why are people so against epidurals

[porcamiseria]

I am just curious, as the general vibe here (MN) and with the NCT and some midwifes is they are a bad thing.

I had one as was induced and literally could not cope with pain. I wont go into the whole story but its the usual ventouse, stitches etc. But baby was healthy and fine

My point is for me the epi was a godsend and the intense pains were not bearable.

If it happens again, I will have an epi if I can't cope. am due August, so its pertinent for me

It upsets me rather this attitude that they are to be avoided, as if you DO have one some people might feel like a failure?

I had an epidural after being induced, it was awful for me (not saying it is for everyone, just me) I only felt numb on one side and as a consequence got into a difficult position which I felt damaged my back with a very prolonged labour.

The next pregnancy I opted for a home birth and hypnobirthing as I feel that it was largely anxiety that led to needing an epidural (I was in agony, and the midwife told me not to push - as if you can help it!) After a lot of reading I think that if I'd had a midwife with me during my labour she might have noticed I was actually in transition. So for me having an epidural lead to a really long labour and vontouse. At home I was more relaxed, I felt better informed about my labour and I had a midwife with me! No drugs and happy mum and baby...I know not everyone is lucky enough to have this but for me it was fab.

Good luck with your next labour, you know what you're doing so you can relax (easier said than done I know :)

Lots of people have said epidurals cause more interventions but with modern epidurals there is no conclusive evidence for this at all.

Women in more pain ask for epidurals more often and more severe pain is linked to more obstetric problems which lead to caesareans and instrumental deliveries. That does not mean epidurals cause the problems.

There was a Swedish study of 97,000 women which showed no link to the level of epidurals and interventions.

France has a sixty five percent plus epidural rate - ove twices ours - and lower instrumental delivery rate.

In other words, women with complications ask for more epidurals and have more instrumental deliveries - but they might well have ended up with the same outcome regardless of whether they had an epidural or not.

The 'cascade of intervention' is way way overplayed.

In one large London teaching hospital which shall remain nameless, epidural rates for first time mums is over 70%. The MAJORITY of these mums will have an assisted delivery. I think that statistic speaks for itself.

Re: 'cascade of intervention':

You have an epidural so

• You have a drip

• you are catheterised
• you have continuous fetal monitoring, perhaps fetal scalp monitoring
• you are highly likely to have a supine birth
• you are highly likely to have an episiotomy.

Would you not class any of these as 'interventions'? I would.

BTW - you can't talk sensibly about epidurals without acknowledging that outcome for first time mums with an epidural are VERY different to the outcomes for second time mums

Not that I'm against them though. Bloody useful, and have had one myself!

Meant to add - there are so many things which can impact on intervention rates. BMI being one very, very major one. We're the fattest nation in Europe. You can pack about 3 french women into one trouser leg of your average UK mum.

I don't think a drip, catheter or CFM constitute "intervention". I always thought intervention referred to ventouse, forceps and CS. Not sure about episiotomy. And Ushy is right, curren research and meta analysis show that there is no causal link between epidurals and intervention.

not read all thread but i had an epidural with first child (26 hour labour) and drug-free with second (4 hour labour). Personally i thought the epidural was fab! I went from being in total agony to watching TV, eating cake and pushing out baby with DH chilling on a bean bag! Lovely experience which i would highly recommend.

I understand peoples concerns but i had no problems and was home 24 hours later. I asked for one with my 2nd child but they were short staffed so wouldnt give me one. In the end the birth was better without it but thats because it was so much shorter and less painful. I'd definitely have one next time, no hesitation. Not sure why anyone would suffer if they didn't have to?

Spudulika you are right to say that a lot of women in uk with epidurals give birth on their backs and have continuous fetal monitoring but both of these practices lead to increased instrumental deliveries. This is believed to be the possible reason why epidurals in the uk are linked to instrumental deliveries and not in other countries. There is no reason to give birth on your back if you have an epidural - there is a research study going on into this called the BUMPS trial.

Also, most hospitals have around 9-13% instrumental delivery rate. I would have thought any hospital with instrumental rates above 36% would have rung alarm bells at the Care Quality Commission. Which hospital are you referring to? (This is public information so there are no legal issues about naming the hospital).

Epidurals are a godsend, women who look down their nose at them are women who were in labour for a couple of hours. The way i see it is there are no medals for how you gave birth, the only prize is the healthy baby at the end of it. I've told my partner this time my only birth plan is to get through labour with as little pain as possible and preferably with me and baby in one piece.

Ushy - primips are in a minority so the overall instrumental rates are not 35%. Seriously though - look at Birthchoiceuk - fascinating how hospitals serving similar populations can have VASTLY different c/s, induction and assisted birth rates.

Re mobility in labour - it can be a huge challenge getting a mum to SAFELY ambulate if she's had an epidural up for a while. Which is why most mums end up on their backs. CEFM and catheterisation don't help much either.

Every epidural thread says an epidural = catheterisation. I have had four epidurals at three different hospitals. Never had a catheter in my life. Would just like to reassure any first-timers that it's not a given!

All women at our local hospital are catheterised with an epi. But I imagine not always with patient controlled epi.

Stupid - there are lots of people who cope well with pain - even in a long labour. Also a good few who'd rather put up with it if it means they can give birth at home or in a MLU.

A lot of people find the idea of augmentation, drips and spending their labour on the bed being monitored (or with a scalp electrode stuck in their ba y's head) completely horrible and alien. Just as there are some women who are quite happy with all these things and intact welcome it because it makes them feel safe. Each to their own.

Coffeeaddict thanks for re-assurance. My doula (who is an ex-midwife) told me I would definitely have a catheter if I opted for epidural, but when I checked this out with my midwife, she said I'd have it only if I needed one.

(she's actually quite lovely - she knows I'd like to have an epidural so she's taken me on a private tour of the hospital, showed me how the beds work and all the positions I can be using with a mobile epi including possibly using a birth stool, and given me tips on how to avoid things like catheters, being able to ask to remove the continuous fetal monitoring machine if all is well for 45 mins or so etc.. all the things they don't tell you about in NCT)

Spudulika I wonder if you're referring to St. Thomas'? I'm due to give birth there any day now.

I am a first time mother and planning to have an epidural for reasons I mentioned in earlier post (far too many positive birth stories in my own family using an epidural). I have an uncomplicated pregnancy, and a high pain threshold, and I just can't understand why oh why I would put myself through unnecessary pain.

I don't see what is wrong with having a continuous drip or continuous fetal monitoring?? Is this a comfort issue? Realise it restricts mobility. But my aim is for a calm and happy birth resulting in a healthy baby so unless it directly and negatively affects those aims....

Anyway maybe I'll be eating my words in a few weeks time. I will let you know. But in the meantime, Epidural it is. :)

"I wonder if you're referring to St. Thomas'? I'm due to give birth there any day now."

Isn't that funny - I was thinking of tommies! I've spoken to several people who've had epidurals there where they've been left with enough sensation to change position - get on all fours to push etc.

"I don't see what is wrong with having a continuous drip or continuous fetal monitoring??~"

People who don't want a ctg generally feel that way because they don't want to have their mobility hampered in labour. It can be very difficult to move normally with a ctg on - the pads slip and lose the trace. For women without an epidural this can feel like torture as being upright and mobile is the main thing that makes most labours bearable.

As far as CTG goes - if you're labouring without an epidural it's not recommended (according to NICE) because it results in a higher c/s rate, without improving fetal outcomes. That's because it picks up so many false positives.

Different situation with an epidural, because of the frequent use of syntocinon to augment the labour, which can result in stronger contractions (which of course you can't feel, but your baby can). When you start to disrupt the normal process of labour - which is what you're doing with an epidural, a mum needs really good one to one care and lots of monitoring to keep it a safe birth.

Some women will be offered internal monitoring by the way, if there are problems getting a decent trace with external monitoring. This is when they clip one of these to your baby's head: <a class="break-all" href="http://www.google.co.uk/imgres?imgurl=www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/9324.jpg&imgrefurl=www.nlm.nih.gov/medlineplus/ency/imagepages/9324.htm&usg=__bCQT3qSgLRK6hAyftNuNjndvl_Y=&h=320&w=400&sz=16&hl=en&start=0&zoom=1&tbnid=9nx3wcLlY_MhqM:&tbnh=137&tbnw=171&ei=M8X9TeW1O9Ddsgac4cDwDQ&prev=/search%3Fq%3Dfetal%2Bscalp%2Belectrode%26hl%3Den%26biw%3D1280%26bih%3D871%26gbv%3D2%26tbm%3Disch&itbs=1&iact=hc&vpx=128&vpy=83&dur=195&hovh=201&hovw=251&tx=120&ty=139&page=1&ndsp=30&ved=1t:429,r:0,s:0&biw=1280&bih=871" rel="nofollow" target="_blank">here . It attaches by means of a thin wire which punctures your baby's scalp.

"But my aim is for a calm and happy birth resulting in a healthy baby so unless it directly and negatively affects those aims...."

Yes - birth with an epidural is usually fairly calm and lovely. But whatever USHY says about research on the continent, the research used as a basis for NHS guidelines here shows an high level of association between the use of epidurals in first time mums, and assisted deliveries. Also higher levels of assisted birth among women giving birth in obstetric led, rather than midwife led units, or at home. The rates will vary though from hospital to hospital and midwife to midwife. Some midwives are very skilled at delivering babies when the mum has had an epidural, and have much lower rates of ventouse and forceps than others.

If your baby is born by ventouse or forceps they may have bruising and swelling to their head or face. They may be more likely to experience jaundice in the first week of life. None of these things have implications in the medium or long term, but it's not nice to feel that your baby has been damaged in any way by your birth. I speak as someone who had a forceps delivery whose first baby looked a bit like this when she was born: <a class="break-all" href="http://www.google.co.uk/imgres?imgurl=www.i-am-pregnant.com/images/assisteddelivery2.jpg&imgrefurl=www.i-am-pregnant.com/encyclopedia/Birth/Assisted-Delivery&usg=__4Zabociw7vP9cRAuV6JvW5FHXQs=&h=330&w=417&sz=20&hl=en&start=121&zoom=1&tbnid=yjAXViwOAjfyXM:&tbnh=153&tbnw=217&ei=nMn9TczbDYjFswbW0YDwDQ&prev=/search%3Fq%3Dforceps%2Bbruising%26um%3D1%26hl%3Den%26biw%3D1264%26bih%3D855%26tbm%3Disch&um=1&itbs=1&iact=rc&dur=356&page=6&ndsp=20&ved=1t:429,r:16,s:121&tx=99&ty=50&biw=1264&bih=855" rel="nofollow" target="_blank">here

You're also more likely to have an episiotomy with an epi than you are without, which is associated with more painful sex than a perineal tear of the same degree.

As for which information you can trust about the pros and cons of epidurals - I personally think you'd be more sensible to give weight to NHS patient information, which has been written and reviewed by UK doctors and midwives, than listen to someone on the mumsnet who is getting her information from googling individual studies from various non-uk sources and who clearly has an agenda.

nhschoices

Would point out - that when it says there's a 'slight' increase in the rate of assisted deliveries - you need to separate out first time mums from second time mums. Second time mums have much, much lower rates of assisted birth with an epidural than first time mums. So overall it's slight, but for first time mums it's not.

I'm not trying to put you off having an epi by the way - I think they can give you a happy birth and it's good if knowing you can have one makes you feel more relaxed about your labour. But you need to be straight about the fact that it's an invasive medical procedure which disrupts a normal physiological process. As such it will have benefits and risks - some rare, but serious.