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.

sabire - you are absolutely correct that anything which inhibits the pattern of hormone release during labour is interfering with the natural process. That's not 'having an issue' with epidurals, or being judgemental, it's a fact.

Something else I wanted to add - maybe someone here can help with this - I wonder if there is such a thing as a study which compare outcomes for low risk mums who opt for elective epidurals compared to low risk mums getting one to one continuous care from a known midwife?

All the research I've seen so far (most of which concludes that epidurals are not linked with higher rates of emergency c-section) compares mums who've had epidurals in labour with mums who haven't. Now given that many women in the epidural arm of the study will have had epidurals because of labour dystocia..... and many women in the 'no epidural' arm will not have had one to one care in labour (which is thought to reduce c-section rates) - well surely these things sway the outcomes of the research in favour of epidurals not being linked to operative birth?

I've also been thinking about all the continuous support in labour issue and how it affects rates of instrumental birth. The research on support in labour that I've seen shows a reduced risk of instrumental birth for women who have one to one care throughout labour. But the only women in consultant led units who can guarantee that they'll have get this at the moment are those women who've had epidurals..... So are we comparing rates of instrumental births between women who've had epidurals who are currently getting one to one care with women who haven't had epidurals who are often not getting continuous one to one care... and yet still the rate of instrumental births associated with epidural use is higher? Again - I wonder what would happen if we compared rates of instrumental births with two groups of women (one epidural, one non-epidural) who were equally well supported throughout labour.....

"women have the greatest chance of a positive experience where they are well supported and empowered to believe in their body. "

You see, this is the kind of thing that gets my goat a bit. No matter how positive I was thinking, no matter how well supported and empowered I was, nothing could change the fact that the cord was wrapped around my baby's neck twice and because of that I couldn't push him out.

Why does it 'get your goat' that good support is a positive thing??!!
When I had my dd2, no amount of positive thought stopped her having IUGR and needing to be delivered by csection to save her life. So I had an epidural and a csection. No one is saying that exceptional circumstances never happen! But most births are straightforward. My dcs 1 and 3 were vaginal births (unfortunately as dc3 was a VBAC I was not allowed to deliver in a midwife unit and had to go to hospital) but I still delivered them both naturally. Why wouldn't I?
I really don't get these negative responses to mums who have had natural births!!

just a note to all you expecting your first.

you may not think so, especially after reading this thread, but instrumental birth and csection are NOT the end of the world.

when you and your baby come out healthy and alive, the fact that you had an instrumental birth or csection is just a blip on the radar.

i would have probably died without my epidural and instrumental delivery with DD1. she would have likely been brain damaged or worse.

her positioning was anything but optimal.

I totally agree with Expat.
DS1 was delivered by ventouse, I had a spinal as it was almost a C-section. I couldn't have cared a jot at that point.
A healthy baby and mother is the most important outcome.

Epidurals, c-sections and all those other interventions certainly have their place. If one has an epidural, it is 50% more likely that other interventions will be required.

But I think it's when a woman is not fully informed about these procedures that postnatal issues can happen. By issues, I mean regret and depression. It can be connected to a sense of no control or understanding of what is going on.

But every woman, every labour and every birth is different.

Of course csection and instrumental delivery are not the end of the world. Of course saving a baby's life is the most important factor. But many women who end up with epidurals and instrumental deliveries have had the potential to deliver naturally; even a baby in an awkward position can be delivered by a good midwife who knows how to support the mother. My experience of giving birth naturally in a large hospital (dc3, VBAC) is that the doctors and midwives were rushed off their feet and were all too ready to intervene. In contrast, during my first labour, the midwife let me labour at my own pace. I think many first time mothers don't have enough confidence in their own body that they can go through labour without all sorts of interventions. That was certainly what i witnessed when I had my babies. Which I think is a shame as a natural birth is IME very different from a medicalised one - even if the outcome is the same.

Of course csection and instrumental delivery are not the end of the world. Of course saving a baby's life is the most important factor. But many women who end up with epidurals and instrumental deliveries have had the potential to deliver naturally; even a baby in an awkward position can be delivered by a good midwife who knows how to support the mother. My experience of giving birth naturally in a large hospital (dc3, VBAC) is that the doctors and midwives were rushed off their feet and were all too ready to intervene. In contrast, during my first labour, the midwife let me labour at my own pace. I think many first time mothers don't have enough confidence in their own body that they can go through labour without all sorts of interventions. That was certainly what i witnessed when I had my babies. Which I think is a shame as a natural birth is IME very different from a medicalised one - even if the outcome is the same.

Research shows that the more +ve you are going into labour, the more likely you are to have a +ve experience i.e. a non intervention birth. Will find link.. . . . .

I never said that having good support was a bad thing. Of course not.

I said it annoys me when people assume that 'being positive' about your labour makes it more likely that you'll have a non-intervention outcome.

If you weren't saying this, alfiesbabe, then I apologise for having misread you.

However, ItsGrimUpNorth has now said exactly that, so I reiterate: where is the evidence that says 'being positive' means you are less likely to have a problem in birth which makes intervention necessary? Again, how does 'being positive' increase your chances of a non-intervention birth? Do you unwrap the cord from around your unborn child's neck by sending positive vibes?

There is so much "I wasn't allowed to.." and "if only I had been allowed to..." in this thread. Who has the power and is really making the decisions?

Surely a well informed woman (here, even a not-so-well informed one) can choose to birth how and where she likes?

It's very typical of people to defer to the medical profession. There have been a few threads on MN for example, where a pg woman has asked if she has to have a sweep after a midwife has suggested one.

Doesn't that suggest we don't feel we can make decisions and tend to automatically defer to others?

Krang, nobody is suggesting that positive vibes can unwrap a cord from around a baby's neck. That and other circumstances require urgent intervention by medical staff.

"when you and your baby come out healthy and alive, the fact that you had an instrumental birth or csection is just a blip on the radar."

A 'blip' on your radar perhaps - but you can't speak for other people. I have met women who are hugely grateful for the safe birth of their child by emergency c-section, but who are still devastated by the experience of operative birth. It affects everyone differently.

I came away from my first birth thinking very much like you - that my baby could not have been safely born without forceps, and that my huge episiotomy, subsequent pelvic floor problems, postnatal infection, and the difficulties I experienced breastfeeding were a price worth paying for my beautiful daughter. I went around saying 'in the past women like me would have died' - convinced that the doctors had saved me and my baby.

Later on I found out what actually constituted good midwifery care and it really sank in just how appallingly badly my labour had been managed. And I started to think about how those first precious few weeks with my daughter might have been different had I been helped to avoid what I strongly suspect now was an unnecessary instrumental birth.

Sabire your experience is so familiar. So many women say the same thing. You're very very right about the difference that good midwifery care can make. COntinuity of care is so important, no matter what choices you make.

Sabire - "At the moment the majority of women in the UK feel they can cope with the pain of labour without an epidural, and the majority who don't have an epidural are happy with their decision."

Erm can you please link to the study which showed this seeing as you are so keen for other people not to talk for other people.

I think the problem with this subject is that everyones judgement is clouded by their experience or even non-experience I have yet to give birth but the fact my first choice of pain relief mobile epidural nd my second water birth will only be allowed IF the one birthing pool is free and IF their are 2 midwives are available make me even more nervous about what is going to happen.

All I know is I'm with expat as long as I'm alive and the baby is alive at the end of the labour then I will be happy. The women who has devastated by the experience of operative birth would they have preferred to be left to get on with it?

Sorry that didn't make sense. my first choice of pain relief isn't offered in my hospital (i mean why would a method of relief that allows a women to retain control and yet block pain be available!)

Sabire, my labour was VERY well managed with DD1.

I had one midwife with me from 6AM till she was delivered at 4.05PM.

And though I suffered after the delivery - infection, severe PND, etc. the fact still remains that she was OP and had her hand up by her head and the best thing for me and her was the delivery we had, but a superior consultant who did an outstanding job.

Similarly, you can't speak for other people and what their experience would have been like if they didn't have their csection or instrumental delivery or whatever pain relief they chose.

I had great support. One on one support.

I was fully dilated and she was not turning from OP and her hand way up.

I am glad I had a forceps delivery. I don't want to know what might have happened had I kept on pushing and pushing to get her out, because it wouldn't have been good for either me or her.

"All I know is I'm with expat as long as I'm alive and the baby is alive at the end of the labour then I will be happy. The women who has devastated by the experience of operative birth would they have preferred to be left to get on with it?"

I personally don't think birth experience should be underestimated. In the anecdotal experience I have of friends/relatives a half decent birth experience (whatever that is!) makes a huge difference to the first few months.

I don't think the poster who was devastated at having a CS was suggesting that her or her baby was put at risk to avoid a CS. But I know a few MWs and it isn't uncommon for intervention to be done because of 'policy' rather than because of need. I narrowly avoided being prepped for theatre and an assisted delivery with DS. There was nothing wrong with him or me. Just policy on how long I was 'allowed' to push for. I'm sure there are horror stories both ways but I have 2 friend who had CS due to failure to progress. Neither, having been back over their birth notes in later pregnancies, had any risk to them or their child if they had 'hung on'. One wanted to hold out but was told she'd have to go home to do it. The other was glad of the offer of a CS.

It would also make a huge difference to the first few months if the mother or child didn't make it.
1.5 women per 100 is not a small number.

1.5 women per 100? Sorry, haven't read all the posts so I have no idea what that figure refers to.

I agree that it's not worth any risk for the sake of experience. But I do think that good MW care can make a better experience for many. And quite often that would be to avoid intervention.

Sorry - just found the post you refer to. 1.5% will also presumably cover antenatal care too. So that includes women with high risk complications antenatally before they even get to labour. Of course there are always valid, good reasons to have an assisted delivery or CS - thank goodness we have those options available to us. But there are also not so good reasons like hospital policy.

Birth is ultimately a natural process and mothers and babies are put at risk when assisted deliveries and CSs are unecessary. It goes both ways.

My DD was back to back, home labouring for days left me weary and fed up with any idea of my home birth happening, so I went in and had an epidural from 3cm. Got to lie down on the lovely bed and rest through the night, not exactly sleep but properly REST so I was ready to push her out in the morning. I had some pain in my kidney/waist region but it wasn't as bad as pain with no epidural.

My advice: have one (I am hoping to have one this time too)

Lie on your side to push out your baby, get them to hold your leg in the air - the comedy helps!

I could feel when to push only very faintly - the contractions were feeling more like painless Braxton Hicks I guess, just a tightening.... but I could generally feel each one coming, just before the MW who was checking the monitor leaned over to tell me to push again. I suppose I could have stopped asking for top-ups of the pain-relief near the end but was really happy to push "blind". Make sure you listen to exactly what they say when they tell you to only gently push/stop/push/stop at the end, so you don't tear.

"Similarly, you can't speak for other people and what their experience would have been like if they didn't have their csection or instrumental delivery or whatever pain relief they chose"

It was you who said "when you and your baby come out healthy and alive, the fact that you had an instrumental birth or csection is just a blip on the radar". I was making the point that NOT all women who've had operative births feel that way. Some are very upset about it, even though most feel that their c-sections were inevitable. I know this because as a user representative on an MSLC I talk to women all the time about their birth experiences. And there's pretty good evidence that some c-sections are avoidable, as are some instrumental births - not in individual cases - it's impossible to identify which ones are avoidable in individual cases, but overall we know that intervention rates are higher than they need to be.

"It would also make a huge difference to the first few months if the mother or child didn't make it."

Sorry - but this is SUCH a silly point. Nobody is suggesting that ALL interventions should be or can be avoided! The point that's being made as far as I can see is that many women experience UNNECESSARY interventions. There's nothing controversial about this. Every midwifery journal you pick up is full of articles on this issue - the majority of midwives AND consultants feel that the current c-section rate could safely be reduced if changes were made to the way women are cared for during labour.

"The women who has devastated by the experience of operative birth would they have preferred to be left to get on with it?"

I recently spoke to a young mum who'd planned a homebirth who ended up with a c-section under GA, following a failed epidural, which left her with a dural tap. She understood there was no other way to deliver her baby, but she was distraught about the birth - the first few weeks of her daughters life were hell for her. She has stopped bf earlier than she would have done because of health difficulties related to her operative birth. Perhaps when she was telling me about the problems she was having I should have just said 'well, would you have preferred to be left to get on with it?" It would have undoubtedly made her feel SO much better about her experience.

As for references to the research I mentioned - I will dig it out. It was from a recent study into UK maternity services. I have a paper copy somewhere - not sure if it's available online.

eventually, sabire, most people move on from that trauma and even go on to have other children.

but you just keep on beating that drum!

i'm off to write EPIDURAL one more time on my notes.