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.

Interesting link there jaynz. I totally agree that it is not ok to spout incorrect or misleading information. This article describes many potential pitfalls of having an epi, and while the risks of certain outcomes may be small, that doesnt stop them being devastating for the mother and baby involved. My primary reason for not wanting an epidural was because I didnt want to increase the likelihood of further interventions. The huge empowerment I felt at giving birth naturally was a huge bonus, and was an important factor in going without an epidural for my other VB. But the safety factor was definitely the driving force first time round, and I'm sure is the case for a lot of women.

My drug-free birth was devestating for me.

I was in an extreme state of panic due to the pain.

Afterwards, I felt scarred by the memory of that pain.

I still do. I'm on pins and needles this time round, afraid I won't be able to get pain relief that is adequate, which for me is epidural.

G&A makes me vomit and gives me suffocating panic attacks. Opiate drugs and my mental health really don't get on.

My mental health is paramount to a good delivery.

Epidural gave me back my sense of control and relaxation.

Oh goodness me. I support women's choices. The increase in risk with an epidural birth IS tiny. Or it wouldn't be regarded as a safe medical procedure. The long and short term effects are different to risks. I have read that healing arts link several times - it's actually one I've used to support myself in other debates. When we are talking risks, we are talking mortality and morbidity. When we are talking effects, short and long term, there are many more possible negatives. I do not wish to minimise these, and personally, for my births, I put great emphasis on avoiding them. But in terms of risks (mortality and morbidity) to the neonate, modern epidural anaesthesia is very, very safe. Nobody should be made to feel that they are putting huge amounts of extra risks on the birth process by choosing epidural pain relief during labour or prior to onset.

I am deliberately disregarding the extra risks to the mother, as we are discussing stigma, not because I don't feel them to be important. I am merely trying to understand why the British public as a whole stigmatise wholesale pain relief in labour, and personally I think it is to do with the increased risk to the baby.

Yes, the baby has an increased chance of being exposed to synthetic hormones, instrumental delivery and all that entails. Barring the chicken-and-egg situation mentioned earlier, in that you really don't know which women would have needed instrumental delivery/augmentation regardless of pain relief options, although even a low dose epidural is unlikely to help, you still have to acknowledge that by no means all babies are injured through assisted delivery. It is also not uncommon to have an assisted delivery without having opted for an epidural, or to have one sited so that the assistance can take place.

For every story of a baby born injured that can be directly or indirectly attributed to the choice of epidural anaesthesia, there is another story where the baby was born healthy thanks to the choice for epidural anaesthesia. Exhausted women who had the epidural to rest and then push their babies out, previously traumatised women with a stalling labour due to fear, women with high blood pressure have it lowered through the epi, and so on.

Honestly, I support any woman in her informed choice. I don't feel it's an informed choice if you only hear one side of any story. I don't like the idea of any woman being coerced into having an epidural, or being denied one if that's what they choose. For some women that is the only way they can countenance a vaginal birth - for some it is a last resort to acheive that end. There are a lot of positives, and some risks are mitigated by them.

For me, personally, I would consider an epidural to be a complete last resort only to be undertaken in dire emergency. I know they carry risks regardless of stigma. For me, unless medically indicated, it's not worth it. But other women look at the same facts and draw a different conclusion. That's autonomy. That's choice. The chances of your baby dying or being injured solely because you chose to undergo epidural anaesthesia for labour are tiny. That's true.

I do not consider myself ill-informed.

Agree with all you say about autonomy and choice but I don't agree that epidurals are linked with more favourable outcomes for birth in general.

"Exhausted women who had the epidural to rest and then push their babies out"

If this were true then there'd be lower rates of c-section and instrumental deliveries in countries where epidural anaesthesia is in common use. In fact we see the opposite. The higher rates of epidural go hand in hand with higher assisted delivery and c-section rates.

I'm all for epidurals being available on request, but I suspect that if maternity care was better in this country - if we were also offered the option of one to one care in labour from a skilled midwife with whom we'd had a chance to develop a relationship with during pregnancy then far, far fewer women would opt for an epidural in the first place.

I'm sure that a lot of midwives are losing their skills (or never developing them in the first place) when it comes to getting women through longer or more challenging labours untraumatised, because epidurals are the norm now in some hospitals for first time mums.

I wonder if the stigmatising of epidurals has got anything to do with people seeing childbirth as a sort of rite of passage for women. Like - men have to go into the bundu and spear a lion. We have to give birth.

I have to lay my cards on the table and say that I personally can't help thinking that going through the pain of labour might psychologically and hormonally prepare you for being a mother in some way. I'd always acknowledge though that a hidious, terrifying birth experience doesn't set you up for being a mum - and if an epidural enables you to survive labour emotionally then it's obviously the right thing for you. I'm just not thrilled with the idea that epidurals are a good thing for most labours, as some anaesthists obviously seem to think, obviously because they see pain in labour as pathological and without a purpose.

I was planning a home birth with gas and air. Ended up in hospital with an epidural. I had to be induced due to starting pre-eclampsia and initially failed to dilate. Five hours of hormone drip contractions on gas and air alone was all I could take to be honest and I am no wimp. Although I needed forceps in the end and I do regret not having felt myself push my son out (was told to push and gave an almighty shove somewhere near my rear end I hoped - it worked, I pushed half of baby out in one go )but it really was unavoidable. It was epidural alone or epidural and c-section, IYSWIM.

So I would say that if we offer a woman who is afraid of labour an epidural as a remedy we fail her badly, but epidurals are fab when needed!

I haven't read all the posts but I really am not looking forward to giving birth again (am not pregnant at the mo as ds is only 6 months!) I asked for an epidural at 5cms dilated but couldn't have one as there was an emergency elsewhere and so no one to administer it.

I ended up having just g&a but was so knackered (and not a particularly long labour 11 hours) that I couldn't push and had to have a ventouse. Also, placenta wouldn't come out and after another hour after the birth of being induced and in massive pain again I had to go into surgery and have an epidural anyway

If I do have another I will be asking for an epidural as soon as the contractions start and will not stop until I get one Why should childbirth have to be painful? I had to have medical intervention anyway!

Actually, I'd like them to get the baby out by key hole surgery and leave no scar

I had an epidural because both myself and the baby were being closely monitored and I think that it was a great idea. I can't say that I enjoyed the labour experience but it wasn't nearly as scary or unenjoyable as I thought it was going to be.

My baby was delivered by forceps in the end but I had absolutely no pain throughout the entire labour. Surely the whole child labour experience shouldn't put you off having another baby and what better way than being in no pain at all!

I had an epidural 24 hours after going into labour with DD (the MWs said I had been in labour for 'only' about 12 hours but I'd been having extremely painful, frequent contractions for 24). For me, the epidural was fantastic. Although I was exhausted I pushed her out without trauma (although not for another eight hours) and was then ready to hold her and focus on her immediately. With DS, labour was much quicker (seven hours start to finish) and the MW seemed keen that I do it without epidural (and I was willing to give it a go). It was horrible. Like expatinscotland, I shall not forget the pain and the fear. When DS came out I could do nothing but lie very still and hope I was in one piece (actually I don't remember having many conscious thoughts at all by that stage, I was so traumatised). I didn't feel like focusing on DS at all (although I should say this has had no lasting effects on my relationship with him). So although I'm not planning any more, if I were, I would plan from the beginning to have an epidural.

I'm with fabsmum on this - I reckon half the problems that result in women begging for an epidural wouldn't arise if they had better and more consistent care in labour from someone they know and trust.

And it's worth remembering that over 80% of mums in the UK give birth sitting on their arses or lying flat on their backs. The majority of these women are low risk.

No wonder so many women turn to anaesthetists for help in labour......

An epidural costs the NHS £500. THAT is why the mw said "you don't want one of those".

I very badly did want one. And didn't get onw.

no stigma here

Hi guys just intrigued as i am still wondering what to do when baby finally comes,I think Ihave decided to have epidural if there is time as I have had 2 previous bad back 2 back,'stuck'labours and been in a lot of unbearable pain (I coped 4 hours both times at 9cm's DD1 episiotimy,forceps in the end 7lb 7oz,DD2 epidural 9lb 2oz) this is a boy though finally!!! is the sex likely to make things any different??? (Wishful thinking) I believe he is currently back 2 back-DUE TOMORROW!!!!!- I have been doing the positional thing i.e moving onto my tummy to watch TV etc. he seems to turn temporarily and then go back into my back so am not entirely sure what labour will bring.sorry my thought turns to EPIDURAL or not???and if so how do you get one 'quickly' i.e do I need to make fuss or just write a dependable birth plan???

"An epidural costs the NHS £500. THAT is why the mw said "you don't want one of those"."

Dont' think that's got anything to do with it at all.

Most midwives don't give a damn about things like that.

Midwives want mums to have normal births because they know that these are healthier for them and their babies and lead to fewer problems breastfeeding. They know - because the research shows - that if you have an epidural you're more likely to have other interventions and perineal problems after birth.

Some midwives probably also dislike taking on the role of 'obstetric nurse' - which is a role they end up occupying once you've got an epidural in place. They don't need to use their support skills in the same was as during a normal physiological labour - what they're mostly doing once you've got your epidural set up is monitoring you and checking drips etc. Some of the best midwives avoid working in the NHS for that reason alone - they don't want to spend their working lives reading the print out from a monitor and checking catheters.....

the cost was also quoted to me albeit in a different way

laughaminte you need to holler and demand imho

good luck for tomorrow ans let us know on here what you decided!!!!

Re the cost of epidurals.

If the ever increasing numbers of women opting for epidurals reduces the amount of money left in the maternity pot to pay for larger numbers of midwives in the NHS to provide one to one care for ALL women in labour, the opportunity to choose a homebirth and new birth centres (all things that make epidural use less attractive and necessary for mothers) could we still argue that universal provision of epidurals is a good thing?

'If I do have another I will be asking for an epidural as soon as the contractions start and will not stop until I get one Why should childbirth have to be painful?'

Exactly! It seems like a weird badge of honour here - I did it without drugs so so should you.

I don't buy that.

If a woman requests one she should get one, not be talked out of it. It's HER body and she shouldn't be infantalised and patronised by healthcare professionals trying to convince her they know what's best for her body.

I want the epidural asap and I have made that VERY clear to them.

I had both types and I know which is better for me, for my health and therefore for my baby's health. My mind's way of coping with the extreme and intense pain I felt had a negative effect on how I felt about the baby, and yes, that affected breastfeeding as well.

Ok I don't know the answers but having had an epi with ds1 and a completly natural birth with ds2 (ran out of time, even though labours was 26 hours long!) I will give you some advice.........TAKE THE DRUGS!!

It's perfectly possible to have a limb amputated without anaesthetic - but why would you?

I don't get the stigma either. I decided I wanted a natural birth, but that was partly because I was scared of having a needle in my spine. I was also totally aware that when push came to, er, push, I may change my mind.

When I was in labour the first time I actually asked my mum if she'd think I was a wuss for having one (she thought I was nuts for asking) before shouting 'I want a fucking epidural!' Actually, I was too late - the intensity of the pain was me dilating from 4cm to 10cm in one hour. The m/w knew that, and not wanting to slow me down told me the anaethetist was in theatre, for which I was very grateful - she knew what was best and had read my birth plan but knew better than to wind me up by telling me that to hang on a bit and see what happened.
The second time round I didn't even have time for G&A - dd arrived 45 mins after we got to the hospital - the mw almost missed it because she'd gone to fill the pool.

Re 'normal physiological labour' - there's not such thing as a 'normal' labour - we all birth the best way we can, and if we need to numb the pain and the option's there, then why the hell not? As someone said, it's not an endurance test.

I know that the fact that I could do it without is because of the way I birth - it doesn't make me hardcore or better, just lucky.

hatrick - if the government wanted to ensure that all women had GUARANTEED ACCESS to epidural anaesthesia they'd have to get a lot more anaesthetists working on maternity wards. This would cost a huge amount of money. At the momen not all women get an epidural when they request one because staffing doesn't allow for this.

Exactly! It seems like a weird badge of honour here - I did it without drugs so so should you.

I don't think anyone here has said or implied that other women 'should' go without pain relief.

That said if women attempt to go without pain relief because they feel it's safer and healthier for their baby to be born after an unmedicated labour - well hats off to them. Why shouldn't they be entitled to feel proud of themselves?

"If a woman requests one she should get one, not be talked out of it. It's HER body and she shouldn't be infantalised and patronised by healthcare professionals trying to convince her they know what's best for her body."

Yes - I think this is VERY important. There was an editorial in Practicing Midwife about this issue last year. Asked if a midwife could truly be said to be practicing 'woman centred care' if she fobbed off those women who'd requested an epidural during transition - even if she was fobbing them off because she felt that clinically it was a very bad decision and would complicate and lengthen the labour. The article came to the conclusion that women should always be allowed to have the final say on this issue - no matter when in labour they request an epidural. My only worry about this is the poor provision of antenatal education in the NHS - I worry that women wouldn't always be making fully informed choices, which is categorically not a good thing.

Me too phlossie. I couldn't have put it better.
igivein - giving birth vaginally (a natural process) and having a limb amputated (which is not) are not really sensible comparators. Nobody would argue that anyone should ever have surgery like amputation or, in the birth context, a c-section, without anaesthetic. Birth is different. Your body is built to endure it, but, if you don't want to endure it, that is entirely your choice. But it is not like choosing to have an amputation without pain relief, which is clearly mad!
I think the marathon example someone gave below is much better.