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See all MNHQ comments on this thread

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

286 replies

GeraldineMumsnet · 28/02/2011 10:08

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.

OP posts:
bevmid · 05/03/2011 07:23

I guess that ,many of the comments above demonstrate again a case of research by means of personal experience only. I was a senior University lecturer with a degree in Applied Health Science and Bioethics plus two registrations in nursing and midwifery. I tend educate (I have a major in education)using sophisticated methodology research based evidence to apply to any practice.

I have been a midwife of over 50 years in Victoria Australia and saw many experiments with so called pain relief. Examples are Ether, Twilight sleep, Heroin, Valium and Pethidine. Heroin was used in one of my pregnancies which left my son near death at birth. Many of these clinical trials on pregnant women such as before epidural became fashionable and an impost on the health dollar, have been tried and discarded.

As I explained to a pregnant client today who did not realise why it was important to move and walk - that these joint movements and pressure on soles of feet and other important pain relief spots releases natures endorphins which act like heroin. No labour is pain free but the achievement of women with normal presentations and vaginal labours without complication shows in the huge euphoric smile after birht where contractions are soon forgotten. The natural inclination of a baby to crawl to the breast and feed with immediate separation of the placenta without the speed up artificial oxytocic injection. Multiply the cost of this in countries of millions of births and you can calculate in whose interests these drugs are being used.

If women had not laboured without this wonderful memory amnesia effect of normal birth over the eons of time - analgesic free (before men of science had us lying on our backs pushing up against gravity- a very painful position)- we would have never had another child. QED population sustainable??

Epidurals were long ago demonstrated to have an effect on the baby and reduced the newborn baby's ability to suckle. Sweden evidence demonstrated the lack of bonding as being significant in women who did not achieve a normal epidural free labour. The giving of epidural lowers the blood pressure and compromises the fetus - the subsequent remedial pumping of fluids to pump up blood pressure arising out of trial and error because oops lowering blood pressure is not a good look.

I am interested in comments which focus on the woman and not the baby which cannot argue for itself.

DrMcDreamy · 05/03/2011 08:42

Ok now have I read this somewhere or just made it up but some animals gave birth using epidural anaesthesia actually rejected their offspring? I'm going to bed right now following a busy night of epidural denying (that is a joke btw) but would be interested to know if this did happen or I dreamt it up in my post night shift catatonic state.

LessNarkyPuffin · 05/03/2011 10:27

Hmm "the huge euphoric smile after birht where contractions are soon forgotten"

Where does this the patronising bollocks leave the women who do remember the agony and suffer PTSD as a result? Are they not only 'over-sensitive' about the pain but abnormal not to shrug it off after labour?

"I am interested in comments which focus on the woman and not the baby which cannot argue for itself."

Oh. And apparently selfish and bad mothers even before they deliver for not putting the baby before their pain. Ignoring the effects of stress and pain upon the baby.

MummyBerryJuice · 05/03/2011 10:52

bevmid you are of course diff but there is no denying that the majority of women in our society today are giving birth in a medicalised environment where ther are often forced or encouraged to stay on their backs, for monitoring during labour, and ease (for attendants) during delivery. In this unnatural set-up, pain is often exagerated and women more frequently need analgesia. I stand by my opinion that well supported women are less likely to ask for an epidural(hasn't this been proved many, many times?) but that if someone does ask for one she as the patient who is actually living though the experience is the best judge of whether she needs one!

McDreamy are there any studies that show whether the incidence of PND is increased, decreased or similar in women having had epidurals compared to other forms of pain relief or none at all?

Anecdotally, I had an epidural before the commencement of syntocinon augmentation and it didn't work completely but certainly helped hugely and changed me from someone who felt totally out of control (and I could rationally recognise tha I felt out of control) to a calmer more controled person. I could still feel my contractions and we stopped any top ups when I was fully dilated so I had some sensation during the 2nd stage. I had no problem latching DS on and bf within the first hour (excellent skin to skin and being left alone with DH after delivery helped) and I continued to ebf until 6 months and am stil bf now at 14 months.

I would be interested to see studies showing effect of epidural on bf rates (particularly compared to pethidine -which is IMHO a useless drug) but considering tuis countries poor bf rates at 6-8weeks I don't know if you'd be able to see any significant statistical difference b

bevmid · 05/03/2011 14:43

Bollocks is not a word I would use to describe what is put by me here to stimulate debate about a very dangerous procedure in the wrong hands.

I have never denied anyone the right to pain relief because not all women are able to access good midwife support. Most hospital atmospheres are noisy and busy with emphasis on reading machinery and pushing women to have their babies quickly - through attempts to induce by chemical and instrumental means. Women who 'fail' the trial period which has now I am told been reduced to 9 hours in some hospitals - (normal labour and birth used to be over 24 hours with good outcomes). The women are distressed even further and suffer more pain because artificial oxytocics are put in to veins with high doses by those doctors who are in a hurry to finish their day between 9.00 and and 5.00 pm.

When nature is discarded and pregnancy is terminated in this harsh way - of course women feel out of control. The pain of chemicals is horrendous and I have felt the difference of a uterus normally paced slowly and gently waltzing in to birth with a staged increase in length intensity and time apart. Chemically induced labours start straight away launching into intense long strong and brick like contractions - these contractions of course are very painful and abosutley require epidural.

Apart from that the gel which is used to begin induction containing Misoprostol/Cytotec - chemicals used in cancer treatment transferred to use in obstetrics. This method has been banned in some states of the USA because it is being linked to severe infections which are killing some women.

When you kill off body cells which is the aim of Misoprostol in cancer treatment you also kill off good cells a.k.a. the bodies normal ability to fight bacteria. This method of induction is not conducive to relaxation and in fact causes extreme fatigue in some women who then are unable to withstand the long but painful haul of ruptured membranes and pressure to give birth in a hospital.

When accompanied by infusion of oxytocic there are cases of some wombs rupturing because of the behaviour of impatient incompetent/lazy clinicians - that is they don't wait for the required period of at least 6 hours after receiving the gel. The artificial oxytocic starts pouring in.

When induction fails this leads to automatic Caesarian birth. This is major abdominal surgery which requires the surgeon to cut through layers of fat the omentum muscle and the uterus.The bladder is peeled back - thus resulting in a number of women experiencing incontinence of urine and more pain for months after birth. A catheter is already in and these also introduce infection causing E.coli a normal passenger which colonises to pathology.

Of course if the epidural has been inserted to cope with the pain caused by another sneaky way of forcing the baby to descend i.e. rupture of membranes. Rupture of membranes of itself research has shown, causes even more pain than when the membranes are left intact.

Of course the poor uterus not only has to contract after this birth it has to mend itself leaving a scar in to which subsequent placentas bury themselves and refuse to leave at the next birth/s. The pain after Caesarian birth apart from the scar requires more pain relief and hinders access to the baby for breastfeeding. The drugs of course last for up to 3 weeks in the breast milk and hence the baby with the half life of many stronger drugs remaining to affect suckling.

Intact membranes protect the major blood vessels providing oxygen and nutrients to the baby when in labour. Intact membranes protect the baby from infection. Intact membranes allow a soft cushion in front of the head and prevent damage and pain when entering the vaginal canal in normal labour.

Women who stand and squat of course aid the birth with use of gravity. A good midwife knows how to keep her hands off and use words of encouragement. Midwives are the faceless people using Masterly Inactivity that silent encouraging and supportive care which is irreplaceable. I have yet to in my wide experience find a doctor sitting with a woman in labour.

The after effects of interfering with nature causes extreme fatigue with a mother unable to perform in labour and afterwards too fatigued to care for a baby. Result is she needs more pain relief and so the cycles of obstetric cascade now similar to a torrent begins. Postnatal depression is sstrongly linked to indcution and Surgical births. Normal vaginal births have most women up and about able to breast feed and enjoy their baby.

Rates of Caesarian birth in Private Hospitals is significantly higher because women are booking or bing coerced to choose elective births with the encouragement of some doctors. Some even promote Caearina birth as a choice. I term this uninformed consent because the harmful effects of repeat Caesarian births are not mentioned.

Look up Placenta accreta increta and percreta. Once rare these events are now responsible for doubling of maternal deaths if not secondary infertility because of uncontrollable haemorrhage which results if these events occur. Interestingly this is more likely to be in the in the African American population in California USA. This research was held back for 7 years and was produced November 2009. I call this assault and battery and it is time these uncontrolled experiments of convenience were reported to the police.

Of course fear and poor education about birth and I hear from my UK colleagues that midwives are in short supply over there. There is overwhelming evidence that when the midwife is with the woman less pain relief is needed.

I would like it if Narky could walk in my shoes and hear the stories of women being paralysed up to the neck and unable to breathe when incompetent inexperienced with pregnancy physiology doctors give epidurals - this anesthetic is given into a space in your spine. I have heard the results of women being operated on without sufficient anaesthesia.

It was emphasised to me that only specialists in obstetric anaesthesia should administer this method. If you re read what I wrote I stated that not every one was able to make it through - it is the transition stage which is brief but the most painful - but if as we do, have the buoyancy of a deep bath to labour in many women are more able to cope. The experience of normal pain of childbirth provides its own euphoria after the event.

I watched one anesthetist in a major hospital arrived so drunk his breath "nearly put the women out". We were powerless to prevent this man from being covered up by his colleagues for a number or years.

Your attempt to speak to me about the euphoria after birth is uninformed. My observation comes from my being there hundreds of times over in the bush where there is no anaesthetist within 200 kms in urban hospitals at night with no doctor available and being in charge of hospitals where you are the only one on duty to care for women who choose a hospital.

If you have ever been to a home birth you would actually know what I mean. And yes I have been pregnant and gave birth twice had one baby by Caesarian birth. I was not asked if I wanted Heroin for the first and I refused analgesia in the second even though I was lying on my back pushing up hill.

I have reared four children and have 7 grandchildren 6 of whom were intervention free and one of them in a midwife only hospital in Far North Queensland Australia

Alimat1 · 05/03/2011 14:49

*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?

DavidBogod: Margles. Yes - a very odd business, the saline injection into the skin overlying the back of the hip-bone, and almost exclusively practised, as you say, in Scandinavia. Studies have shown that it has no useful effect and probably only works as glorified distraction therapy (apparently it stings a lot!). I think even the Swedes are dropping it now*

on this point - can i just say that NO Swedes are not dropping it, it is as popular as ever and they are starting to come over to the UK.
They are used in my hospital, using water, not saline, and are VERY popular for OP labours as they basically take the pain away entirely in the back on some women. They are also being trialled at a very large teaching hospital locally, where reports so far are very good. The studies I have seen show good effects from them
David - have you seen them used in labouring women. Its midwives who give them in early labour, not anaesthetists. They obviously do not replace epidural as they do not take pain away abdominally and are best used in ealry labour - but they do work, fantastically

StarlightMcKenzie · 05/03/2011 14:55

This reply has been deleted

Message withdrawn

DavidBogod · 05/03/2011 14:58

@Alimat1

*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?

DavidBogod: Margles. Yes - a very odd business, the saline injection into the skin overlying the back of the hip-bone, and almost exclusively practised, as you say, in Scandinavia. Studies have shown that it has no useful effect and probably only works as glorified distraction therapy (apparently it stings a lot!). I think even the Swedes are dropping it now*

on this point - can i just say that NO Swedes are not dropping it, it is as popular as ever and they are starting to come over to the UK.
They are used in my hospital, using water, not saline, and are VERY popular for OP labours as they basically take the pain away entirely in the back on some women. They are also being trialled at a very large teaching hospital locally, where reports so far are very good. The studies I have seen show good effects from them
David - have you seen them used in labouring women. Its midwives who give them in early labour, not anaesthetists. They obviously do not replace epidural as they do not take pain away abdominally and are best used in ealry labour - but they do work, fantastically

Thanks Alimat1 - Can you tell me where this is being trialled? I'd like to find out more
Alimat1 · 05/03/2011 15:07

David - I have sent a private message to you

Mum2Phoebelicious · 05/03/2011 15:57

I've been reading bevmid's comments with interest. I'm always sceptical of statistics given around pregnancy and childbirth. The studies are very rarely robust enough to stand up to statistical scrunity. I work in the pharma industry so spend half my life critically appraising trial work and find it shocking that some of the most unsound stats are quoted in the media etc causing outright and unneccessay panic (mmr and autism anyone?). The same thing seems to happen a lot in supporting arguments for natural births, in fact if you looked hard enough you'd probably find a study to support any stance you wanted, whether the fact that that particular outcome was found in 3 people in a remote corner of the globe would be repeatable in a fully fledged double blind, parrallel controlled study in 10s of 1000s of people is an entirely different matter.
Interestingley in a highly scientific trial of me and my mates ;) only 1 of the 7 that had a natural childbirth (all without epidurals) managed to breastfeed and 4 of that 7 suffered PND. Myself and another friend that had an emergency cs brestfed for 4 and 12 months respectively and certainly had no issues bonding and no PND. And my own mum who had a very difficult but natural birth with me will readily admit she never bonded with me because of the pain and horror I remind her of. She certainly didn't breastfeed. Just goes to show that its perhaps how positively a mother finds her experience, regardless of what that actually is, that impacts on bonding, breastfeeding and recovery times. The human mind is a powerful and complex thing.

MummyBerryJuice · 05/03/2011 16:24

bev you are right that no doctors sit with a woman through labour but that is because they are jot necessary unless something goes wrong. During a 'normal' labour and delivery there should be no need for a doctor to even see a women. However, in my experience (not only as a patient but also as a hcp who has had a fair bit to do with maternity services) mws don't sit with their patients either, I know a lot of this has to do with understaffing but I can't help but feel that many mws don't think it is their job to 'sit with a patient' that that is what their partner (or doula) is for and that highly trained mws are should monitor and manage the labour.

Lulumama · 05/03/2011 17:34

bevmid wrt to misoprostol, AFAIK, the NICE guidelines say it is not to be used in inductions in the UK

Alimat1 · 05/03/2011 17:45

Lulu - we use misoprostol for IUD inductions Sad

During a normal antenatal/ labour/ postnatal and discharge - a woman does not see a doctor at all for the whole period, as long as she is low risk

Lulumama · 05/03/2011 18:04

ah Sad, but obviously that's different to IOL under normal circs.

Alimat1 · 05/03/2011 18:08

yes - I have never seen it used in the NHS for 'normal' IOL

LessNarkyPuffin · 05/03/2011 18:46

"My observation comes from my being there hundreds of times over in the bush where there is no anaesthetist within 200 kms in urban hospitals at night with no doctor available and being in charge of hospitals where you are the only one on duty to care for women who choose a hospital."

I wonder what would have happened if they had actually had the choice. I don't care about your experiences with women who could not opt for an epidural. How arrogant to assume that women should give birth a certain way just because it is possible. It's possible to give birth strapped into stirrups and man-handled by doctors too. That doesn't make it desirable.

You are extremely patronising, and no better than those who seek to impose medicalised births onto women.

NellieForbush · 05/03/2011 21:18

McDreamy It would be great to get the other side to this from the RCM. I think there would be lots of interest. It needs to be discussed.

working9while5 · 05/03/2011 21:30

Once again, I am aghast at the contributions of midwives on a thread on MN. I thought I had fantastic midwifery care during my own pregnancy and childbirth but as I read, I find the contributions and anti-woman tone of some of these posts putting me off and making me quite fearful about meeting a midwife who thinks she knows what's best for me and forces a particular type of birth on me (if I am lucky enough to get pregnant and give birth again).

The single factor that most influenced my birth was a very badly conducted VE at 3cm (three students, two midwives, lots of muttering about my deep cervix) which led me to take the epidural earlier than I really wanted to. I had been induced on a synto drip and was tied to a bed for constant monitoring with my back to back baby and hyperstimulating uterus and just could not bear another one. Have just found out today that I could have refused a VE anyway! I can't believe it! I was never asked, I was told I was having one. So my "cascade of interventions" (leading to Kielland's forceps delivery, baby with a low Apgar and subsequent bfing issues) could just as easily be attributed to midwifery care as to any other factor, who knows?

Is it nature's way to have five other woman rummaging about looking for a cervix when a woman is in pain? Isn't nature just as "discarded" when this happens? Isn't the natural way, well, freebirth? With a fair amount of babies dying as a result? Should we all be chewing through our umbilical cords (as I watched my cat do when I was child).

It's easy to be theoretical about pain relief and what's needed and what's not, but reflective practice on behalf of midwives who have strong views on what women need that run contrarty to what those women are telling them is probably poorly accounted for in the literature. I am hearing a lot of arrogance on these threads. I had really hoped a midwife would come along who was reasoned and listened and shared examples of good evidence, but sadly, no.

Alimat1 · 05/03/2011 21:42

I think alot of midwives have come on here with very valid and good evidence, but it has been repeatedly ignored or shot down in flames along with them being called liars.
It is pointless any midwives trying to give a reasoned example as it is not accepted as the truth.

I am puzzled how at the beginning of your post you say you thought you had fantastic midwifery care, yet a paragraph down you then say you had a very badly conducted VE by 5 people and bad care easily attributed to midwives.

I really dont understand why 3 students and 2 midwives Ve'd you - if this is the case I would complain. This is not right, and if you did not consent to it (as everything must be done with consent) it is abuse

NellieForbush · 05/03/2011 22:00

I think a lot of midwives have been on here (the original thread) with some pretty unpleasant opinions about what pain relief is suitable for labouring women.

This is reflected in some of the many horrible birth experiences that other posters on here have related. Telling lies to labouring women would appear to be quite common.

A 'reasoned example' is just that - not valid or good evidence.

Alimat I'm not sure why you are puzzled by the previous post. I hope I've interpreted it correctly working but in hindsight, it seems like you midwifery 'care' may have contributed to your complicated delivery even though at the time it seemed acceptable.

Looking forward to hearing the official line from the RCM on this. Where do they stand?

MummyBerryJuice · 05/03/2011 22:10

I have great respect for mws and believe that many of the points that have been made have been both valid and thought provoking. It is important for a woman to know that there is an increased risk of instrument delivery when having an epidural and that her baby may be very drowsy for a very long time if taking pethidine etc etc.

The issue I have with some (not all) of the mw posters on here is that they seem to view a woman resisting an epi not only as weak-willed and pathetic but as negligent and a bad mother and as a personal failure on their part.

Alimat1 · 05/03/2011 22:10

possibly - but until working came on here she was more than happy with her midwifery care - no PND, PTSD, and only now 'jumping on the bandwagon' for want of a better phrase.
Seems odd.

I appreciate what you are saying about the other thread - but the whole point is - IS IT LIES?
And Im not going off the one anaesthetist who says it is - im going off the several midwives who say otherwise, having to deal with it day in and day out

Repeatedly midwives have commented that they ask for epidural but the anaesthetist is busy - I know for certain I have NEVER refused an epidural, but have unfortunately had to tell women the anaesthetist in busy in theatre with an emergency - to then have comments on here basically saying Im lying is frustrating in the extreme.

Yes, I appreciated women have horrible birth experiences, I dont deny that - but many times it is not due to the midwife lying about the availabiltiy of the anaesthetist.
Yes, as I said on the other thread, there are some bitch midwives around - as in every job - some people are very good in their job, some people are very bad in their job, but on the whole I would hope and pray there are more good midwives than bad.
Just dont seem to hear it on here very much.

NellieForbush · 05/03/2011 22:29

In light of new knowledge working has questioned the standard of her care. Certainly not 'jumped on a bandwagon'.

Surely you aren't suggesting she remains in the dark and in the event that she has another child simply repeat the same process including a VE without consent which as you rightly say is abuse?

Perhaps we are both reading what we want to hear but I see the majority of posts as being from women who have been fobbed off an epidural 'too early/too late/not dilated enough' etc etc Rather than told honestly 'sorry s/hes in theatre it could be hours'.

There are many great midwives. Mine were exceptional. I consider myself very lucky in light of some of the threads I've seen here and the stories I hear regularly.

Sorry to discuss you working hope I'm not reading anything into your post that isn't there.

MummyBerryJuice · 05/03/2011 22:49

But the anaesthetist is busy in theatre isn't really an excuse for not getting an epidural, is it? A reason for delay, yes definitely but not for not having one at all.

A unit with a 24hr dedicated obstetric anaesthetist should reasonably be able to provide an epidural within 2hrs of the anaesthetist being informed. Afterall, an uncomplicated caesarean section only takes about 20minutesfrom start to finish.

Alimat1 · 05/03/2011 23:17

yup - totally correct, I never said it was an excuse

As I said we inform the anaesthetist and they generally come as soon as they can.
In my unit, they are very good at coming as soon as they are free.

What more, as a midwife, can we do.
We cant put epidurals in. Its not our fault there is an emergancy happening that is holding the anaesthetist up. But we seem to get blamed for the hold-up.Or simply not beleived.

I dont know which section you are talking about, but it certainly takes longer thn 20 mins - it takes that long to prep them and give them the spinal and make sure its working correctly,prob at least 20mins, then maybe 10mins in an emergency then to get knife to skin and baby out, then maybe another 20mins to suture up afterwards, then transfer to recovery of the pateint. Then prescribing and paperwork. The anaesthetist stop with the lady until all of this is finished.
MUCH longer than 20mins

that length of time, in a multip especially, could mean that some women have delivered by the time the anaesthetist is free.
Again, normally if that does happen, most of our anaesthetist will pop in and say hello and apologise for the delay.