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.

Libra, I would love to know what scenarios risks a baby/mothers life that couldn't be treated (in the first instance at least) in a MW led unit rather than an obstretric unit. I don't mean that in a cheeky way, just would honestly love to know what these complications are that could cause a woman/baby to die due to transfer time. From my reading when planning my homebirth (2nd child) and from speaking to MWs and 2 friends who are doctors, I came to the conclusions that:

• transfer to hospital would occur if there were any doubts about baby/mother health (I assume the same from MW to obstetric led)

• the chances of me (personally) stressing in hospital and therefore labour slowing would mean a higher chance of intervention and therefore risk

• most emergency situations can be dealt with in the first instance by the MWs whilst on transfer to hospital and that the treatment would not be any different from that received in an obstetric unit while the Dr is called

• Those situations that the MWs can't deal with, have a pretty poor outcome in hospital too.

Don't ask me for references for where I drew all these conclusions - too long ago and I still have baby brain! I would just be interested to know, as the partner of a Dr, what you feel the risks are to you/baby if giving birth in a MW led unit.

And I'm one of these weird women that loved labour. Not my first with DS, it was fine but after meconium in waters, transfer to obstetric from MW led, things slowing down, lots of pain due to lying down, morphine sending nuts, I decided that for DD I'd like to avoid all the bits that happened in the hospital and labour/birth at home or at least labour at home as long as possible. My labour was great with DD. I thrived on the pain and pressure. I felt totally empowered and had a huge endorphine rush that I can only liken to a very powerful drug. I loved the whole experience and am actually saddened that DD is my last and I won't get to do it again.

I guess that's why I can't understand why anyone would choose an epidural straight away before they know how they're going to cope. All I think when I hear of that is that these women could be missing out on so much. Just my opinion of course. I think pain relief is a wonderful thing if you want it.

"I would love to know what scenarios risks a baby/mothers life that couldn't be treated (in the first instance at least) in a MW led unit rather than an obstretric unit."

If you had a cord prolapse or a catastrophic placental abruption you generally need a c-section VERY fast.

When I booked to give birth at home I was aware that there were some instances where having a baby at home would increase the chance of a poor outcome - cord prolapse, placental abruption and shoulder dystocia were three things I was concerned about. Not concerned enough to stop me booking at home though - I felt these risks were fairly remote and in some ways balanced out by the risks associated with hospital births such as infection and higher rates of intervention.

Those were the three things that I also had on my 'cons' list Sabire, along with PPH. Though from the MWs I spoke to, the transfer time and treatment en route wouldn't be a long way away from the theatre being prepped and Dr scrubbing up. I suppose a lot depends on how far you are away by ambulance and how long an ambulance takes to get to you.

I suppose that risks are a very individual thing. Like you, I believed the risks of giving birth in hospital to be higher than the risks at home.

I'm with Suzi. I loved the pain of childbirth. Whenever I think of it I smile.

I think Lulu sums it up very well. No one has to 'suffer' pain. Some of us choose to labour and give birth naturally. There's a big difference.
I agree that it's difficult to compare consultant led hospital care with a midwife-led unit, because as is rightly said, the midwife units won't deal with the high risk cases. However, from what I've read recently particularly the Northwick Park (I think that's the one) hospital, the whole point is that a hugely disproportionate number of women have died in childbirth over the last 3 or so years - it is news precisely because there seems to be no apparent reason other than mismanagement. And of course the sad story recently about the baby at St Peters Chertsey - that was clearly a badly managed birth as the doctor used excessive force with forceps and crushed the baby's skull. I repeat, there is no way midwife units would continue to function if they weren't judged to be extremely safe.

This thread has been so interesting to read.

Sabire, I have to tell you that it is my personal belief that being at home in my case is less riskier than at hospital.

I know that when I arrive at hospital I will be checked and then left to labour on my own. The only sure way of having a MW available to detect any problems which may arise will be to have an epi!

It's a very sad outcome and I have fought for a HB right till the end but the hospital/mw's cant guarentee the babies aftercare over something small and I really dont see the point in labouring at home just to get transferred to the hospital for get this anti-B's (That is how bad my local untit are in providing care).

The pain of labour does not really worry me. (unless I have back to back) like my first. My second labour was great. I held off the G&A until the last hour when it worked to great effect and I have to agree with lulumama, I felt really empowered during the pushing stage.

I was very panicky at various stages though as I could not get any care from the MW. THIS is my BIGGEST fear. If I had the money I would of got an IM for sure.

I think the nail was hit on the head when sabire made the comment that if women were more supported maybe the need for pain relief would be less.

I have still written in my books that I would like an epi for this very reason. (even though the hospital have advised that if there are more than 3 women having an epi, I wont get one because of MW 1-2-1 care). If I feel I can cope on the day then of course I will but it scares me to death that I will be left on my own. Especially at night when they send your partners home if you are less that 4cm dialated and then when you shoot up to 8cm in the space of 1hour.....make you walk to the phones to get your birth partner back to the hospital....then leave you alone in a room...screaming with back to back until your family arrive

It makes me feel really sad that unless I have the money to spend...the likelyhood of me actually getting the birth I want is minimal. There seems to be so many obstacles when all I really want is basic care and support.

I have spoken to the hospital and MW about this but it's their resources and all they can offer

Sorry for the long post

you can't possibly considered a perfect parent unless you have given birth to twins natually - at home - breastfeeding one while gving brth to the other - whilst smiling cerinely - enjoying the experience thoroughly - and cooking organic paella

Who wants to be a perfect parent?

"Sabire, I have to tell you that it is my personal belief that being at home in my case is less riskier than at hospital."

This was my thinking too when it came to weighing up the pros and cons of homebirth vs hospital birth for myself, Horseshoe, for precisely the reasons you mention (being left to labour alone in a CLU).

I live five minutes from the hospital and when I did call an ambulance during my second labour it was outside the door in less than 3 minutes. It was passing apparently though when the call went out. I reckon 10 minutes door to door would be a 'worst case' scenario.

Was talking to a midwife recently about the fastest crash c-section she'd ever seen. She said that she'd seen one c-section where it was five minutes from decision to incision - literally five minutes..... But that was a very unusual case, and it was a severe placental abruption.

Horseshoe - have you definitely decided an IM is financially impossible? I had always thought I was the sort of person who couldn't afford one but when push came to shove (scuse the pun) we raised the money from somewhere (actually we remortgaged and spent the money on the midwife's fees - if we hadn't done this I would have got an unsecured loan or used a credit card). We're not on benefits but we havent' got loads of cash - no savings, our car is 9 years old, we haven't had a holiday abroad in 5 years and I buy my most of my clothes in charity shops. I looked at it this way: my peace of mind and my child's safety is more precious than anything in the world. I wouldn't hesitate to spend that much money on a car or a holiday (if I had it) and the memories of the birth will be my most important memories for the rest of my life. It is tough, but I know other women in my financial position who've also gone into debt to pay the midwife..... they all feel (as I do) that it was worth it.

amen, custy!

sabire, you're not a saint. please quite acting like one.

How does anything I've said on this thread justify that nasty comment expatinscotland?

"you can't possibly considered a perfect parent unless you have given birth to twins natually - at home - breastfeeding one while gving brth to the other - whilst smiling cerinely - enjoying the experience thoroughly - and cooking organic paella"

Custy - are your comments a hint that you see the issue of pain relief in labour as primarily about little more than competitive parenting?

Wow. Can't think why it's descended into the personal.

alfiesbabe - this very much goes back to the orginal question of the thread, that some women do feel they have to suffer pain as otherwise they are somehow less of a woman because they did not have a "natural" birth (Personally I still stick to the feeling that if it comes thru the birth canal it's natural) Also the poor baby who died due to a crushed skull, that was due to an incompetent doctor not necessarily a mismanaged birth.

Sabire if your childs safety is your most important aspect surely hiring a private obs/gyn doc would be better than a midwife? As for worse case scenario being 10 minutes I think that is a very naive assumption based on the luck of last time.

suzi2 - as for being the partner of the doctor, I suppose I have a little advantage in that the hospital he works in I am going to give birth to (completely different department however) so I cling on to the hope that I will be kept relatively well informed on what is going on, but still have the worries that there is not going to be enough midwfe support and I will not be able to have the birth that I want. However I am not going to a MW-led unit because after 9 months of avoiding wine, cheese, pate etc I am not suddenly going to start risking my baby during labour I want a healthy alive baby and my partner wants a healthy alive baby and wife. I also want the option of having an epi, I am not one of the women who think pain is empowering.

Libra, Your last point is about personal choice - you feel you may want an epidural for pain relief - that's fine, given that you have obviously thought about the risks. That's your choice. I don't entirely agree that I would describe natural birth in quite the same way as you do. I didn't find the pain empowering; it was the sense of having found the resources within myself to labour and give birth naturally, without being numbed up. But tbh, this was a secondary issue. The main reason I didnt want an epidural was to avoid the increased risks of other interventions which all carry some risk to the baby. The fact that I felt hugely empowered was a kind of bonus!!
What I really object to though, is the misleading comments about midwife-led units, that you are somehow risking your baby. I cannot repeat it enough. Midwife -led units have an excellent safety record.They have to. They would be shut down if they didnt. The awful news stories recently about mothers dying and the baby who was crushed with forceps are about incidents which occurred in large hospitals!!!
If you dont want to book into a midwife led unit because you want an epidural then fine, that's your choice, but why not just say so rather than trying to make out that your choice is somehow 'better'.

Libra, you're missing the point lots are making.

Natural birth isn't about suffering and making you prove you're more of a woman for going through it. Far from it. It's about learning about other ways to cope with the pain and discomfort that labour and birth brings. And also avoiding interventions that often do bring unwanted consequences.

Having a doctor about isn't necessarily the best option either. Why do people assume that when you're having a baby, doctors should be about? Are women ill when they're giving birth? Sure there can be complications but not very often and help can be sought for those. I think it's a problem when people start assuming having a baby is a medical problem.

By the way, a crushed baby's skull suggests more than incompetence on the doctor's part, surely? FGS!

Please don't attack me for my personal views.

I believe you when you say midwife led units have an excellent safety record, for a start they only accept low risk cases which is why I have pointed out it really isn't a fair comparison to compare the safety records of a hospital and a midwife led unit. There is no such thing as a risk free birth in either hospital or a midwife led unit.

I said I ALSO want the option of an epi, my primary reason, which I also stated, for not going to a midwife led unit is IF there are complications during my labour, of which there is ALWAYS a risk, I want a doctor 30 seconds away not 2 miles away.

If that's what you want Libra, then hopefully you can have what makes you feel comfortable and safe in labour.

I doubt it as I agree with most of the points that there are not enough midwife resources and being supported by a good midwife is probably invaluable to a positive birthing experience.
I think I made the point several pages ago that I think it would be much better to have lots of midwives and a calm and supportive atmosphere somewhere where there were doctors on hand as well. I already know that my first choice for birth plan is not viable and probably my second as well.

"However I am not going to a MW-led unit because after 9 months of avoiding wine, cheese, pate etc I am not suddenly going to start risking my baby during labour I want a healthy alive baby and my partner wants a healthy alive baby and wife. I also want the option of having an epi, I am not one of the women who think pain is empowering."

I have to say that your post comes across like MW led units are dangerous! Which we all know isn't the case. I hate to say it, but perhaps you're risking your baby by going to an obstetric unit where you may not get the birth you want, may have an overmedicalised birth and may have more risks due to epidural. There are different risks to giving birth in different places. I didn't think pain could be good until DD...

horseshoe I find it interesting that you'd choose an epidural to get 1-1 care from a MW. I never thought of that as an option before. I was 'lucky' when I had DS that there were only 2 of us giving birth at the time so my MW was only away from me for longish periods when I was still coping quite well. Though she left me at one point when I was pushing, out of control on morphine and NEEDED her shoulder to put a foot on. I was screaming at her and terrified when she left the room. I did quite like having 2 MWs all to myself for my homebirth. I was monitored so closely that if there had been anything wrong it would have been spotted far faster than in hospital IMO. I also had some lovely accupressure massage from one of the MWs.

I really hope that you get the birth you want horseshoe. Isn't it a sorry state of affairs that you have to have an epidural to guarantee the care you need?

"Sabire if your childs safety is your most important aspect surely hiring a private obs/gyn doc would be better than a midwife?"

Do you say this because you believe that women delivered by doctors have better outcomes than midwives?

Surprising then that the USA, where almost all babies are delivered by doctors, is 24th in the infant mortality tables, behind many countries where the majority of births are midwife led. And of course the USA has a very high c-section rate compared to many European countries - something that's also linked to obstetricians being involved in normal birth.

Personally if I'd had specific problems that I felt required the expertise of an obstetrician, and the ability to lay my hands on £10 000 I might have considered going private. But as I felt midwife led care was more appropriate for me and my baby I went for an IM instead.

"As for worse case scenario being 10 minutes I think that is a very naive assumption based on the luck of last time."

No - it's based on geography. I live a 3 minute drive away from the hospital - it's less than a mile down the road. There are three back routes to my house from the hospital and no major traffic blackspots or road junctions.

"However I am not going to a MW-led unit because after 9 months of avoiding wine, cheese, pate etc I am not suddenly going to start risking my baby during labour I want a healthy alive baby and my partner wants a healthy alive baby and wife"

I assume you must have arrived at this decision because you have evidence that outcomes are poorer for both mothers and babies in midwife led units, even those located within CLU's. Would you like to share it with the other women who are reading this thread? At present women in the UK are advised that current 'best evidence' seems to show that for low risk mothers, MLU's and birth at home have similar statistics for infant mortality and morbidity when compared to CLU's, and significantly lower rates of maternal morbidity. (there was a recent study which received much press coverage which seemed to identify higher morbidity and mortality for babies born after a transfer from a homebirth - we've discussed this study here - it may well form part of the evidence when this whole issue is re-addressed centrally, but I don't think it'll influence govt. policy as it's such a poor quality piece of research).

"I also want the option of having an epi, I am not one of the women who think pain is empowering."

No - and if you want an epidural then you need to be in a CLU, so an MLU isn't an option for you anyway.

BTW - it's not the pain itself that's empowering - it's being put under severe duress and discovering that you're stronger than you ever thought possible. You learn about yourself. I also feel that in my case (and I'm sure other people here will have felt the same), the experience of being supported by my partner in labour has brought a different dimension to our relationship. I'll never forget what it felt like to be so vulnerable, or how amazing my partner was in helping me get through it.

And before anyone starts shouting at me - no I don't think that everyone gets this from labour or that everyone should. Each to their own.

No I say it because if something goes wrong I want a doctor there not a midwife.

And a spare ambulance on standby incase you need one?

You stated
"When I booked to give birth at home I was aware that there were some instances where having a baby at home would increase the chance of a poor outcome - cord prolapse, placental abruption and shoulder dystocia were three things I was concerned about. Not concerned enough to stop me booking at home though - I felt these risks were fairly remote and in some ways balanced out by the risks associated with hospital births such as infection and higher rates of intervention."
I feel the opposite way i.e. I think the risk isn't worth taking re:cord prolapse, placental abruption and shoulder dystocia

Yes I know re:epi and CLU but I do keep pointing out I only want the option, I have no idea if I am going to take it or not.