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.

I have to disagree Krang. While positive thinking can't turn a breech baby or stop a pre-eclamsia, I do think it can make a difference to the birth. If you're thinking postively chances are you're more relaxed, less panicky. This means that there will be less of the stress hormones in your system which are known to interfere with normal labour. If your labour starts stalling because of these things then chances are you're more likely to get put on a drip or to get an epidural due to length of labour and then intervention due to epidural/failure to progress. Also, IMO, if you're fairly negative or dwelling on the bad things then you're likely to go to hospital sooner. Then it seems like a long labour when you're in hospital and MWs start niggling about you failing to progress or your labour slows down due to a change of environment.

Being prepared is absolutely essential IMO. But I think being positive and relaxed is also a good thing and does influence labour. My advice would be to think of the birth you want and do what you have to to achieve that. It might not be achievable as there are things out of your control and you have to accept that. But there's no harm (and probably good) in planning and remaining positive.

My top tip is to labour as long as possible at home in your own territory. It always seems much worse when you get to hospital!

"It always seems much worse when you get to hospital!"

I don't know about always. I was very happy to be there, partly because they had pain relief but also the reassurance that it was going all right.

ds 1 induced, G&A pethadine epidural ventouse as baby was distressed baby 9lb 1oz

ds 2 spontanous labour epidural (worked only down one side) G&A forceps as baby stuck 3rd degree tear -baby 1/2 oz off 10lbs

I'm 5 foot 3 and wouldn't consider having another baby unless I could have a c-section due to 2 awful deliveries. (If that means going private then so be it) I seem to grow big baby's that I can't deliver. I am still having treatment for the damage my ds 2 did to me.

Epidurals were a god send in my experience but I think if you can manage without one fab for you, but if you need one like I did, don't be afraid to ask and have one. Don't be put off by the nursing staff if you feel you can't cope I was told you can have one anytime after 3-4cms dilated as then you are definately in labour. People who look down on you I would feel are lacking in some sort of self esteen that they turn something like childbirth into a competion. Childbirth is natural but dangerous if things go wrong and I am under no illusions that 100 years ago I would have probably died in both my births.

DS 1 G&A - made me sick, then Pethedine - made me sick, then an epidural which wore off just in time to push.

DS 2 G&A then epidural.

I am not brave, I am very proud that I have 2 beautiful boys who I love very much however they popped out of my body.

I made sure that the first thing I asked my midwife about my impending one was whether they discourage epis in Devon as I had my other 2 in london! She said it should be fine! Hmmmmm how encouraging!

Anyway, I am going to try (or cry) my hardest to get one as I know it will be a better birth for me and ultimately my baby that way.

Your body, your choice

muppetgirl - I also have big babies (9lbs 6oz - epidural/pethidine/forceps) 10lbs 12oz and 9lbs 3oz. I'm average height and a size 10.

I remember thinking the same as you after my first birth - that I probably would have died in years gone by as my body made babies that were just too big for me to get out on my own.

I was encouraged to see it in a different way by my independent midwife during my second pregnancy. She pointed out that I'd managed to birth a large baby vaginally (albeit with some help) despite having everything going against me: I'd had an epidural which made it harder for me to push and made it difficult for my baby to get into a good position for birth, I was exhausted from not eating throughout a looooong labour, and I was off my box on pethidine. She said that getting a small, poorly positioned baby out under these conditions would be hard - let alone a large one.

I was saddened that she was the only health professional who I encountered during my second pregnancy who talked to me about the things I could do for myself to facilitate birth with a larger baby. She pointed out that if your baby is on the big side you need all your strength and mobility to get him or her out - and to think through our strategies for coping with labour with that in mind. We talked through birth positions before my labour, and what we'd do if the baby got stuck (as he did - shoulder dystocia - but she sorted it out).

I do think it's incredibly intimidating to know you're carrying a large baby, but with the right sort of help it doesn't always have to be an obstetric disaster - as long as your pelvis is big enough to let the baby through (as yours clearly is - otherwise it would have been a c-section for you with your second: forceps are only used once the baby is a good way down the birth canal).

All that said - if like you I'd had a third degree tear and a forceps birth second time around I think it would have hugely dented my confidence - I can understand how an elective would appeal in those circumstances. And I think most consultants would be sympathetic to your request for an elective c-section.

Sabire -thank you so much for your experience it's good to hear from someone who's had a similar experience. I too was sick on G&A, off my box on pethadine and totally scared out of my wits when having ds 1. When I found out I was prgt with ds 2 they gave me growth scans every 4 weeks from 24 weeks which sometimes showed ds 2 as 4/5 weeks ahead which scared me even more -these scans were supposed to reassure me I don't trust my body at all and I trust my mind even less after having severe PND after ds 1. I really want a dsc 3 but need to be mentally fit for my 2 children I already have so we really haven't made the final decision yet. Having ds 2 has made me feel I can be a mum and a good one at that so I would love to have more. I think I can only do it by a c-section as I feel no trust with the NHS (not all aspects just target setting/budget constaints that effect every decision they make)

It's very sad that that is the only reason I may not have any more children

Like Anagram I have lived in several countries and have only ever heard of epis in a negative light in this country! In my experience MW are very militant on preaching their views and listing all of the reasons for a 'natural' birth. As my Consultant says natural is whatever it takes for each mother to give birth.
My DH is a medical person and I asked him to do a lot of research into epi's etc. He was not able to locate any stats that show an epi birth is more complicated etc.
I have problems with spine/pelvis from a serious car accident many years ago and had no ill effects after the epidural and c section. Now if I were to tell you how my MW reacted when I told her my birth plan was a C section...but that is another thread.
All I can say is that I am having a Consultant lead birth and am so grateful of her open minded approach. I encountered this openess and rational approach during my previous births from the Consultant lead approach also.
I sometimes feel MW are trying to compete/outdo Consultants when in reality they should co-exist more as partners...

That's an interesting theory Trolleydolley, about the religious thing, though I don't know how much weight it carries - I've certainly never come across a woman who cites Biblical reasons for not having an epidural!!
As has been demonstrated on this thread, I think most women who choose the natural route, do it because a) they want to avoid the associated risks of intervention (and epidural in itself is an invasive thing, even if you avoid subsequent interventions) and b) because they understand that natural birth is attainable, and they have a desire to experience it.
I don't think the analogy with having a tooth out is comparable at all. Childbirth is fundamentally a totally different process.

Yeah, the reason a) is first is that IME that's the primary reasons for most mums - they just don't want the risk of complications if they can help it. The b) can be an added bonus!

Krang it's sad that your experiences have led you to really believe this. I agree that information is essential, it's important that women know what a pair of forceps are and what a section involves, but to say this is ridiculous.

What do you think it is that gets women through the pain without drugs? Not luck that's for sure. What about women who have decided they do want pain relief and persist until they get what they need? Is this luck? No, it's women having the attitude that they know what they want and how to get it. This is definately positive.

To say that your whole labour is down to luck undermines women's intrinsic knowledge of what they want and need. Should we just give over everything to luck and not crawl around on our hands and knees trying to turn our posterior babies? Or should we resolve ourselves with the section we don't want because our baby is breech and no-one has the skill/desire to support a breech birth, rather than try acupuncture, and ecv, and webster's technique? And how does this attitude affect the rest of our lives? If we're infertile should we just accept it and move on? I should think the hundreds of threads on ttc would disagree that a positive attitude makes no difference in anything.

Of course sometime things happen that you can't control/change, but this is the minority and even in these cases a positive attitude can be an essential coping mechanism.

The glass is half full, not half empty.

Totally agree Jaynz. Why would having a positive attitude NOT conducive to a good birth experience? After all, a positive approach towards many other things in life is seen to be a good thing. You wouldn't go for your driving test thinking 'Oh god, it's going to be awful, something's bound to go wrong'. You don't walk into work every day thinking 'Oh well, today might be shit, i'll just have to trust to luck!' Having a positive attitude is essential to cope with all aspects of life effectively. Of course it doesnt wipe out every possibility of something going wrong - but it sure as hell helps. As Jaynz says - what is it that gets a woman through labour without drugs? My first labour wasnt easy, it was long and hard and painful - but I did it naturally. It certainly wasnt down to luck! It was down to being emotionally prepared for the fact that it would hurt but that unless something unexpected happened, there was no reason why I shouldnt give birth naturally. It was also down to having a wonderful midwife in a MLU who was dedicated, passionate and the EXPERT in delivering babies.

Erm, at no point did I infer that infertile women should 'accept it and move on', and or that 'we should give over everything to luck.' That is a complete misunderstanding of what I said.

I have absolutely no knowledge of the effects of positive thinking on trying to conceive and that has nothing to do with what I am saying here. Kindly do not drag a completely different yet equally emotive situation into this debate.

I shall repeat what I said in simpler words. Of course you can do all the aromatherapy, crawling, acupuncture and conventional pain relief you want - why not? But in the end, a great deal of what happens in the delivery room is, in a large part, down to simple luck, and will be full of variables you cannot have a hand in.

Perhaps you are lucky in that you have a sympathetic midwife attending you. Perhaps you are lucky in that your baby comes very quickly. Perhaps you are lucky in that your blood pressure does not drop for no reason in labour. Perhaps you are lucky in that you get on with the gas and air and it doesn't make you sick. Perhaps you are lucky if you don't, as I did, go into labour unexpectedly a few days too early for the birth centre. Perhaps you are lucky because you go full term and don't give birth very prematurely for no reason that anyone can fathom.

These are all factors that you can do nothing whatsoever to change. Hence, luck, or lack of it.

We are all encouraged to think of birth as something we can completely control - there are so many threads on the 'ideal birth' and the 'dream birth' and 'the only kind of birth I want'. I think this is dangerous. I know. I used to think it. Yes, we can control aspects of it. But some, we can't. We just can't.

Krang I sooo totally agree with you!

Personally I would like to add that the birth is such a small part of the big picture of being a parent. I do not understand why we focus so much on a 'perfect' or 'natural' delivery (though I still maintain my epi and c section was natural for me)... Trust me after years of working with children, how 'perfectly' you deliver your child has little impact on the rest of their lives! Nor does it make you a better mother! Why on earth anyone would think they had failed if they had pain relief, a c section etc. is beyond me. The ultimate aim should be to deliver a healthy baby using whatever means are required, if they are required.

To be fair, I don't think anyone has suggested a natural delivery makes you a 'better' mother!! I think it's been said many times already, that some mums simply want to avoid the risks of interventions during birth as far as possible (given that, yes, some things will be beyond our control). As you rightly say, the birth is one part of the bigger picture of being a parent, and we all try to take steps to eliminate risks and make other aspects of parenting positive. For many women, this starts with how they look after themselves during pregnancy, avoiding things which could pose a risk. The birth is the next stage, and then the major task of parenting really starts! Why should women not want to maintain a positive approach and try to eliminate risks at all stages of the process?I agree, The method of delivery probably won't have a great impact on their life (though there are risks associated with csection, forceps etc) but I think the kind of birth a woman has can definitely have an impact on how she feels.

At the end of the day, if we all simply wanted the greatest chance of a pain free birth, we'd all book consultant led care with an epidual wouldnt we? But the fact is, most births (I think the stats are around 66%)are without epidural. That has to be for a reason, and my gut feeling is that it's not whacky religious reasons, it's not that most women are masochists, it's simply that most women want to avoid interventions in the birth process where possible.

For me the main benefit of a positive outlook was to get me through all of the things which did not go remotely to plan when I had DD and in fact went tits up. I personally also agree with Krang that a great deal of luck is involved in the process. I read all the books, had sympathetic IM, etc etc but none of that mattered when the first contractions started. I didn't appreciate at all how different the experience could be from my expectations, despite all my investment in 'preparation' beforehand. I don't think anyone is saying that you should just give up and go back to the GA and the stirrups our grandmothers had in hospital. But any discussion about birth plans, for instance, should start with the caveat that is usually found at the end of these talks: God likes to laugh at our plans. I do think fewer women would feel like failures when things don't work out as they hope from reading all the books beforehand.

"But in the end, a great deal of what happens in the delivery room is, in a large part, down to simple luck, and will be full of variables you cannot have a hand in."

No - this is simply NOT true. These are the thoughts of someone who sees childbirth as USUALLY complicated, whereas MOST healthy women with uncomplicated pregnancies are actually capable of giving birth without needing loads of interventions. And we should be asking ourself the question - why are so many of low risk, healthy women having such difficult and complicated births? And why does the rate of normal birth vary so wildly between hospitals and other care settings?

Where LUCK really plays an instrumental part in childbirth is in the way you're looked after - having a good midwife, and having access to a birth environment where you'll be given the best chance to labour effectively. Even some of this you can control to some extent, if you have the money to pay for an independent midwife, or a choice of birth centre or midwife led unit.

I look back on my last two labours and feel I had many things working against me: I had gestational diabetes, was carrying large babies, in my third labour I had a previous history of shoulder dystocia and was nearly 40, and I had had a previous forceps birth. I also reacted very badly to pethidine. I've also only had one labour that was a normal length. My other two were three times as long as average. In my case the fact that I got through these births in good health, with no perineal damage, no instruments and a healthy baby was down to really excellent midwifery care -not random chance.

"We are all encouraged to think of birth as something we can completely control"

No - you can't control your labour and you shouldn't even try - it's the one thing that is likely to make things go wrong.

But there are things you can do a lot to give yourself a better CHANCE of an uncomplicated birth. Personally I feel that a first time, low risk mum - especially one who wants a natural birth - who books herself into a busy consultant led unit with a high epidural and c-section rate, where she won't get one to one midwifery care is basically setting herself up for things to go wrong.

Sabire, you talk a lot of sense.

But Sabire, when you talk about women 'setting themselves up for things going wrong,' you are basically implying that it IS a woman's fault when she doesn't have a 'normal' birth. This is what I find so damaging.

And all the factors you talk about to avoid an instrumental birth are indeed down to luck. Excellent midwifery care - well, I'm sorry, but that IS down to luck - it entirely depends whether you had a good midwife at the time.

Tell me how I could have avoided my instrumental birth, then. I couldn't wait for the birth. I did all the yoga, all the active birth classes. I booked myself into MLU. I was determined only to use gas and air.

What happened? I went into labour too early for the MLU - luck.

My blood pressure nosedived during labour so I couldn't move - I would have passed out. Luck.

The gas and air made me vomit. Luck.

Cord wrapped round my baby's neck twice so he couldn't get out unaided - luck.

The alternative to my luck theory? It was my fault that I didn't have the birth I wanted. I was stupid and cowardly and couldn't stand the pain. It was my fault that I ended up traumatised and hating my baby. I somehow 'set myself' up for things to go wrong. All my fault.

However, I suspect I'm now arguing from a personal rather than evidence-based stance, so I think I'll stop now. I have found it really interesting reading your posts, though, and hearing about your experiences.

Sabire I am very positive and feel very positive about my next c section/epi birth. I also feel lucky that it is a consultant led unit. (Not sure why you added busy, emotive language maybe? because in my experience both units are busy!) Not sure also why you think a vaginal birth is less complicated? I went in, an incision was made and it was all over in 20 minutes with no problems and a happy healthy baby. I intend to give myself a better chance of an uncomplicated birth again by following that process.
Can't you see that associating a vaginal birth with positive thinking and less complications is just not true? It is so very individual and we should all go in with a positive but open mind and stop being indoctrinated into thinking one approach is better than the other/more positive than the other etc.
The UK has average childbirth mortality rates(except in Lincolnshire where they are diabolical), it is not top of the list. Yet there are countries with higher success and intervention rates and vise versa so I do not think that it is necessarily a good yard stick from which to measure the success of birthing in this country.

But Sabire, when you talk about women 'setting themselves up for things going wrong,' you are basically implying that it IS a woman's fault when she doesn't have a 'normal' birth. This is what I find so damaging.

Yes - I shouldn't have said this. I think what I meant was that 'women are being set up for things going wrong'.

"And all the factors you talk about to avoid an instrumental birth are indeed down to luck. Excellent midwifery care - well, I'm sorry, but that IS down to luck - it entirely depends whether you had a good midwife at the time."

Yes - I did say that to a certain extent it is down to who you get on the night, but if a mums does have the choice of MLU, homebirth and CLU and they don't want an elective epidural - and the evidence supports the safety of birth at home/MLU - why do so many actively choose a CLU where they won't get one to one care and are LESS LIKELY to get good midwifery care focused on supporting physiological birth?

"Tell me how I could have avoided my instrumental birth, then. I couldn't wait for the birth."

But I didn't say that bad luck is never a factor. You have chosen to read that into my post. You were very unlucky and I'm sorry you had such a bad experience.

"Not sure also why you think a vaginal birth is less complicated?"

I suppose it depends what you mean by 'uncomplicated' really. Most full term, healthy mums can give birth to a healthy baby without having lots of things 'done' to them and without the involvement of half a dozen highly qualified professionals, anaesthetics and antibiotics!

I'm not quite sure what you think I'm saying about c-section and interventions. The point I have been trying to make all along is that most women don't want interventions in their labour if they feel they can achieve a healthy birth without them.

The best approach is one that results in the highest number of happy, healthy mothers. I personally feel that the evidence does not support high rates of routine intervention and highly medicalised births for a large proportion of low risk mothers as the most direct route to this.