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.

'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?'

Because it isn't always safer and healthier, for all mothers or their babies.

And there's a difference between being proud and being smug.

It's also up to women themselves to educate themselves, too. Some personal responsibility is in order in this and ALL things, and the tools of education are easily and freely acquired nowadays.

"Because it isn't always safer and healthier, for all mothers or their babies."

No - but it usually is. Particularly in the case of opiates. And women know this - which is why so many to have an unmedicated birth if they can.

As for being either proud or smug - well that's going to be in the eye of the beholder isn't it? You're allowed to be proud of yourself as long as you're not belittling other people for making different choices. I don't see anyone on this thread doing that - do you?

"It's also up to women themselves to educate themselves, too"

Yes - but what about those women who don't have English as their first language, or those women who've newly arrived in the country, or those women who have poor basic literacy, or those women without internet access or very young women? It's simply NOT true that we're all equally able to access good quality information, in relation to this issue or any other.

I considered myself reasonably well informed when I had my first child 8 years ago but I've learned so much about birth afterwards and it really changed my choices for my second and third births.

I had a so called "natural" birth and don't feel proud or smug, just really let down

Hello ButterflyMcQueen Yes the MW's in the care team said I could have an epidural at any stage of the labour, and thats what happened. On the day of the labour I was being looked after by a MW from a different team, who did ask if i wanted to try G&A and pethidine first. When I said no, and that i wanted to feel comfortable and in control she did not hesitate to contact the consultant, who prescribed the epidural.

Had big gulps of G&A whilst waiting for the anaethetist.

Whilst pregnant with DS1, at appointments with the MW, I explained that I am terrible wimp when it comes to pain, and that my anxiety levels spiral. And i also said that i would probably want an epidural at some point in the labour. At that point did not realize it would be so soon!

For my second child it was the first thing on my so called birth plan - Epidural. I did my research and homework and decided that it was best for me (had em c sec for first birth after a long, difficult and traumatic labour). I asked for the epidural as soon as I went to hospital (I just nicely said to the MW - could I please have an epi when I'm in established labour please please?) and it took me about two hours to be at 4 cm. With first birth, it took me 12 hours to get to 4 cm!. Anyway, established labour is a rather subjective thing I have found. Some say 4 cm, others say with regular contractions.

The only thing I would say not to wait too far along. If you wait until you are 8 cm it might be refused as it will really impact on your pushing.

To comment on the remarks from your MW, I've had both remarks made as well: 1) you don't want one of those AND 2) isn't it nice to have a patient who is not in pain (a very nice MW who said that during labour!!)

'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?'

Totally agree. Many women do believe that birth is a natural process and they want to keep it as unmedicalised as possible. They do believe that it's healthier to give birth with as few drugs as possible - and they should be allowed to feel that! Feeling proud that you have coped with labour and birth naturally is not the same as being smug. I couldnt care less what other mothers decide for their births - I cared about my experience and the outcome for my baby. I've been on both sides of the fence: dd2 had to be delivered by CS, which I had under epidural - this was a medical necessity to save her life. I am profoundly grateful that the technology exists that enabled this. dc 1 and 3 were straightforward pregnancies, and I was able to give birth vaginally, which meant that an epidural wasn't necessary and in my view not a desirable thing for my babies. Why should anyone have a problem with that view?

To try and answer the original question: I am an anaesthetist. From our point of view, epidurals are best started after labour is established, the definition of which is 4cm dilated. We do not want to perform an invasive procedure on a woman who is not actually in labour. It can slow things down, and in early labour that means it can actually stop.

Except, and there are always exceptions, where the lady in question is absolutely, definitely, going to deliver in the next 24 hours i.e. they are being induced, and are facing the "cascade" of intervention anyway. So it is quite common in one of the obstetric units I have worked in for midwives to ask for an epidural on behalf of a lady before the syntocinon drip (which make contractions stronger and more frequent) is attached, regardless of dilatation. This is fairly sensible, given that the lady is more likely to sit still for the procedure, making it easier to put in.

At the other end of labour, it is very common for women to ask for an epidural in transition, as the pain changes in nature and is often stronger. It is really not a great idea to put in an epidural at this time. They can take 10 minutes or so to get in, and a further 20 to fully take effect. Most women are well through transition in this time, so have been exposed to the risks of epidural with little or no benefit.

However, there are always exceptions, and I have put in a fair few epidurals late on (9 -10 cm). Some women feel the urge to push a bit early, and can make the cervix swollen, preventing full dilatation. An epidural removes that urge, so very useful. Some women reach fully, but the baby needs to decend more or turn, again a late epidural can be very helpful.

So in short, between 4-8cm dilatation, with exceptions.

I wonder that it is our general perception of pain that relates to increasing epidural rates. We are constantly told:
birth is painful, how sore you'll be, ooh that burning feeling, just don't think about the labour until you have to etc etc

So we are setting up an expectation that the pain will be too much to bear and instilling fear. And we know for certain that fear increases pain, so we really are doing ourselves a disservice.

Another call for better antenatal care/funding I think.

I love anaesthetists! They're your best friends.

Perception of pain?

My brain was definitely feeling it, and I had the blood pressure to match.

But societies have always thought of birth as painful. It is not a new thing or something confined to the developed world.

I was fine until I realised that I wouldn't be getting an epidural, then I was frightened! (and my expectation of pain shot through the roof!) believe me an epidural would have meant I wasn't so scared, I wasn't too knackered to push and then I possibly wouldn't have had to have my feet in stirrups and a ventouse on my baby's head

Sorry, but I see absolutely nothing wrong with being frightened of pain.

Perception of pain - well, yes and no. All pain is subjective, because the person experiencing it is the only one experiencing it. That means, though, that that person is the expert on their pain. There would be something deeply patronising and worrying in not listening to them.

I've had an epidural, after two agonising days which got me to 3cm. After the epidural I was fully dilated within the hour, but then things slowed again and I did end up with a series of interventions - syntocin, episiotomy, ventouse - although the whole labour had been very start-stop and I might have needed at least some of those interventions anyway. And I've had a drug-free birth, a couple of hours of very manageable, 'positive' contractions and utter shock when I got to hospital having gone there on the bus to be told I was 9cm. Transition, then, was very painful but always bearable - much more so than the frustrating misery of those seemingly unproductive contractions pre-wepidural in ds1's birth. With ds2 in transition I was screaming for an epidural, but I really didn't mean it.
FWIW, ds2 ended up as a ventouse birth too.

I am very glad I did it without the epidural the second time - I do genuinely remember that half-hour of intense labour in the hospital as empowering, and recall an odd feeling with ds1 of regret at the loss of the feekling of 'labouring' mingled with the blessed relief -, but I feel no shame or stigma in having had one the first. I was still 'learning' birth.

I don't mean we shouldn't be scared of pain - that's how we learn not to jump off the roof of the house etc, that's keeping ourselves safe and alive. Our bodies experience pain as a way of telling our brains something. What I mean is that we are socialised to see pain in childbirth (specifically) as a bad thing.

Having a baby blimmen hurts - don't get me wrong. But if we can change our thoughts about why it hurts then we don't have the fear, and the pain may become a guide and an indicator to what your body is doing and how your baby comes, rather than an unnecessary evil.

I don't think this is coming out like it sounds in my head

It's like if you can think each time - that one bought my baby a little bit closer, my body is working and doing

It's not so much that there's anything wrong with being frightened of pain - I'm sure most people have a fear of pain. But it is possible to have a well managed birth where you are supported by a midwife/doula/lovely partner and you can kind of go 'through' the pain barrier. That's the best I can describe it. A lot of women who have natural births describe them as a positive experience; not because they aren't painful, but because they have been well supported to cope with the pain. My first birth was the most painful thing I have ever experienced in my life - but I still feel good about it, and it was a positibe experience in a way that my painfree csection wasnt.

berloni i agree with you re the 'loss of experience' feelings

i had no birth story to tell! lol no screaming agonising no f- ing or blinding

no begging to die etc etc etc

there is a sense of loss but the calm soothing birth my child experienced was lovely for us both!

what it's supposed to do.

My sister in law said that when she has her next she's going to ask for an epidural, but she's glad she didn't have one first time. She said she feels complete now that she's expeienced what her body was made to do. I was a bit surprised when I heard this cos she's only a young 23 - its not really like her but I thought it was a good way of putting it.

Re the one little step closer thing - IME (I had one easy birth and one hard one) it is easy to feel like that when everything is going as it should and your labour is clearly progressing. When you've been in very painful labour 24 hours or more and the mw is constantly surprised by how little you're dilated, it's harder to see it in those terms. IMO epidurals have an enormous value in situations like that. Also where the labour's been long and relentless and physical and mental exhaustion is a problem.

I wasn't keen on having one mainly for the reason I fainted in my ante-natal class when the mw started banging on about them - the word vertebrae was mentioned but I hadnt ruled it out right until about 30 mins before she was born when I knew I wouldn't get one. I had G & A and pethidine.

THere is a huge stigma attached to epidural here in Japan, where I had DD. The bad thing is, that there is no other alternative methods of pain relief , so its epi or nothing.
But to be fair, Japan has the lowest infant mortality rate in the world, and a very low C-section rate, so perhaps the two are connected. (then again, it also has one of the lowest birthrates in the world too, so perhaps there is also a connection there...!)

Sorry- not suggesting that epidural and infant mortality rate are directly connected , more of a general musing about the approach towards birth and labour in Japan. Another example of the way they view it is that its not covered by medical insurance because its not considered to be pathological i.e something that needs to be "treated" (a C-section is though, of course). Instead the gov gives you a cash gift worth abotu 1500 pounds to cover expenses and a bit left over.

i laboured for 6 hours on just g and a on an induction and wasnt dilating and in the hour of actually administrfating it i dilated 5 cms which was horrendous

but once it was in it was fab

bt then lo had braddicardia [sp?] and had to have emergency section

i get more stick for the section than the epidural which is silly coz it saved her life

I have trouble understanding why people think epidural is bad for mother/baby's health wheras 'gas & air' is quite OK.

Epidural is a local anesthetic. The 'gas' is a dissociative drug that you inhale, which goes into the blood stream.

How can G&A possibly be better for the baby than epidural?

"IME (I had one easy birth and one hard one) it is easy to feel like that when everything is going as it should and your labour is clearly progressing. When you've been in very painful labour 24 hours or more and the mw is constantly surprised by how little you're dilated, it's harder to see it in those terms. IMO epidurals have an enormous value in situations like that. Also where the labour's been long and relentless and physical and mental exhaustion is a problem."

If my independent midwife had expressed constant surprise at my slow progress during my third labour (contractions started 5am monday, 5cm 10am, 7cm Tuesday pm, 8cm, transferred to hospital Wednesday 1pm and was 8cm on arrival. Baby born 4pm Wednesday) my confidence and my ability to cope would have been completely undermined. Luckily she concentrated on supporting me instead and reassuring me that my baby was ok.

I think so few women who are having longer labours are given the help to cope in the way I was. Had I been in hospital for the whole labour I'm convinced I would have ended up with an epidural and a c-section for failure to progress (particularly as I had gestational diabetes).

Luckily I was at home for most of the labour with a midwife who's a colleague and a friend, and who knew me well because she'd delivered my last baby. What got me through that labour without an epidural was being in my own home, eating and drinking as I saw fit, having freedom of movement, but more than anything else it was her confidence that I could do it that got me through.

I'm NOT stoical - anyone who knows me knows what a hypochondriac and whinger I am when I'm not well. My labour was horrible - but I coped because I was well cared for. Yes - I was knackered and yes I did go through some dark moments when I was being sick from the pain of the contractions and felt like it would never end, but there was always someone there to say to me: you will do this, you are doing it, you're fine and your baby is fine. That was all I needed in the end. If I'd had someone around me undermining my confidence I would have crumbled after the first day of contractions.

I think the point I'm making is that epidurals aren't the only answer to a longer labour. I also had a very long labour with my first in hospital. What a different experience that was. I saw about 4 midwives over the course of the labour. Until I had my epidural sited none of them stayed in the room for more than a few minutes. Not one of them touched me except to take my blood pressure/monitor the baby. They were positively relieved when I opted for an epidural (their suggestion) because it meant they could sit down and get on with writing up their notes, rather than mopping up my tears and reassuring me.....

i was ridiclously out of it on gas and air and fair more conscious with the epidural too