue and seems to get people all in a lather like nothing else (other than perhaps smacking or fox-hunting) not quite sure why- that in itself is of interest to me! So am quite prepared to get shouted at, but would be interested to here what everyone thinks

Yes but it hurts. Owwwwwwwwwwwwwwwwwwwww.

Dear Hettie,

It is a really emotive subject. I was determind not to have an epidural with my son - for following reasons

• Potential long term back problems - I believed to be rare but possible (have a dodgy back)
• Chain of Intervention - as discussed in NCT classes - slowing down of labour and then requiring further medical intervention. Possibly lower blood pressure?
• Believed and still do that avoid medical treatment unless it's needed. Everything has an impact and potential complications.
• Some heroic notion about doing it naturally!

My experience was that when the syntocin drip was put up - when I was about 7/8cm (under time pressure due to waters breaking with meconium in them) I probably should have opted for an epidural, as the intensity and pain of the contractions combined with the lack of freedom - monitoring and drip stand and then fish hook thing in ds's head, meant that I was lying on my back in agony and still would n't give in! I think with hindsight it would have been better for me to have had an epidural, but have got up on to my feet and in a better birth position.

I understand much more about epidurals now ....partly because my husband had one for about 3 days after his liver surgery - it was a fantastic way to deliver pain relief and they are a wonderful tool.

BUT I'm slightly wary of the research. To me the major downside to epidurals is that you are hooked up to pain relief - it requires constant monitoring and starts to hinder you from moving around freely. It takes the mother out of the natural state and into a medical one. Once you start to go down that road - protocols start to be followed - length of labour, speed of dilation etc etc. Women & babies are not the same. A lot of the pain of labour can be dealt with by the right care and support to labouring women. To me it seem more sensible to have the right environments and support for women. Epidurals should be saved for when they are really needed.

I am pregnant and hoping for a natural birth, with me in control. I will only have an epidural if I feel that I am stressing out the baby, by not handling the pain well. The proirity is always the baby. This is from someone who has spent the last couple of years in and out of hospital with my ds and I have become very comfortable within the medical world and the fantastic things that medics can do.

Best of luck with this one!

Hettie, I would be interested to have the reference for the meta-analysis you've mentioned.

Re pethidine and drowsiness - this can cause real problems with establishing breastfeeding, so I don't think it is something to be dismissive about.

I managed with no pain relief what so ever. Not even gas and air. Went into the whole labour thing very open minded and if I felt that I needed something I defo would have asked.

Daisymoo have just read your post and am wincing on your behalf!

One other question Hettie, hope you don't mind me asking, what position are you doing this research from - doctor, midwife, sociologist? Just interested (and nosey!)

hi daisymoo- erm bit wary about revealing my 'identity' on mnet- as think it might make people perceive me in a certain way (back to my attitudes research ) But just to satisfy curiosity it wasn't so much what epidurals do or not do but peoples attitudes to 'medical' information and the medical professions attitudes to how they find and give out info. So very much from a psychological/social point of view really. The ref was in American journal of obstetrics (which of course you could argue has it?s own vested interest! But it is peer reviewed- so they have to at least make sure figures are accurate), I think it was 2002 (think there was a ?special? on epidurals), don?t remember the authors but could go back and find out. Interestingly it seems the medical profession is also quite ?politically? divided on this issue- in particular there is a divide between midwives and Dr?s (perhaps because midwives have more experience of being able to guide womeon through birth without having to use epidurals?).
Oh and should have added it was especially interesting reading as I am 6 months preggers with my first! I have no particular personal take on the whole deal and reckon I will do whatever seems best at the time depending on how the birth goes?.. But I do know if I did have an epidural I wouldn?t? be nearly as worried as I might have been about it causing side effects and I certainly wouldn?t have feel I ?failed?

well i decided that i only really wanted to have G&A on the ground that it is actually quite good for baby. also wanted birthing pool but was induced so couldn't. did not want anything else cos of side effects although if baby was distressed because i was stressed then i would have had it.

yes, definitely manageable.

Important to be prepared to change your mind quickly though!

OK, I understand Hettie! And congratulations on your pregnancy.

With regard to epidurals themselves, the Cochrane Library does still actually state that current research indicates they can lead to more intrumental deliveries, and this is from 2006, so has been updated since the research you mentioned. And of course there are other side effects as well, rare yes, but they should be mentioned so that women can make an informed choice.

I agree that there probably is a difference in attitude between midwives and doctors, but then part of a midwife's resposibilities is to promote normal birth, and anything that makes this less likely is going to be viewed negatively by them. I think more generally it is a 'political' issue because as women, birth is what we're designed to do and can be quite an important part of our identity. Any perceived implication of failure in this area can elicit strong reactions.

What about other countries and their attitutes to pain relief? I believe in France they routinely give women an early epidural as standard.
Surely for some (ie those that want it) it is better to have an early epidural, as you are not in so much agony, and will find it easier to stay still for the anaethsatist (sp). I know when I had mine I was writhing around like a stuck pig - I'm suprised he managed to hit the spot at all.

one word answer has to be "depends"

Everyone's different. I'm on the positive end of the scale - an unplanned home birth lasting 2 hours from 1st contraction meant that I'd no time for anything other than the paracetamol & a half (which I'd crushed) 1st stage was the worst in that I couldn't 'do' anything to ease it second stage the way to ease it was on all fours, a push on the back and concentrate on my body doing it's bit. So I know i was lucky, but went into the expereince with a certain amount of trepidation/nervousness, but with the birth plan of take it as it comes. As it happened I had no time to make any decisions really. This time - still an open mind (although may have more options for pain releif at home) won't be traumatised if I end up with full intervention & emergency c.

one word answer has to be "depends"

Everyone's different. I'm on the positive end of the scale - an unplanned home birth lasting 2 hours from 1st contraction meant that I'd no time for anything other than the paracetamol & a half (which I'd crushed) 1st stage was the worst in that I couldn't 'do' anything to ease it second stage the way to ease it was on all fours, a push on the back and concentrate on my body doing it's bit. So I know i was lucky, but went into the expereince with a certain amount of trepidation/nervousness, but with the birth plan of take it as it comes. As it happened I had no time to make any decisions really. This time - still an open mind (although may have more options for pain releif at home) won't be traumatised if I end up with full intervention & emergency c.

Absolutely YES

Pain is a state of mind.

From personal experience from one home birth and one CSection - I had no pain relief at home, did not feel I needed it at all - was quite happy without.

The moment I was at hospital I was like... give me the drugs!!

hey daisymoo thanks for the pointer on Cochrane- what a great site! Makes for intersting review, sounds like a much more uptodate analysis. It's such a pain becasue even with the best meta-analysis it depends on the design of the analysis doesn't it. May well go back and probe the stats in the journal obstetrics paper......
trouble is have now been reading about the realtionship between attitudes and behaviour (all very confused!)
as for my own situation- well who knows! I'm hopnig for the luck of two hours then out!

I feel for a lot of women the level of pain felt is connected with their environment, how safe they feel, how much trust they feel for those supporting them/looking after them. It really comes down to the flight or fight instinct - if women consciously or subconsciously feel unsafe, watched, or unsure of their attendants they will have a longer labour -which along with fear can play a big part in levels of pain.

Obviously there are many different factors which can affect the length and sensation of labour, position of babe, levels of fitness and nutrition, but I am always interested to see how many women find that their labour slows, stops or becomes more painful on arrival at labour ward!

my answer is yes

absolutely. pain is definately a state of mind.
everyone told me how awful it was going to be and i had to work really hard to ignore them and concentrate on having the type of birth i wanted...at home, in a pool, second stage 19 minutes. awesome experience. and it only went that way cos i willed it to be so. dd 23 weeks - i'm still buzzing from the experience. can't wait to do it again

Hi Hettie

I really hope it goes well for you. I'm not quite sure whether you're looking more at attitudes of midwifery/obstetric professionals or labouring women, but if you're interested in looking at some alternative views on pain relief and labour management you might like to look at some of the Ina May Gaskin and Henci Goer books, if you haven't already. I don't agree with all of it, but it makes very interesting reading.

Nope couldn't of done it - i had complications and the fact I had already accepted an Epidural made the whole experience for me less traumatic but I have a good friend who had two blissful natural births with no pain relief so we are all different. My birth and my friends birth were poles apart and I will have pain relief next time based on my experiences the first time.

first time had pethidine, was given a large dose i think.
all i remember is screaming in fear as i was trying to push ds1 out and then feeling so out of it i wasn't even interested in my baby and can't really even remember it much.
so, second time, wanted to feel the thrill of meeting new ds and opted for only gas and air. was very painful but o.k. much better imo.