Midwives say women should pay for epidurals

[TheDullWitch]

At least £500 a baby it says here

I wouldn't consider myself to be an earth mother exactly, but nor do I think it's a term of abuse or scorn btw.

MI - out of interest has there been any research done on cascade of intervention after diamorphine? Many thanks for quoting the uptodate research on epidural and cascade of intervention.

Having diamorphine led to cascade of intervention for me - it stopped me dilating any further, DS became distressed, ended up with Syntocin drip to get me contracting again effectively, labour flat on back with monitoring belt, episiotomy and ventouse.

If anyone saw the Wright Stuff yesterday (pinned by nursing baby is a good excuse for watching shit TV, I find ), you'll have seen the "let's scare women by telling them birth horror stories" line that the prog took. That's not helpful, I don't think. Why not talk about how to manage pain, what your choices are and how to get the best birth you can, supported by sympathetic, empathetic, well-informed midwives?

Yes, of course giving birth hurts (and I wasn't being flippant when I said it was easier than periods for me - they were crippling, quite literally - my insides were glued together with adhesions and raw patches of endometriosis).

I don't like the snide "oh, you had an easy time of it if you didn't have pain relief" line either - no, it bloody hurt, but when I'm in labour, I don't want to be interfered with - I go "into" myself and focus on getting it over with. I've had that level of pain once a month for years, so I know how to deal with it - I had to, because there's no cure for endometriosis and the only thing that worked for me at all was surgery to remove it (which I've had to have three times).

Oh Hattie i did that with both my labours. Just at the point of 'i can't take it anymore' i asked for pethidine. The first time the wonderful midwife was waving it in my face asing, 'You don't want it really do you, lets wait till the next contraction' and the second time the midwife was a little less freindly and jovial but of the same thought, 'hang on just for a bit'

I am pleased i managed with gas and air as that's waht i'd hoped for but i will say again, i was very lucky in that both times i gave Birth in about 3-4 hours and had great midwives.
I felt every single MILIMETRE of dd2's head coming out though.

However, through all this i still agree that women should still have the CHOICE! I was more scure in trying not to have painreleif safe in the knowledge that it was there if i needed it. I may have been more panicked thinking i HAD to do it without.

Caligua on what grounds are you saying women will be treated like shit and given no pain relief?

I don't understand your comment at all, please elaborate.

Angeliz i see your point, about fear setting in if you 'know' theres no pain relief. But that wouldn't be the case, the pain relief is there if a midwife feels you need it.

fairymum - I think you misread the whole point of what I said I agreed with - The headline/quote said "Women having babies in NHS hospitals should pay for epidural injections unless there is a medical need for them..."

Who decides medical need? And what does that mean?

Hattie my point is that women are already treated like shit in many maternity wards. They go in, they are ignored, they are patronised, they are treated in a way no male patient over the age of 10 or under the age of 80 ever is, and unsurprisingly, that leads to their bodies responding accordingly - the hormones necessary to enable labour stop being produced leading to the necessity for epidurals and other interventions to begin with.

I'm not saying that that's the only reason for the necessity for medical interventions - that would obviously be mad - but I do believe that in many cases, intervention has to occur because of the way women are treated in labour in the first place.

And it makes me livid that instead of dealing with the way women are treated and focussing on that, the RCM has decided to focus on the results of that treatment as if the treatment itself doesn't have a contributory effect.

Isn't it ridiculous - one day thaty are ranting about no money to pay pensions and having a labour shortage due to fall in births and the next day we are all having to pay for pain relief putting anyone off having babies - they couldn't do it surely - and this woman should be hunted down and a huge great melon stuffed up her arse and made to shit it out over and over again hoping it causes her terrible agony!!

joash how would you define medical need for pain relief?

Agree totally, Caligula (again!).

WTF is this that if you don't get an epidural you're being treated like shit???? Our delivery unit doesn't offer them unless there is an extreme need, but thousands of women locally have gone on to have good deliveries, using other pain relief, good management and one-to-one care. Woemn actually travel to our hospital to have their babies, so it can be done without an epidural you know.

I'm still trying to figure out where all these hospitals are that just have anaesthetists always to hand to give people epidurals. Everyone I know had to wait hours and hours or didn't get one at all b/c of lack of anaesthetists.

agree expat. at our local hospital you were very likely to have to wait hours for an epidural, or not get one at all.

Exactly. Our hospital's rationale was that if there was a medical emergency, then the anaesthetists had to be on hand for that - and rightly so.

Paososgirl if you read my post properly you'll find I didn't say that if you're not given an epidural you are being treated like shit.

To clarify, my point is that women are routinely treated like shit when they enter a labour ward.

This is not to say that every single woman in every single hospital is treated like shit every time she is in labour.

Hope I have been clear enough there!

OK Caligua, although that is not my experience, neither is it the experience of many others. I am thinking along the lines of epidural as an intervention that needs to stop being used so freely.

So i'm agreeing with you on one hand and not on the other!

not being a medical 'expert' - it's not my job, nor within my capabilities to define medical need for pain relief. Can't understand why someone would want an epidural unless it was absolutely necessary anyway, they have so much potential for causing or exasserbating problems (can't spell).

Caligual, I'm sorry you're of the opinion that women are routinely treated like shit when they enter the labour ward. You're right that not every single woman is treated in that way - and I think it's a sweeping generalistion to make that does no credit to the fantastic midwifery services that are working right now, and which do not routinely treat women like shit.

But surely the point about pain is that it's always subjective, ie the only person who knows how much pain they are going through is the woman herself? It's not about medical expertise.
That's why I'm so horrified by this idea of only giving epidurals for free where they are 'medically indicated' - who defines that? So many of us have experiences of not being listened to or believed when we said how much pain we were in.
If by 'medically indicated' they mean only in the certain situations (eg after induction, back-to-back presentation) where they know it's likely to be bad, then that's all very well, but what about the women who are having a similar level of pain from a normal birth?
Personally I am astonished that the RCM seems to be implying that the medical profession, not the mothers, are the best people to judge what pain relief they need - what a f-- cheek!

Agree with Caligula. Where do you draw the line between women who should pay and women who shouldn't? Also - if an epidural doesn't work, are you still liable to pay? I had two - neither of which worked - would they still send me a bill for £1000? Would we start to see women pretending they were still in pain in order to avoid paying the fees??

I think this whole idea is daft - a reactionary simplistic solution to an extremely complex issue. The focus should be on improving conditions for women in labour, and empowering them so that they feel in control of their labour - then maybe many women wouldn't feel that they need an epidural to get through it. That is not to say I disapprove of women who make a well-informed decision to have an epidural - the choice should be there - but IME those women are few and far between. All the women I know who have had an epidural have done it because they have felt distressed and unable to cope. If they were labouring in a more supportive environment, maybe they would not have felt that way and had a more positive birth experience as a result.

Paolosgirl - you obviously attended an excellent hospital, which just goes to show that a supportive environment can reduce the need for epidurals. Unfortunately many maternity units do treat women appallingly badly, including the one I attended, so I completely understand where Caligula is coming from.

I have heard a lot about how some women are treated during labour, etc and yet in the 25 years since I had my first daughter I have never actually met anyone who has been treated like shit in a labour ward. Every woman I know personally, or have worked with, etc have all had nothing but praise for the midwives. I personally have had three children in three different hospitals and all were brilliant. I was never treated with anything less that respect by a number of midwives and doctors who were all wonderful.

Current NICE guidelines say that epidurals do not make a C-section any more likely. They do make ventouse/forceps a bit more likely, but only by a very small percentage (can't remember how much but less than 5% I think).

Paolosgirl, I'm sorry you're sorry about my opinion, but what I'm sorry about, is that masses of women are treated appallingly in labour in this country. Fantastic midwives who don't treat women like shit don't need to feel that my comments apply to them do they?

joash maybe you live in an area where the midwifery services are brilliant.

I've had 2 different experiences in maternity wards, one abysmal, one brilliant.