Epidural questions - Why the stigma attached

[horseshoe]

I had one with DD1, G&A with DD2, desperately trying for a home birth for DC3.

I have said to the MW that if I end up going to hospital I am just gonna ask for epidural if I feel I want one to which she replied "Oh you dont want one of those".

With DD1 I did have vontouse delivery but I had epi after 18 hours of labour when I was 8cm dialated and before they realised that baby was back to back and getting stuck in birth canal.

Everyone I speak to especially "angellic "i've had 3 natural no drugs birth sis" appears to look down their noses at this decision.

So can anyone tell me why they are so wrong and what is the best time to have one - nearer birth or early labour. I seem to remeber that they wait until at least 4cm dialated.

expatinscotland - sorry - what do you mean by 'you just keep beating that drum'? What, that I keep arguing on this thread that unnecessary interventions are a bad thing and they spoil women's experiences of birth and can have implications for early postnatal life. And your point is... that because it didn't matter to you, it shouldn't matter to anyone? And that because your forceps birth was unavoidable, all other instrumental and operative births births are necessary? And even if they could be avoided by better or different care, well, what the heck, let's just be complacent, because in the scheme of things - who cares, as long as you get a baby at the end of it....?

It's a good job that not everyone feels that way - otherwise we'd have even worse maternity care than we've already got in this country. Fortunately there are people out there who want to change things for the better for mums and babies.

People keep on beating that drum because time after time women have birth experiences that affect them deeply. Sometimes what happens to women in birth is unnecessary. Sometimes it is.

Whatever it is, it's hugely important to go on beating that drum and not dismiss it as something just to get over.

You can go on to have other children after a traumatic birth experience. It doesn't necessarily mean you get over the trauma.

For what it is worth - I planned a natural water birth and use of hypnobirthing, but the contractions were so severe I was begging for an epidural. Although I didn't particularly like the loss of sensation in my legs (could still move them) I would have let them cut off my right arm to take away the pain. The gas and air just did not work for me. I did not feel as if they had taken away my birthing experience - because quite frankly I could not have taken the pain much longer, so was grateful for intervention.

expat, it sounds to me as though you had a traumatic time with your birth, as it was too fast too cope with, and your solution is to have an epidural as soon as possible next time, which is absolutely fine. and i hope that your birth is far more manageable in terms of pain and panic this time.

however, i totally agree with sabire and winky, that the trauma suffered in previous births never goes away and will inform our choices for the next time, it there is a next time.

it is important that women know the pros and cons for each and every method of pain relief and the availability of it. which is especially important with an epidural which can only be administered by an anesthatist.

I think sabire has had a bit of a bashing on here and I don't really understand why. She has pointed out repeatedly that it is un necessary interventions which are a problem, not life saving procedures. The fact is that an epidural DOES increase the chances of further intervention, including instrumental delivery, which does carry risks for the baby. (See some of the recent threads on injuries caused by forceps for instance). It may not be a huge risk, but it is there. And for many women, it's a risk they would prefer not to take. They believe that birth is a natural process- very painful, yes, but natural - and they want to aim to keep it as natural as possible. Pain doesnt necessarily mean that a labour is bad. My first labour was very painful but it was a positive experience and yes, that was in large part down to having a fantastic midwife who I'd already built up a relationship with rather than being in a large impersonal hospital where I knew no one. Of course positive thinking can't stop a baby's cord getting wrapped round its neck! But what it can do is enable you to go into labour believing that you can get through it without it being hugely medicalised. Of course, some women decide before labour that they want an epidural. As long as they are aware of the pros and cons, that's fine. I just don't get why some people don't understand why a natural birth can be a positive and desirable experience.

And nobody is condemning someone for having an epidural.

If that's what a woman wants, then that's exactly what she should have. But no woman (or anyone) should have a drug put into her without knowing exactly what it will do and what some of the results or consequences could be.

Lots of people don't get informed. It's important that they are informed. And make their own decisions based on that information.

The other problem is the benefit of hindsight is a wonderful thing so as well as each women having a different experience in labour which colours there opinion it's easy to say afterwards when mum and baby are fine oh well instrumental or an operative birth was just not necessary but not as easy to make the call (and most of us don't have the medical knowledge to make that call) during the event.

Sabire - It sounds like that poor women had a horrible labour but at the end of the day if medical intervention hadn't taken place there would have been a death I KNOW you are not advocating no medical intervention at all but I am not really understanding what this example is suppose to prove as you have stated she had to have medical intervention and it was not unneccessary.

WinkyWinkola - I haven't been to the NHS anti-natal classes (which are available to everyone) I presume this information would be available then.

Libra - I don't think it's as simple as just providing the facts and statistics though.Yes, of course these should be available to everyone, and should inform their decision making. One of the main factors with my first birth was wanting to an epidural because I DID know the facts, which are that once you have an epi, you are often confined to the bed (restricting movement and therefore possibly slowing labour) and also that there is increased likelihood of other interventions. But I think alongside the facts, women need good quality care and support before giving birth to enable them to feel confident that MOST births are in fact medically straightforward. Not all, but MOST. I was quite frankly really surprised at the number of first time mums when I had my dc1 who just took forgranted that they NEEDED to give birth in a large hospital 25 miles away with an epidural rather than go to the lovely midwife unit a couple of miles away. We were shown around the unit as part of our antenatal classes, and it's fantastic - much better staff/patient ratio than the hospital, very calm, supportive atmosphere. I just can't help feeling that the balance is wrong. I accept that there are some people who are just not prepared to labour naturally (I have a friend who was almost phobic about birth and insisted on having an epidural very early in labour and insisted that it must not wear off at all). But I honestly think that's the exception - most women aren't phobic, but somehow our systems in this country are making huge numbers of them feel that birth has to be medicalised with invasive procedures.

sorry, I meant one of the factors with my first birth was NOT wanting an epidural - duh

Alfiesbabe I completely agree with your statement that it isn't as simple as just providing the facts and statistics AND that women need good quality care and support before giving birth AND that most births are in fact medically straghtforward. However the problem is that you just don't always know which ones are going to be straightforward and which are going to have complications and a midwife unit a couple of miles away from a hospital is far enough away for the child to suffer brain damage or the mother/child to die if there are complications. We spend 9 months avoiding alchol, blue cheese and rare meat but think the statistics about maternity risks are worth it to have a natural birth.

I have to admit I am slightly biased, I am married to doc and every single woman doctor I have met would not think about having their baby anywhere else but a hospital, their views maybe biased because docs mainly only see things going wrong but then again they have seen what can go wrong.

Wouldn't it be lovely to have lots of midwives and a calm and supportive atmosphere somewhere where there were doctors on hand as well like a hospital, shouldn't that be what we are working towards?

Midwife-led units would notbe allowed to exist if they weren't safe! I've heard that argument trotted out before and it doesnt stand up. My local unit has an excellent safety record - women who have complicated pregnancies or risk factors are not allowed to deliver there. There have certainly been no deaths in the 30 years it's been open - unlike hospitals such as Wexham Park, St Peters Chertsey which have been in the news recently for awful reasons.
I agree its true that most doctors want to be delivered in hospital - and interestingly most doctors I know who've given birth have opted for epidural, not for medical reasons but for pain relief - as you say, maybe they have a biased view from seeing too many complicated births. Or maybe they're just a bit drug-happy!

It's not an argument, a midwife led unit a couple of miles away is far enough away that if there are complications the mother/child could die or there could be long-term consequences for the child and it's not only complicated pregnancies which have complicated labours.

I am not sure how you can compare records for a hospital and a midwife unit, as you have admitted yourself women who have complicated pregnancies or risk factors aren't allowed to deliver there.

Why do we continue to think that pain during childbirth is something that should be suffered?

plenty of babies and mothers are compromised in obstetric units.

there will never be risk free birth, but there are steps that women can take to reduce risk and make it as low as possible for their individual situation

an epidural has risks

pethidine has risks

being induced or having a c.s has risks

etc...

but being able to make an informed choice is vital.

not everyone 'suffers' from the pain of birth

some women find it, especially the second stage, empowering, powerful and positive, and being able to feel the sensations of birth, and that includes pain, is important to them

not to everyone, but to some women

i do not see scientifically how one can state that there is a straightforward correlation between epidural and intervention

too many variables

it might not be straighforward but it is definitely a factor, even if not the defining factor in every case. thre has been some good stuides, if you read AIMS and some of sheila kitzinger's work, don;t have particular refernces

one thing is a definite, and that is that an epidural relaxes teh pelvic floor, which is definitely a factor in the baby needing to be helped out with forceps or ventouse as the baby needs to meet the resistance of the pelvic floor to rotate correctly for birth

the expulsive contractions and sensations that occur to get the baby out?

Butterfly, there really can't be a direct correlation because when you have an epidural it means, that you are also getting continuously monitored, and you are immoble. So the question is "is it the epidural, constant monitoring, being immoble, or a combination of the three that causes interventions" But at the same time you could argue that the epidural is the cause of the constant monitoring, and being immoble, so the epidural really would be the cause of the intervention in an otherwise unproblematic delivery.

Does that make sense to anyone other than me?

starlight, you have had a baby ! how did you feel in the second stage, in terms of the the contractions?

makes sense to me mom2latinoboys... it is a chicken and egg scenario and / or self fulfilling prophecy in some cases

if you did not have that urge to push and you wanted to sleep, then you might have been in the rest and be thankful stage.. where there is no ruge to push, hence the doc using fundal pressure to move things along, whereas really they should have let you push when you were ready. IMHO !

had no pain relief at all with ds1. it was bloody awful. he's nearly 16 and i still remember the pain. had an epidural with ds2. it was fantastic.