What gives a midwife the right to say

[finallypregnant]

You are doing fine without an Epidural?

I don't mean that in a horrible way but it appears that my hospital are not really that responsive when you ask for an epidural.

When my time comes, I'd rather not have one but I have read threads on here where the girls have been turned down an epidural because the midwife says they are doing fine!

Surely, it is not the midwife who makes that call but the mum screaming in agony when TENS, G&S and Pethidine are not working?

Obviously if you are at 8-9 cm and they say it is too late then fair enough.

mine was a dream 2 years ago

just small area of numbness
walked straight after
no catheter

a dreeeeeeeeeeeaaaaaammmmm

am v surprised

maybe everyone lies to me! even my boss who gave birth 18 and 15 yrs ago could move about...albeit with difficulty (@ the homerton which i know is much better these days)

Message withdrawn

and i pushed baby out
i could feel to push ( odd not nice!) it was all over less than 3 hours

Having been told the reverse twice now - that I cannot cope with the pain (turns out my body doesn't look like it is doing much, then it all happens at once), I would say, they don't know anything, but are probably trying to encourage etc. F*ck knows what they were trying to do with me though

I do agree with pruners.

I respond brilliantly to the "you're doing so well" flannel

I remember my bay having a laugh at a woman in the opposite bay who was screaming (and I do mean screaming, she was probably hoarse) "GET ME THE PETHIDINE NOW!!!!" We then heard a MW say "But you're only 2cm"!

My trainer was saying that she has been to women who have said that BFing (just to use an example) was excruciating. She asked them to put baby on so she could observe the feed. After a few minutes of having a chat with her while she was feeding her baby, my trainer said "how's that?" "Terrible, it's excruciatingly agony".

Pain is often relative and a trainer outside observer can often tell how you are doing when you think it's really bad, they can see that actually it's not as bad as you think.

I remember apologising (???) to my OH after Lily-Hope was born and saying I'd do it better next time (lol not sure what I was thinking about) and he said that you would have thought I'd stubbed my toe, I hadn't made as much noise as I thought, I'd gone "Ow ow ow" through contractions. In my mind I'd been a mess, noisy, angry, aggressive, making a fuss but to the people outside I hadn't been like that. Lily-Hope was actually born whilst the MWs were out the room because they hadn't thought I was that close, it took awhile on the Call Button (OH couldn't suss out the "Emergency Pull" part of the button) to come back because they thought it would be to say I needed pain relief not that she had been born.

Bundle, there are two types of epidural you know? One is supposed to be mobile, one takes everything away. The mobile one doesn't usually leave people with the ability to walk around with it. They give you limited ability to move around and allow you to control your bladder, which a traditional epidural doesn't.

Tinkerbellesmum and Bundle -

The low dose mobile epidural is just that, it is a diluted dose of local anaesthtic and fentanyl which blocks pain (and temperature) pathways but leaves motor functions intact, which means that you can indeed get up and walk around, and in the unit where I work, its not unusual to see women walking about the room and the corridors with an epidural. In reality, after 5-6 top ups (or 5-6 hours) the legs start to get a bit too numb to keep walking and most people take to the bed.

The full strength epidural takes away most motor function and therefore you cant get out of the bed.

In answer to the OPs question / comment, I agree that its cruel not to give someone an epidural, esp if they are being induced or have an OP baby. If someones getting close and I think they would make it without an epidural, I would certainly encourage them to do without, but if they insist, then no problem, they can have one.

has anyone ever turned to a midwife in when they feel that they are being callously denied and epidural, or overhear them telling others that you don't need one to bellow: get me a fucking epidural you don't have a fucking clue how I am feeling (and don't fucking talk about me behind my back). Because I certainly think I would!

yeah, the mw refused me one even though it was my second birth, I was 5 cm dilated and I was begging for one.

She initially refused me G & A as well.

She said I was 'being brave' and 'doing really well' and 'why did I feel the need for pain relief?'!!??

My first birth was much much better, with pethidine and an epidural, though I couldn't move about.

Am changing hospitals for my third birth.

the hospital i gave birth in didn't offer an epidural service, only spinals for emergencies. i took the risk that wouldn't need one but next time i'll definitely go somewhere where they are available. had to have spinal and hated the immobility afterwards.

Pruners, I enquired about mobile epidurals when I was pg, and was told that my hospital didn't offer them for health and safety reasons - they said they were worried about potential accidents (if you tried to walk while the epidural was too strong I think?)

Re epidurals and instrumental deliveries - yes there is a higher incidence of instrumental deliveries with epidurals - but it is not necessarily causative.

Consider this - it is often those women with difficult labours who are offered and generally the epidural (i.e. basically they would have needed an instrumental delivery even if they had declined the epidural)

My first labour was like - after 24 hours of back to back and little progress I was given an epidural. Frankly my baby was going to be delivered with forceps and ventouse irrespective of the modality of pain relief

I've also previously read academic papers which make the same point (but forgive me if I don't do a literature search to find the references now, really must go to Post Office!)

How long does it take to get an epidural set up (from the time the mw goes 'OK, let's get you an epi then'), and then for the pain relief to kick in?

I think I read somewhere it could be a couple hours so I guess if the midwife thinks you'll finish birth by then there's no point?

Haven't had my first baby yet - all I know is the midwife-led unit at my hospital can't do them but when I asked if it was easy to be transferred downstairs for one if I changed my mind the midwife said "Of course, no problem". They don't do mobile epis, though.

So far I don't want an epi as I'm scared of my spine being injected and don't want a catheter (I'll have enough traumatised orifices as it is...), but I reserve the right to change my mind!

They don't want you to have an epidural because there aren't enough staff. Midwives are often looking after 3 women at different stages of labour - once you have an epidural in place you need (or at least should have) a midwife with you most/all of the time. It is just a matter of resources.

The time to pain relief depends entirely on how quickly they can get you an anaesthetist - getting the epidural in is really quick as is the pain relief itself.

My SIL had two unmedicated labours & absolutely refused to do it a third time. The midwives of course were obstructive, luckily my brother is well informed, not intimidated by HCP & she was labouring during the day so he could get a doctor to come in. She had one & it was her best birth but she still feels very angry abut the way she was treated (like a lazy, naughty little girl who should just shut up & do what she's told).

When I say 'best birth' I mean in terms of intervention, with the previous unmedicateds she needed ventousse, had large tears & a very serious (requiring transfusion) PPH with her second delivery. She had a really rough time & the only way she'd consider another pregnancy was because she was promised an epidural as soon as she came into hospital. I'm furious about they way she was treated & it ensured that she wouldn't have any more children.

"Consider this - it is often those women with difficult labours who are offered and generally the epidural (i.e. basically they would have needed an instrumental delivery even if they had declined the epidural)"

I would love to see some research which compares outcomes for women who've had elective epidurals (ie - low risk women who have decided prior to labour to opt for an epidural), with low risk women who opt to try to labour without an epidural and who are offered one to one support in labour and the option of an active birth instead.

Personally I'd eat my hat if the rates of instrumental births weren't higher in the elective epidural group. It's just basic physiology: epidurals turn your pelvic floor to mush. This means your baby is less likely to rotate effectively into a position which will expedite birth, and also that it's harder for malpresentations like OP to be corrected in labour.

I've just been looking at an Australian population based study on interventions in labour. (data from 363000 births)

The figures for low risk primips were:
No epidural, no induction: 11.8% ventouse/forceps (1.7% c-section)
No epidural, induction, 17.9% ventouse/forceps (3.4% c-section)
Epidural, no induction, 36.7% ventouse/forceps (31% c-section)
Epidural, induction, 36.7% ventouse/forceps (33.51% c-section)

Striking I think.

Back to the issue of causation (below, from the same article)

"The one prospective randomised control trial which was 'uncontaminated' by high rates of crossover from the experimental to control groups and vice versa, found the relative risk amongst primiparous women of having a caesarean section following an epidural during labour was 11.4 times greater. That trial was stopped on the grounds that it was unethical to continue to randomise because of the statistically significantly increased rates of c-section amongst those with epidural pain relief"

RE: the OP, my personal feelings are that it's completely unethical for a midwife to deny a mum access to epidural anaesthesia in labour, once she has established that the mum is able to make an informed choice. I understand why midwives do it, but it's WRONG.

Bundle - I'm a m/w and I've never seen a woman be able to walk about with an epidural yet. And we apparantly have the "low dose" ones . I'm sure it does happen in other hosptials that must use some type of different drug bit its not available in every hospital.

If a woman I'm looking after asks for an epidural then I will get one sorted for her unless;

she's not in established labour
she's in transition
there ward is too full and there aren't enough m/w to cope with the one-to-one care needed (shit reason I know but I just work there)!
Very occassionally a woman will ask for one but in a half hearted manner and instead of immediatly saying yes I will try to encourage her to carry on without one. If she persists I will sort one out for her as I totally agree that its not me feeling the pain.

I think you are missing the point entirely Sabire. I am not disputing that there are higher rates of intervention associated with epidural, I am disputing that it is causative.

Women with complicated, not progressing well, difficult labours are more likely to be offered and accept epidurals. They would have likely required intervention anyway, even if they had gamely turned the epidural down....It wasn't their epidural that led to the intervention, it was there atypical labour....

Whereas women who are progressing well through labour with a well positioned baby (like myself with ds) would not want or desire an epidural and will doubtless go on to a straightforward delivery.

It's rather simplistic to conclude that epidurals are the cause of labours with interventions. It's not a level playing field

(I don't know how to explain this any other way, does everybody else follow?)

I do wonder about elective epidurals though - will concede that I have grave doubts about that (although should be taken on individual case by case basis)

And I should have put "disputing that it is always causative" (since the scenario I am talking about is more epidurals that take place after prolonged established labour that is not progressing)

Sorry about grammar and english in last post