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.

It sounds like you work on a great unit. I would (personally) certainly understand that there may be a delay and would very much appreciate the anaesthetist popping in even if I no longer need the epidural.

I have seen,assisted and performed many c-sections (I'm not an obstetrician and have not worked in obs in the UK) and in experienced hands an uncomplicated section takes about 30 minutes from getting on the table to recovery. 20min skin-to-skin.

MistyValley, catheters are not automatically used with an epidural but it depends on the hospital. Among my friends the rate was about 50-50. I didn't have one with mine. I had the chance to pee a few times before the epidural.

As for reasoned evidence -- give me accurate statistics any day. I personally do not want to be the end recipient of a game of telephone featuring horror stories about drunk anesthetists (was that a suggestion that they are all drunk and that none of them care about their jobs?) or internal exams leading to the death of babies from GBS or epidurals having the effect of uterine rupture unless there are statistics to back up the whispering.

Nor do I want to hear how hard it is to be a MW and how put upon they are. Other patients in equally poorly staffed areas of hospitals get pain relief. Maternity wings are perhaps very lucky that the hormones involved in birth, including the synthetic ones, have the side effect of reducing memory of the pain associated with the event.

LessNarkyPuffin ? to be fair BevMid did refer to euphoria/amnesia in relation to "the achievement of women with normal presentations and vaginal labours without complication?. I suffered PTSD for years after my first delivery, but that was not a normal presentation and as I said earlier I had been denied pain relief when I most needed it. I suspect you also had a problematic labour? I most certainly did not experience any post-birth amnesia after that delivery, and was still having flashbacks 4 years later. I didn?t let DH near me for a full 3 years and a smear test reduced me to a quivering hysterical wreck.

By contrast my second delivery was normal and straightforward, and I find myself getting broody again only 8 months later (it ain?t going to happen though, no way!). Before I had DD I thought the whole forgetting the pain business was a total lie, but it really isn't. But I would never have a third, never, because I would be terrified of having another labour like my first. I took the risk to give DS a sibling. Never ever again.

What I mean is that a maximum of (except in unusual circumstances) 2 hours certainly would certainly not be an unreasonable expectation.

DrMcDreamy, why do you say the alternative to MW attendance for women having an epidural is going to be someone with ten minutes' training?

Employing labour and delivery nurses for monitoring and delivering care to patients is an alternative that is already practiced. An average L&D nurse in the US, for instance, is a Registered Nurse (graduate of a university school of nursing following four years of study) with a licence to practice in labour and delivery.

A MW in the US has undergone postgrad studies after the basic nursing degree or other degree(s) as described here.

Midwives here often used to be nurses first with an additional 12 month(?) midwifery training on top - no doubt there are still plenty working who qualified like that.

In the present climate where PCTs won't/can't employ enough staff can you really see them going back to choosing to pay someone with 4 years training - if they can get someone with much less training for half the cost?

Any chance to reduce costs is grabbed at - and if we don't like it tough seems to be the general attitude of the powers that be.

How dare you Alimat! This is what I mean by the unprofessional and unhelpful tone of midwife posts on this topic. I did feel very traumatised by my birth but I assumed it was to do with how injured I was by the forceps (took the bones of 8-10 months to recover from the Kiellands and I still have some issues I'd rather not discuss online) and my flashbacks are all to the forceps delivery and my first night in hospital which I can't even write about. But I am jumping on a bandwagon? How dare you! The others have interpreted my posts accurately. I had never reflected on why I took the epidural in the first place til recently. I never realised that I could have refused a VE.

I posted on the other thread that your personalised rubbishing of women's experiences ill-behoves a professional and reflects badly on your profession, which I doubt the RCM would look favourably on. Tread carefully in your interpretations of people's experiences. I an shaking writing this. Again, your job - my life.

Nellie, thank you for pointing out the obvious interpretation of my post. I am going to write to the RCM about this thread because I do worry that dismissive posts will reduce public faith in the profession of midwifery and I know as a HCP myself that the views of a few online posters (who may, after all, not even be midwives, such is the nature of the Internet) are unlikely to be fully representative but perhaps it is that your professional body could do to issue guidance on discussing the profession with potential and past clients that reflects your general guidance with refernce to patient and public experience. You would do well to read the tone and manner of David's posts, Alimat, and take care in discussing individual's thoughts, feelings and experiences while posting as an anonymous representative of your profession..

Also, isn't it quite normal for women to only really reflect on their birth when they are planning pregnancy (and hence birth) again? Surely it's not that odd to seek new information to make sense of a previous complicated delivery in this scenario? Isn't this the reason some trusts have Birth Reflections services? Are you actually a midwife Alimat?
It seems odd to me that another poster could quickly see what I was saying but a supposed midwife can't see the wood for the trees!

@MummyBerryJuice

It sounds like you work on a great unit. I would (personally) certainly understand that there may be a delay and would very much appreciate the anaesthetist popping in even if I no longer need the epidural.

I have seen,assisted and performed many c-sections (I'm not an obstetrician and have not worked in obs in the UK) and in experienced hands an uncomplicated section takes about 30 minutes from getting on the table to recovery. 20min skin-to-skin.

I'm trying to stay out of the discussion, having done my bit, but I feel a couple of points may be helpful here.

Firstly, I've seen the occasional Caesarean take 20 minutes, but that's an increasingly rare phenomenon nowadays. Most take about an hour from arrival in theatre to transfer off the operating table.

Secondly, I'm aware that anaesthetists are indeed sometimes busy in theatre. But, my own experience is that the anaesthetist is not always told when there is a woman asking for an epidural (perhaps because the midwife doesn't want to disturb them when they are in theatre). The result is that a midwife may sometimes be mistaken when she says there isn't an anaesthetist free to do an epidural. A snapshot survey of 250 colleagues at a conference last week showed that 42% had encountered a situation where a midwife was mistaken in this way. This is why I suggested that women insist that the anaesthetist is told when they request an epidural.

Thank you for correcting me, David.

I still don't think that it is unreasonable to expect a epidural to be available within 2hrs of request (provided adequate staffing, 24hr obstetric anaesthetic service and not an exceptionally busy theatre)

*I posted on the other thread that your personalised rubbishing of women's experiences ill-behoves a professional and reflects badly on your profession, which I doubt the RCM would look favourably on. Tread carefully in your interpretations of people's experiences. I an shaking writing this. Again, your job - my life.
*

working - where have I rubbished peoples experiences.

As I said if you had 5 different people VEing you then you should complain as it is abuse.
I have NEVER EVER seen 5 different people VE women to get whatever info they require - when you are examining someone, each and every time you should ask if its ok to go ahead. We must gain informed consent.
If this did not happen then you MUST complain as it is abuse. If I saw students/midwives doing this in my unit - I would complain about them. It must not happen.
You do not know that bad midwifery care contributed to your delivery, it may have, it may not have. What about all of the sudents VEing you - they may also have contributed to it. Or the doctor doing the forceps. Im not denying you had a bad experience, it sounds like a cumulative effect from start to finish, and Im sad that you are now worried about who would care for you in a subsequent delivery. I would hate to think anyone came into a unit in labour and be scared about who is caring for them.

It just the continuous midwife bashing that irritates the hell out of me.

Mummyberry - are you going to thank me for also correcting you about the timeing of a section?

Hello David, I was interested to see above that you talk about a woman in labour "insisting that an anaesthetist is told that she wants an epidural" when she talks to her midwife (if that's what she wants)

I just wonder if it is reasonable to expect such strong assertiveness from every labouring woman. Should we not be able to expect that the midwife and doctor teams work more closely together, indeed as one team, in order to together provide the best care for each woman ?

The existence, in practice, of two teams and two approaches is one insight I have gleaned from this discussion. Would you agree there could be a closer collaboration, and a better understanding of different approaches ?

Alimat I do apologise. You were right to correct me regarding timings of sections. However, I agree with Starlight that many mws (and again not all) do seem to have a large chip on their shoulders on these threads and post comments which seem very defensive and instead of engaging with a woman and her experience, tend to be dismissive and patronising. This is does not help the image of the profession and does not serve to open a dialogue between the profession and the people you are meant to serve.

Thankyou for your apology !

If you go back to the beginning of the oringinal thread - if you have a spare 4 days to read through it!!! - and read it as if you were a midwife - can you imagine how you would feel.

If you feel you are good at your job, and then many many others all club up against you (as a collective group)then you too will become very defensive.

There are very few positive remarks regarding midwives.

Yes, we are professionals, but we are also human, and constantly being called and also patronised - bitch, fucking midwife, devil.....etc - makes it VERY difficult to lose the chip on our shoulders

See - the thing is, if I wanted to be called that in my job, I would have become a traffic warden

I do my best for every woman I care for, therefore - in all honesty - I wouldnt treat her any differntly.

And believe me - there have been several hard-to-please and unpleasant women I have cared for.

And have received several lovely thankyou cards with very thoughtful messages in them.
And no complaints

Can I ask what profession working is in please?

I'm sure traffic wardens feel just as hurt and demoralised being called names too, and did not choose their job wanting in order to hear those sort of things.