Live webchat with David Bogod, president-elect of the Obstetric Anaesthetists Association, Thurs 3 March, 8-9pm

[GeraldineMumsnet]

Following the discussion about epidurals on this thread, David Bogod got in touch because he'd read the thread after seeing it mentioned in the Sunday Times. We're very pleased to welcome him to Mumsnet for a webchat.

David is consultant obstetric anaesthetist at City Hospital, Nottingham, where he's worked for 21 years and carried out more than 2,000 epidural procedures. His unit has around 5,700 deliveries a year, with an epidural rate of around 25%.

He's also president-elect of the Obstetric Anaesthetists Association and vice-pres of the Association of Anaesthetists of Great Britain and Ireland.

David has two grown-up boys (one delivered by forceps, one spontaneous delivery, both under epidural).

If you've got any questions to put to David about the scientific, political or social aspects of epidural pain relief in labour, or any other issues relating to childbirth, then please come and join him on Thursday evening. Failing that, please post your question here as usual.

[Margles]

I have heard of saline injections being used in Scandinavia instead of epidurals. Do they work, and if so, are they ever used here?

[missedith01]

Hello and good luck! I have a question - I had some drastic supine hypotension during pregnancy - started at about 10 weeks and got worse to the extent that scans had to be done in several stages to stop me passing out and I eventually had to sleep sitting bolt upright.

I had an elective caesarian for a footling breech that wouldn't be turned. The team tried tilting the operating table to no effect, and then the anaesthetist gave me some wonderful drug that simply Made It Go Away. It was lovely, like being a normal person again.

My question is: if there is another pregnancy, is there any reason not to take the wonder-drug all the way through?

[RancerDoo]

How often do epidurals not work (partially or wholly)?

Is it common for an anaesthetist to be unable to site the epidural? (This happened to me during the pushing stage of labour - he got the needle in but wasn't sure if he'd hit the right space - and made for a very unpleasant hour (rocking contractions every 3 mins) followed by a general anaesthetic. Am I an oddity or is this quite common?)

[mathanxiety]

Sort of asked before, but can a nurse monitor a woman after an epidural or does it have to be a midwife? I had all 5 DCs in the US and one epidural and was monitored by a L&D nurse (one nurse per patient, with shift change; meant that one nurse could spend her entire shift with one patient) after the epidural, and by one nurse during all the other labours.

Do you think medical personnel give balanced information to patients (in light of the other thread) or do their biases inform them more than actual statistics when it comes to giving women the information they need in order to make their decision on an epidural?

Do you think there are medical professionals who think pain is some sort of magical thing when it occurs in labour, bestowing maternal feelings, etc. 'no pain no gain' and that painful labour is seen by some as a sort of initiation rite that women should go through?

[sakura]

As you must know, there is a long history of hospitals [and society in general] preferring women to be quiet and passive.

Obviously birth, in its natural state, goes against the social requirement of women to be passive. The pain is powerful, you have to scream and shout so your body can birth. As my favourite author puts it "the beast is there for all to see".

I do wonder how the obsession with epidural [most prevalent in the US, where women are forced to watch epidural commercials whilst in labour] is in part to do with a a desire to numb female energy and birthing power, a sort of fear of the raging and screaming of women who are doing what they must to birth their babies.



Epidural causes a sudden drop in blood pressure in the mother, which then has a knock on effect on the baby, which can then lead to the infamous "cascade of intervention" , forceps or c-section.

So I suppose my question is, why did you decide to become an obsetric anaesthetist?

[Ushy]

Hi David,
I listened radio and TV about the Mumsnet thread and was amazed to hear a midwife (who was very senior) arguing that epidurals lead to caesareans!!!! It is a key recommendation of the NICE guidelines that woman are told epidurals do NOT cause c/s. So what is going on?

What about how risk is presented? I had a midwife tell me about the risks of paralysis!! I looked on your website and noticed that it is a risk of 1 in 250,000!!! i.e. you are about 25 times more likely to die in childbirth than be paralysed by the epidural!!

Why is the midwifery profession so anti pain relief? Is this social, historical or what? They claim it is because of the cascade of intervention issue but, in the US, Canada and France, the epidural rate is way higher (double at least) and they have lower instrumental rates.

It is actually scandalous ....my next door neighbour who is a GP claims that it is because some midwives (along with the natural childbirth lobby groups) are so political and strident that no-one will cross them:)

Is he right?

[breatheslowly]

I was talked out of having an epidural before having a synto drip for induction. When I had one later I found staying still for it difficult. It only worked on one side. I have two related questions:

Is it more likely that it will only work on one side if you can't stay very still for the epidural?

Is there any reason why I shouldn't have had the epidural before the drip - is there any benefit in waiting?

[urbanproserpine]

Hello there,

Non-epidural question here.

In my two most vulnerable moments of life the person talking me through it; and the 'front line' of medicine has been an anaesthetist: during my emergency C-section (with spinal anaesthetic), and during the first night of four in ICU with meningitis at 21 ("Hi, my name's xxx, I'm an anaesthetist, and I will be sitting next to you all night in case you go into a coma"!).

Are you aware that you are often the representative for all the Meds when in these situations? You are right by the persons head, closer than their partner on one of the most significant moments of their lives, and they will remember you forever? I have to say in my case positively, and I couldn't tell you what the many other people in theatre during my section said to me.

Just wondered if you were aware of this, and if you consider it's an important part of your responsibilities?

[ChocolateBar]

Why is it the case that so many women report being given insufficient local anaesthetic for perineal repair work? It happened to me and the doctor just said "It won't be long now". The repair work took 25 minutes! That's a long time to be in pain. I know there are guidelines in place that say that doctors should make sure that women have adequate pain relief before starting to stitch - why are these guidelines not adhered to? Why is it seen as acceptable for women to experience pain of this nature?

Second question (if I may) re being given diclofenac after the repair work. As a victim of sexual assault I had real issues with being given drugs rectally. The doctor and midwife basically bullied me into having it (not sure why it was so important to give pain relief after stitching but not during ). I realise that they probably thought they were doing the right thing, but it's caused lots of problems for me on an emotional level since. Why is there so little awareness among HCPs about the fact that victims of sexual assault might have strong feelings about this sort of thing and why do HCPs not listen to women and respect their views?

[Alimat1]

What are your feelings of epidurals being given in the latent stage of labour as per NICE guidlines?

Have you ever given one in latent stage ie not established labour and not due for induction?

[SarahBumBarer]

David - welcome and thank you.

I was just wondering if you could set out your position on epidurals at the start of the discussion - I'm assuming from your profession that you are "pro" epidurals but is that in all cases? ie would you say that epidurals should be routine?

Specifically, how do you feel about Notts City Hospital then as I found my ante-natal care in Nottingham included a reasonably evident anti-epidural/pro natural birth message? (I have almost nothing but good memories of my birth experience at City Hospital by the way)

I'd also be very interested in your answer to DomesticSlattern's question about the removal of gas and air at the pushing stage since this was also a feature of my care at City Hospital yet is clearly not a national practice (thinking of One Born Every Minute here) and is my one minor gripe with City. Would I be able to insist on keeping the G&A next time?

[domesticungoddess]

My husband and I are both anaesthetists. We opted for a home birth. We were very lucky. I think it is every women's right to chose-if they want an epidural unless there is a medical reason not to have one then they should be given one. It should however be 'informed consent'. I think we often don't really get that. How many people in the throws of a bad labour can consent properly to an epidural ? I am a glass half empty person and felt that I would rather not have an epidural as I would be the one person that would end up with one of the rare complications. Is pain relief ever worth that risk in a normal labour-its difficult. I personnaly decided no but everyone is different and have no problem carrying out epidurals on other people.

The association of obs anaesthetists see link :

www.oaa-anaes.ac.uk/assets/_managed/editor/File/Info%20for%20Mothers/EIC/2008_eic_english.pdf

produces the following listing complications of an epidural.

[thetideishigh]

Hi David,

As a consultant obstetric anesthetist do you feel, having read the thread about midwives apparently controlling access to epidurals, that there needs to be much closer liaison/working relationship between anesthetists and midwives to prevent the incidences of uncontrolled pain during childbirth impacting on the mother's mental health at the start of a challenging time in her life. Dare I say it, could the anaesthetists have more control at an earlier stage in the pain relief situation.

I won't post my birth story as it might make me identifiable but if I had been given the confidence in pain-relief availability and choices, it could have been quite different.

Tip for midwifery departments - if you want people to have confidence in the service you are running don't run shambolic ante-natal clinics/lose notes/neglect to refer to notes at all/lose test results/talk patronisingly to educated and intelligent women/deny that there is any such thing as a mobile epidural.

[stoatie]

Dear David

How do anaesthetists decide what type of epidural they offer in labour. Like lulumama earlier, I have heard of mobile epidurals but have not seen them in practice where I work, we seem to have denser blocks meaning the woman has to remain on the bed. I would love to knwo the pros/cons of each so I can perhaps instigate some debate at work!

[Freelance]

I am researching an article about the National Childbirth Trust and hope very much to talk to you about your views on pain relief. Would you mind e-mailing me on [email protected] with a good time to talk to you and a telephone number or e-mail address? The article is for next week.

[yesway]

What do you think the future of pain relief in childbirth will be? Are you worried about the impact of the Tory changes to the NHS with respect to this?

[Fimbo]

I ended up with a spinal headache after an epidural following a c-section. It was the most awful pain and rendered me bed bound for almost 10 days with my husband having to have compassionate leave from work to look after my newborn and 5 year old. Blood patches didn't work. Whilst I appreciate what happened to me is pretty rare, I think more should be done to make people aware of this particular risk of epidural.

[DrMcDreamy]

Just related to the siting of epidurals in the latent phase and with regard to the NICE guidelines that state a woman may have one if in severe pain. How do you think this should be measured and who makes this decision? Midwives? Anaesthetists? Would you feel that you know enough abouot the mechanics of normal childbirth to advise why an epidural in the latent phase can lead to greater intervention? (Not to diss your qualifications btw, just a point that interests me as you'll know far more than the midwife re the effect the anaesthetic has on the body and risks relating to that, I just wondered if your scope of practice included how the epidural itself leads to further intervention or just that it does. If that makes sense).

[rathlin]

Hello, are there any long term effects from a lumbar puncture during the siting of an epidural for a c-section resulting in two blood patches (1st one failed) to cure a post dural puncture headache? Thanks in advance.

[teenyanne]

As a nurse (looking after the elderly mainly), I work on the principle that pain is what the patient says it is, as intense as they say it is and when they say it is and then it is treated appropriately. Why is it that in labour, it seems that pain is deemed to be something to be expected and tolerated by women rather than managed in the way that they want it to be?

I understand contractions are necessary for birth, but surely if a woman's pain is controlled to her satisfaction, then she will be much more relaxed and therefore be more likely to have a less stressful birth.

And what about mobile epidurals - I was told that this was available by the consultant anaesthatist I saw ante-natally, because I wanted to be able to walk around during labour. On the delivery unit, I was then told that actually it's not routinely available in any maternity hospital - so which is it?

[sfxmum]

hello thank you for coming

my question is regarding Pethidine, I was given this half way through a very long labour and it was possibly one of the worst experiences I have ever been through, it felt like being buried alive while still feeling quite a bit of discomfort
(apology for the dramatic language but it really felt awful)

so is common for this drug not to actually work very well and have such adverse reactions?
TIA

[ILikeToMoveItMoveIt]

Is it true that pethadine is a sedative and muscle relaxant? If so, does that mean it can be categorised as a pain relief drug?

[jugglingjo]

I don't know what David feels, but before he kicks off tackling some answers to these points and questions I'd just like to say to my fellow Mumsnetters how impressed I am with the wisdom and thoughtfulness expressed in these posts.

I hope you'd agree David ?
Are there any particular points expressed, perhaps from mothers experiences of birth here, that you'll be taking away with you from this discussion ?

[Chlot]

Thank you for coming and answering questions. I'd like to know if you can tell us the UK statistics of epidurals 'going wrong'. That is, not giving proper pain relief/only giving partial pain relief (for instance only down one side) or worse.