Why is an epidural a big deal

[Muddytoes1]

Currently 30 weeks with my second and spoke to midwife today about the possibility of having an epidural this time round and she was all “well lots of options to consider before that” and started talking about the nice lighting etc in birthing room and aromatherapy etc. Didn’t want to be rude and point out that nice lighting isn’t the most effective pain relief option out there - she is really lovely and only trying to help. I didn't have any pain relief other than gas and air last time because NCT and midwives had made out that was the best option and yes I got through it but it wasn’t some amazing experience where I had a huge sense of achievement it was horrid. It hurt like hell and I don’t see why if there are better pain relief options out there I can’t use them? The main downside I can see to an epidural is not being able to feel pushing so increased likelihood of intervention but I never felt a pushing sensation anyway just lots and lots of pain which I think if anything was hindering the process not helping as I was fighting against it at every contraction rather than pushing. Anyway not really looking for any advice, just wanted someone to vent to and maybe reassure me that it’s ok to ask for pain relief in labour if I want it. Thank you x

I think the culture in certain labour wards is a lot more pro/anti-epidural than others. And even between midwives there will be personal views/experiences that influence how likely they are to come and ask us for an epidural. Some seem to feel that they have "failed" if they haven't supported their patient well enough to deliver without an epidural, when really it's just that some labours hurt more than others and some women want an epidural more than others!

The midwives personal views shouldn’t play a part in how likely they are to ask for an epidural, it’s completely down to the woman requesting it! Intentionally not requesting one just seems like exercising control over another person and is quite worrying. I’d hate to think how likely/quickly am I to get an epidural in the event of making the personal choice to have one would depend on how another person felt.

No one here has mentioned one of the most common serious side effects of an epidural... A post-dural headache.
This is when the needle punctures the membrane of the spinal cord.
It causes a severe and debilitating headache for up to 2 weeks post birth, only relieved by lying completely flat. Hard to do when you have a new baby to care for.
This occurs in roughly 3 out of 100 live births with epidurals.
The treatment is consuming high amounts of caffiene, or another epidural (somehow this seems to relieve the pain).

The midwives personal views shouldn’t play a part in how likely they are to ask for an epidural

I have found that in my experience, midwives make you work for an epidural. I asked for one when they were hooking me up to a syntocin drip after finding meconium in my waters, the midwives tried hard to discourage me, when I asked the doctor they said "Yes I think that's a good idea" and the anaesthetist was requested straight away.

@SockQueen thanks though that seems strange they would be so invested in a patient’s pain relief options. I could understand if a woman said she definitely didn’t want anything and then changed her mind half way through as I guess they might feel they were supporting her to achieve the birth she’d planned but strange for someone who had planned an epidural all along. Maybe they see a lot of labours where things have gone wrong and probably doing what they feel is best for someone even if it doesn’t align with that person’s wishes. I guess everyone on the labour ward is just trying to do their best in a very stressful environment but it makes me very nervous for what will happen on the day. Have another appointment in a couple of weeks so hopefully can go over it properly then.

When I was expecting my first I wanted an epidural but a colleagues daughter had an awful reaction to one. Despite this it was still on my radar but my induction made things happen too fast. With my second and third I actively avoided them.

or if the woman is already fully dilated. cos pushing is a painfree piece of cake.

What other areas of medicine have rooms full of patients screaming in pain? Power to your elbow if you want a natural birth, but midwives are too thin on the ground to properly coach and support women, most women are just left to it with checks until it's time to push.

In my case I wasn't being calm and in control, I was suffering from sepsis - which was spreading to my baby. Makes you a very docile and easy patient though...

I think that it's important to remember that MW are not your friends. You are just another woman in labour. They haven't got time to "be with woman", so the best way to get their attention is to ask for their name and make sure your birthing partner documents everything that happens during labour. Note when you were refused pain relief - the time and the MW. It's your best protection against being fobbed off.

@PrawnofCreation - it's not because 2nd stage doesn't hurt - I know it does! It's because a)most women are not able to sit still for long enough for an epidural once they're fully dilated, so it's not safe to do, and b)From the point of asking, it takes ~45 minutes for the epidural to be in and fully effective, by which time a lot of babies would have already been born, so you've exposed the woman to all the risks of epidural plus made her pushing less effective, for minimal benefit. I have done them on very rare occasions where the woman is fully but for some reason not having strong contractions or feeling the urge to push, though these cases have nearly always ended up in theatre for an instrumental/CS.

As for my comments about midwives views, I can't speak for them, I don't have the same training as them, the vast majority do want to help women and give them a positive experience, but the ways they go about this do vary, and definitely cultures in different units can be very different in all sorts of ways regarding pain relief, involvement of the obstetricians, interactions with anaesthetists etc.

Sorry @SockQueen, my own bad experiences coming out here. The fully dilated thing, sometimes the woman isn't, re: previous poster who was 9cm and refused to let midwife check as they'd be told "too late" . I'm overly defensive and aggressive on this subject and I'm truly sorry I sniped at you. I've no trust in midwives and maternity care as a whole, doesn't mean I can be rude to people kind enough to answer questions as you did.

Humble apologies.

Don't worry about it, I wasn't offended! Just explaining my reasoning, which was not clear in my first post. I'm sorry you've had a bad experience.

Thanks again @sockqueen that does make sense about the late stage epidurals, when I was transitioning there’s no way I’d have been able to stay still! I do find the idea about different cultures on maternity wards strange. It’s like the care/relief you will receive depends on what ‘type’ of midwives staff that ward and their personal ideas and beliefs regarding pain relief options. Surely it should be based on NHS procedure so E.g if a patient has requested x pain relief option and pros and cons have been explained then they get that as long as medically appropriate and suitable person available to administer. Seems v strange that a midwife’s personal feelings on the matter should come into it unless they have very specific concerns.

www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000331.pub3/full

Useful to see the associated risks and analysis here.

I'm pretty sure the midwives aren't interested in the cost either, though may have other reasons for delaying asking for one.

Indeed, the 'natural birth' and 'oh you're doing great, you don't need one'.

As pp, had mine abroad and the midwife was absolutely happy to offer whatever I wanted. Essential oils and whale song - no problem. Epidural - 5 minutes. No judgement, no attempts to tell me I don't need one. Fuck off, it hurts - it probably would not have killed me not to have one, but I sure wanted one. And it was amazing.

At least you have the option when I had my two (5 and 3) my hospital didn’t “do” epidurals 😭 go with what suits you!

@Youngandfree Noooooooo!!

&ForgivenessIsDivine thanks for the link - that is very interesting.

I think epidural slow everything down but tbh I don't know why they're trying to turn you off. I had an epidural for first but decided against it for next three as everything was moving so fast and I didn't want it slowed down, also hated not being able to move my legs after birth, was horrible being lifted

Our hospital doesn’t do epidurals either, Young. In a funny way though, when you know it’s not even remotely a possibility you don’t then get as stressed as if you could have one but you were fobbed off (or anaes busy)

I never wanted an epidural as was scared about complications but was begging for one about half hour before DS arrived. My labour was only three hours long but I was induced and I felt like the contractions never really built up, it was just one on top of the other from the start. Got through on G&A though but was rushed to theatre for PPH so was numb after the painful part. Personally I was gutted after because I was numb and laid up for hours after and I never wanted that. But went part of the way to saving my life so very grateful.

I know people end up waiting a long time for epidurals and I can understand why it may happen. The anaesthetist was called to me just after midnight and she was with me til just before 5am, my experience was really complicated. Doesn't help another lady in labour at the same time though I guess.

My friend never wanted an epidural either as she had heard about people having permanent nerve damage. She ended up having a mobile epidural though.

Mobile epidurals are amazing. I was able to walk around, no issues, just without pain.

I had a big bee in my bonnet about an epidural! It was part of my birth plan. I was happy not to have one until I got near the end of labour (or as far as I could get) but it was definitely part of the plan.

For various complicated reasons which I won’t bore you with, I was sort of dismissed when I was contracting as I believe they thought it was my first baby and what does she know and first labours don’t really move fast and I was told “you have to be in established labour before we think about an epidural”. 🙄🙄 The first time they examined me (after only a few hours) it turns out I was fully dilated. I was FURIOUS. I made a gigantic fuss about wanting an epidural. Luckily I was at a hospital whose policy is it that they will agree to give epidurals when fully dilated (as long as the baby isn’t too far down already). I honestly think they gave me one to shut me up I was making such a bloody fuss 😆 So I did get what I wanted in the end - but not without a fight! Trust your instincts....and keep making a fuss until somebody listens to you 🙂

Thanks again to everyone who posted a few weeks back. Just had the birth plan appointment with my midwife and she was great and listened to all my concerned and was supportive of my desire for an epidural. We went through previous birth and she said it didn’t sound like I’d been looked after that well which was interesting as I never thought that at the time. Anyway all seemed fine and I was feeling pleased and she was scribbling away on my plan. Before I left I checked and said “did you make a note about me wanting an epidural” and she said yes she’d included that. Just got home and looked through it and she hasn’t written it in! Birth plan makes no mention of an epidural?! I am so confused, she didn’t once try and talk me out of it so why did she say she’d included it when she hasn’t? Was she on autopilot and just though she had? Surely she didn’t just lie to me, I can’t bring myself to believe that? Should I call her and ask her to add it? I’m seen again in 2 weeks so guess I could just do it then. I don’t want to write it in myself as I want it in her handwriting to show it’s been properly discussed. She didn’t seem like it was a big deal.

Absolutely call and make a nuisance of yourself if you need to.

It actually never occurred to me that I might have to argue for pain relief and that I could be refused an epidural. I think I would not have chosen to get pregnant and deliver a baby here had I known about this in advance.

Thanks @Kescilly. It all just seems very weird and confusing to me.