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.

'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.'

That may have worked for you, but what everyone is failing to understand is that for some women, pain relief like epidurals help give them teh confidence, sense of control and relaxation others got from support.

It helped me to rest, too.

I had acid reflux and an oesophageal ulcer in the last weeks of pregnancy and was utterly exhausted going into labour, which lasted 24 hours.

Constant support during labour works to help a labouring mother cope with the pain for some the way epidural works for others.

Modern anaesthetics are very safe. Women even have GAs during pregnancy for necessary surgery and during delivery and the vast majority survive this.

G&A did nothing to relief the pain I felt, gave me a panic attack and terrible sense of suffocation and made me vomit.

I found it a useless tool and wouldn't touch it again. I can still remember how it made me feel.

there is no evidence, i have seen cote, and i eremember you discussing this on another thread, that gas & air, even if it crosses the placenta does any harm, where i have read stuff that does imply that epidural does have an effect on the baby. effects which have been outlined lower down this thread

when you stop breathing gas and air in, it is gone and out of your system,AFAIK you cannot stop the epidural once it is in you , you are medicated for several hours.

each to their own ,but it is important for women to know the side effects of each and ever method of pain relief

what works for one might not work for the other

i have had one labour with epidural and one wthout , if i had another baby, i would have a homebirth with nothing other than G&A

As far as I am concerned if it comes out the birth canal then it is a natural birth whether I need pain relief or not.

"Constant support during labour works to help a labouring mother cope with the pain"

• yes it does, but sadly most women don't get this, and they generally don't get one to one care from a midwife they know and with who they've established a relationship prior to labour. No wonder so many women feel that an epidural is the only way to go.

"That may have worked for you, but what everyone is failing to understand is that for some women, pain relief like epidurals help give them teh confidence, sense of control and relaxation others got from support."

I find it odd that you say 'every is failing to understand' the relief and sense of control that epidurals give women. I don't think that's the case is it? I think almost everyone here acknowledges that epidurals (usually) stop the pain of labour. And of course logically you're going to feel more 'relaxed' (whatever that means) if you're not coping with contractions. Personally I've done it both ways. I was relaxed with my epidural. I slept through loads of my labour. I suppose I did get some control back once I wasn't having to cope with my contractions. Not physical control - I couldn't move much once I'd had it done and couldn't feel to push. But emotional control.

As for confidence - yes, once I'd had the epidural in I had confidence that the staff would get my baby out. While I was labouring I lost all confidence that I could do it myself. But then I didn't get much help or encouragement. I think most women probably trust the machines and the doctors to birth their babies than they trust their own bodies.

I do think the fact that labour involves a loss control (in all senses) is something very fundamental that women need to take on board. And that a certain amount of stress relating to this is inevitable - but that the stress and loss of control intrinsic to labour isn't generally pathological - it's healthy and necessary for normal birth and that you might see it as part of natures way of priming us for the experience of motherhood. I think lots of the pathological stress and anxiety connected with that loss of control comes from the way birth is managed today and the sort of environments we have our babies in, and I think an epidural is logical response to this. We create the conditions that make labour unbearable for women then offer them an epidural as a way out.

I also think there will always be people who don't want to experience normal labour, no matter how good the support or how sympathetic the environment, and that's fair enough.

you did do it yourself, though.

i'm with libra, if it came out the birth canal it's a natural birth.

'people who don't want to experience normal labour, '

why is a normal labour defined as any sort of pain relief but epidural?

i find that an odd definition.

I would also like to know what the definition of a normal labour is. It appears that every single women experiences labour differently as every single women is built differently and has different reactions to pain. Which is one of the reasons there is no "right" way to give birth.

The perceived "right" way i.e. birth with no intervention and minimal pain relief used to kill a lot of women and their babies.

I had to be induced, but went into the delivery room confident in my ability to control my pain with breathing and relaxation. I had been coping with contractions by walking around, but as soon as I was hooked up to the drip, I had to stay sitting down for the rest of my labour. After about two hours, the midwife said I should have some pain relief, which I was surprised at as I was coping fine during contractions, and hardly noticed them. Then she turned up my drip and I was suddenly in agonising pain and felt completely out of control. Gas and air made me feel ill, so I ended up having to have an epidural, which then resulted in two hours of pushing. I would have liked to get up and lean over the bed to push, but wasn't able to, so I ended up with an episiotomy, forceps, failure to breastfeed, infections for a month afterwards and depression.

I think intervention can set off a cycle of negative further interventions, and epidural is just part of this. I can understand why people would want one, and feel that it gave them more control, but for me I just felt out of control. I felt like I was just doing whatever the midwives said, in an attempt to get the whole thing over with. In contrast, my mother was much more clued up and strong willed than I was, and although she had an induction with me, she refused to be drawn into the cycle of intervention and ended up having 6 natural labours with no pain-relief and no complications. I can't help but feel that the two must be somehow connected.

Next time I am looking into hypno-birthing

I think, once again there can be a 'competition' to see who can have the most 'natural' labour at times. A bit like breast vs bottle, homemade baby food vs jars, use bath products vs just use water etc. Child birth appears to be no different. Personally, I think any woman, no matter what type of delivery she has had, deserves a bloody good pat on the back for going through it! It's tough!

I had an induction with dd, and kept an open mind when it came to pain relief. I got to 3 cms without needing anything until my contractions got suddenly a lot more painful. I tried gas and air but didn't like it. Got to 4 cms and asked for an epidural as I felt like I'd totally lost control with the pain I was experiencing. Half an hour after the epi was put in, I was pain free and it was fantastic! I basically slept the rest of the labour, except for internals and other checks.

I didn't need any intervention at all, for the first hour I spent pushing, the mw told me when to push. For the last half an hour my epidural had started to wear off so I was still pain free but I could feel when my contractions were coming and push without needing to be told when to. Out popped dd. I did need to be cut, but I'm really small so I expected it.

Having the epidural first time round doesn't mean I'd have it second time, if I do have another baby I will go into labour with just as open a mind regarding pain relief as I did with dd.

"Constant support during labour works to help a labouring mother cope with the pain"
agree with sabine

the only labour i have had this level of support was the epidural one

my fourth delivery i got ten minutes - seriously 10 minutes of support as i pushed him out

rubbish

i was petrified and crippled with pain and fear no one there

I have read this post with so much interest.

I actually phoned my labour ward last night to discuss epis with the midwife there. She informed me that they only allow 3 women at one time to have an epi because of the one to one monitoring they need to provide to women having epis and so if I turn up on a busy night then I wont get one anyway.

With DD2 I was very much left alone until I called to say baby was on her way out. So it seems to me that the only way I can be sure of correct monitoring is by having an epi if I can get one. Otherwise they will leave me on my own and how am I to know if my baby goes into distress?

My alternative is a HB which I have been having trouble getting agreed and now my SPD is much worse I am not sure I would cope.

"why is a normal labour defined as any sort of pain relief but epidural?"

Actually 'normal' birth is often assumed to be any birth that doesn't involve forceps, ventouse or a c-section.

My personal feeling is that a 'normal' birth is when a woman births under her own steam - ie goes into labour spontaneously, doesn't have her labour augmented by syntocinon (so her hormonal responses drive the contractions - not a drip), and and gives birth without the use of instruments. BTW, it's not a term that involves any sort of moral judgement! I've only had one birth that could be called a 'normal' birth by this definition - and that was a homebirth.

"Constant support during labour works to help a labouring mother cope with the pain"
agree with sabine

the only labour i have had this level of support was the epidural one"

I think there are lots of people that could say the same.

How crap is that?

That the only way to ensure you have one to one support is to have an epidural?

And ironically once you've had your epidural you'd probably be alright without the support (except during second stage), if it wasn't for the additional nursing care and monitoring you then need!

lulu - I haven't read anything on this thread that convinces me that epidural has a measured negative effect on the baby.

The 'gas' part of G&A is a dissociative drug, much like ketamine. There is no doubt that it is in mother's blood during labour, getting her high. It does ?">cross the placenta, and I am surprised your reading on the subject has not revealed this. Apparently the amount that crosses placenta is 'small', but the overall effect should of course depend on how long you suck on it during labour.

Epidural drugs also cross the placenta, with amounts depending on which drug is used. Sufentanil, for example, leads to much less fetal exposure than Fentanyl and so is used commonly these days.

lulu, re "you cannot stop the epidural once it is in you , you are medicated for several hours"

Not true. These days, epidural is a drip. It can be cut off or decreased, with near-immediate effects.

horseshoe, how far along are you? is it too late to switch hospitals?

"If my independent midwife had expressed constant surprise at my slow progress during my third labour ..... 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. "

Sabire - yes, I agree with this. As I typed my comment I was thinking 'yes, how crap was it that they were so negative?'

Really the whole thing is utterly nuts. The fact that women are left to labour, for the first time, ALONE (or with partner who knows nothing about it), with no-one who has ever experienced a birth coming in to their houses to check on their progress, and then they get to hospital and are sent home again because they're not far enough on.... how did our society manage to evolve such a ridiculous way of coping with birth?

However I do think the way epis are stigmatised more than others drugs is weird. I chose it because according to research I had read it was less likely to interfere with bf than eg pethidine, yet it is seen as the most extreme option.

"No one gives a medal out for doing it alone with no pain relief and a smile on your face throughout."

I'm sorry - I just don't agree with you that there are never rewards for going without pain relief.

I've had two exceptionally long difficult labours. One with pethidine, gas and air and an epidural and one with just gas and air.

My first birth ended with a forceps delivery, large episiotomy (which became infected) and a baby who was too sleepy to feed effectively - there followed three weeks of breastfeeding hell. There is a strong likelyhood that many of the problems I experienced after this birth were linked to the pain relief I used during my labour.

My third birth (longer labour but mostly unmedicated) resolved with a spontaneous birth with no perineal damage and a baby who was alert and feeding well from the word go.

Epidurals are associated with instrumental births, perineal damage and problems breastfeeding. Pethidine is associated with problems breastfeeding. That's not to say that women shouldn't opt for pain relief - only that we should STOP saying that there are no benefits in going without pain relief. There are. The research shows that there are.

I personally felt that having a healthy, alert baby who fed well, a quicker recovery and no stitches was my 'reward' for going without pain relief.

I know how I felt after a highly medicated birth and after an unmedicated birth. I felt better after an unmedicated birth, I had fewer injuries, my baby fed better and I recovered faster.

"All that crap people spout about women used to be able to do it with nothing etc etc fails to point out the number of people who died in childbirth"

You are confusing two issues here. Women living in developed countries today who have good antenatal care and access to good obstetric care in labour do not die from lack of access to opiates and epidurals in labour!

My reward for having an epidural (which was administered promptly and properly) -- happy, alert mother, short pushing stage, no instruments, and very healthy baby with an Apgar score of 9.

Have read first and last pages, sorry.

Purely practically, I thought having an epidural would slow down labour, with one of the main reasons being the immobility attached to it, and the so called "cascade of intervention" that could follow. In the same way that permanent monitoring often slows things down.

No judgey pants here. What works for the mother.

My experience .. stalled labor before the epidural, and that was with doula support at home. Dilated from 5 cm to 10 in one hour after the epi at the hospital. No cascade of interventions.

"My reward for having an epidural (which was administered promptly and properly) -- happy, alert mother, short pushing stage, no instruments, and very healthy baby with an Apgar score of 9."

Yes - but would it be fair to say that you had a short second stage, and no instruments DESPITE having an epidural, rather than BECAUSE of it?

Or are you suggesting that having an epidural actually expedited the second stage of your labour?

No one is arguing that epidurals INEVITABLY result in instrumental births - only that they increase the likelyhood of it. Particularly for first time mums.

Again - none of this implies any sort of moral judgement on those of us who opt for an epidural - these are just the facts.

Anagram - I do wonder in cases like yours (I've come across many - transfer from home after long, hard labour.... followed by uncomplicated birth in hospital) what the outcome would have been if most of the labour had been spent in hospital.

I'm convinced I would have ended up with lots of interventions with my third if I'd gone into hospital earlier in the labour. My labour stalled at home too - got to 8cm and got stuck. Went into hospital and had straightforward birth after a bit of synto.