Be Informed! Or is ignorance bliss?

[highlander]

As a first timer (well, at 35 I'm an old-timer as well, but that's another story), I've lost count of the number of web sites instructing me to be 'informed' about pregnancy.

However, I find that the information exposure raises my BP and leaves me so terrified and out of control that I immediately make a run for Hula Hoops and Snickers bars!

It particulary gets my goat when the advice proffered is a tad 'you SHOULD do this', or the information is very biased.

Examples:

1. Breastfeeding - like all new mums, I'd love to give this a go and I've found the web info very helpful for that crucial first 2 weeks when I would be likely to give up- Latching position, the fact that newborns don't need a lot in the first week, importance of professional BF support etc. However, I'm not going to beat myself up and subject myself to months of pain if I hate it/can't do it etc. I hate the way the info available akins bottles to infanticide!
   
   
2. Sections - I WANT a section. Despite the disadvantages,It's for me; it's my CHOICE. And yet I can't find a single bit of info on the web that supports me. All I can get are scary stories!
   
   I could go on ............ but I'm seething again. Now, where's the choccy......

[handlemecarefully]

Highlander

You are absolutely right there is a dominant ideology in the literature and amongst health care professionals which enshrines the following commandments:

*Thou shalt breast feed or forever face eternal damnation
*Thou shalt vaginally deliver
*Thou shalt forego pethidine, epidurals etc because to submit to these is the devils work

Having said that I breastfeed my first baby for three months (and intend to try for longer with my second) and I vaginally delivered...so I am not against these philosophies per se - just the fact that they are rammed down your throat as the single best way and an informed choice doesn't appear to be offered.

I had a nasty first birth and would have opted for an elective c-section this time around (have been offered it) but in the end I am reluctantly going for vaginal delivery because my dd will be only 21 months old and is quite a clingy child who likes to be picked up and hugged. She will be freaked out enough by the arrival of a new baby without mummy being able to cuddle her.... so against my better judgement I am risking my perineum again (and for me it just hasn't been the same since my episiotomy). I also live in a rural location and depend upon driving.

A fried who had 2 elective c-sections (both babies were breach) swears by them. It is a major abdominal op but people do cope...and whilst CountessD mentions risk of post partum haemorrhage I asked my obstetrician about this and he felt this was just as likely (or rather unlikely) with a vaginal delivery.

[handlemecarefully]

Should preview ...I might to say "without mummy being unable to cuddle her"

[highlander]

och, you're all just too lovely!

I really appreciate nice section stories!

I had a horrible dream last night. I was in my bath at home, trying to deliver I think. DH left the room and the midwife started forcing herself on me saying, 'you ARE going to have a vaginal examination'. I was screaming like mad for DH and saying that I didn't need one.. DH came back and I think I woke up at that point. I was, and still am, in a bit of a state.

No more dodgy chips for dinner!

[aloha]

No overhang for me either - I am fatter but that's nothing to do with the cs!
The risks of cs are hugely overstated. If Michel Odent things they are as safe as vaginal deliveries then I think we can accept that they are safe. Looking back, I think I might have found it hard to lift a toddler for a week or so, but certainly not hard to cuddle one. I carried my 8lb8oz baby everywhere, breastfed constantly and drove everywhere. It really was all terribly straightforward. It does hurt quite a bit for a couple of days after, but not as much as labour!

[pupuce]

HMC - I see many health professionall RECOMMENDING and encouraging epidurals ! (not pethidine as it is affecting babies - so not to be used lightly).... it's the pro natural childbirth (like me.... ) who woudl say you can do it without an epidural (most of the time).

Higlander - Michel Odent's new book on sections does say women who want a section should be given one....

[dinosaur]

pupuce - so is that view of pethidine gaining wider acceptance now?

very interesting as I think you know DS1 collapsed and nearly died when he was born - at the time no-one acknowledged that it could have been the pethidine - two years later when I had DS2 the theory seemed to have gained a little more currency

[pupuce]

Well as Mears would tell you - Pethidine is a heroin based pain killer and it goes through the placenta..... why would it not affect the baby ?

I disagree with HMC as a lot of midwives in labour wards are quite happy to give you pain relief.... as

1. they don't see many women doing it without any so why would you (chicken and egg thing.... never see them but iffer them too often too)
   
2. they don't like women making too much noise
   
3. it can mean they can hook you up to a monitor and they can get on to other mums....
   
   Personnally I have had to STOP midwives forcing two of my "mums" to use gas and air.... one of them even said to the next MW on shift "can you believe she isn't even using gas and air???" she was completely flabergasted ! (sp?) Gas and air doesn't exist in most countries!
   
   Dinosaur : I found this on the web :
   "Pethidine may not provide adequate pain relief for some women. Nausea and vomiting are common, a medication may be mixed with the pethidine to help reduce these effects. Some women report feeling drowsy and confused. The effects pethidine has on perception may make the contractions difficult to deal with. Other potential side effects for the woman in labour include difficulty passing urine, dry mouth, hallucinations, respiratory depression, low blood pressure and allergic reaction .
   
   There are no advantages to the baby if the mother has pethidine. Pethidine is known to cross the placenta and is present in breastmilk. The major problem for the baby is that pethidine can cause breathing difficulties after birth due to its depressive effect on the baby?s respiratory centre. These effects are at the worse if the baby is born one to three hours after an injection of pethidine has been given. This is the reason that pethidine is ideally avoided when the birth is perceived to be close. An antidote can be given to the baby to reverse the effects of pethidine, however the effects of the antidote only last a short time and when they wear off the baby may re-experience breathing problems. Baby?s are more likely to have jaundice if their mothers have pethidine. Pethidine effects the baby?s sucking reflex and can cause breastfeeding difficulties for the first few days. Baby?s may require special care or neonatal intensive care from the effects of pethidine, resulting in separation of mother and baby."

[dinosaur]

That's so interesting Pupuce.

I wish I'd known that before I had DS1, could have spared myself the most traumatic incident of my life so far.

So ignorance is not bliss, no.

[pupuce]

Dinosaur: I would be amazed if you had pethidine AND a doula...

I am sure she will make you go through the labour with very little pain relief if any.... you will feel far more confident I reckon !

[dinosaur]

Oh don't worry I won't have it this time - I was absolutely adamant about that last time too, and in fact got through without even gas and air (which I think is greatly overrated anyway!).

I have had a chat with my doula about pain relief - she knows where I'm coming from, and I think it will be very helpful to have the extra support.

[hercules]

I am very glad that I was not ignorant when dd was born and didnt have pethidine. DD was crying for most of her 2nd night in hospital and the mvs wanted her to have a bottle as they said I didnt have enough milk. Well I knew that was crap and had been there already with ds, they gave him the bottle and i had problems after that bf him though did succeed by speaking to a bf counsellor.
The mum in the bed next to us when dd wasa born was very worried about her baby as she'd had pethidine and her baby would barely wake up to feed and the mvs were concerned as he was barely feeding. She had to try to wake him up which is hard as when they need to sleep they need to sleep iyswim. She wished she'd known as for her ignorance was far from bliss.
It gives you far more control if you are informed rather than trusting staff who may not be informed either!

[dinosaur]

good for you hercules

I knew there was a risk that babies could be drowsy but not that they could be born blue and only score 1 on their Apgars and have a heart rate of only 40 bpm

[hercules]

Bloomin heckers Dinosaur! Why then is it allowed at all?

[handlemecarefully]

Pupuce and Dinosaur,

I asked both my Obstetrician and 2 midwifes (my community one attached to my GP Practice, and the one at the antenatal clinic at the hospital) about pethidine and correlation with respiratory distress in the newborn and they were not of a similar opinion to yours Pupuce. So I think we have to be careful about promulgating this as established fact.....the jury is still out on this. (They did acknowledge however that it should be given too close to delivery for this reason - but in the early stages of labour, fine)

I had a grunty baby who was overnight in SCBU - but my last pethidine shot was circa 08.20 in the morning and I didn't deliver until 18.30 that night so the two were unrelated. We never established a cause - but I think it was more likely a strep infection (and although cultures from my dd came back negative for this - the NHS strep test is notoriously unreliable and gives up to 50% false negatives)...particularly since when I was given a vaginal swab 3 months post partum (before I had an IUD fitted) I was found to have a strep infection. I am paying for a strep test privately using the enriched culture method this time around (theres only the one lab in the UK offering this)

Dinosaur your experience sounds much worse than mine (i.e. my dd was in SCBU overnight for her breathing but well enough to be discharged next day)...but I think its unreasonable to automatically assume it was the pethidine that was necessarily to blame. That said, I can understand why you would want to play it safe and avoid it.

As for epidurals - I'm truly surprised Pupuce that your experience is so at odds to mine. When I was in labour the two lovely girls one fully trained midwife and one student midwife (and they were 'girls' who had never had babies themselves) kept drumming into me that I didn't need an epidural....but I was truly desperate. I was eventually saved by a doctor who came in a couple of hours later and suggested I had one (he could see that I could cope no longer and he could also see my dh weeping in a corner because he had never before seen his normally stoical wife reduced to this). I felt soooo much better after the epidural - and had I been given it sooner feel sure that I wouldn't have need the birth afterthoughts counselling that I have since had.

Plus my friends who laboured at around the same time as me report obdurate resistance to the notion of an epidural from their midwives.

I am not arguing the rights and wrongs of an epidural here - just suggesting that it seems to me that they are actively discouraged by the majority of midwives which isn't always in the interests of the labouring mum to be.

All highlander is asking for is a balanced discussion in the literature and from health care professionals about the pros and cons of intervention etc - but there doesn't seem to be one - amongst midwives at least. Doctors in my experience are more objective.

Incidentally I'm excluding Mears from this general inditement of midwifes!

[dinosaur]

I don't know hercules. I asked the consultant midwife at the Homerton that, and she said that they do still use it because it's very useful for long first labours (exactly the situation I had it) and that reactions like my DSs are very unusual.

But it sounds from what Pupuce was saying that medical and midwifery opinion is swinging against the use of pethidine.

Certainly everyone who was in my antenatal classes when I had DS2 was completely put off pethidine by hearing about my experience with DS1.

[dinosaur]

That's very interesting hmc.

I was told by the consultant midwife that if DS1 had had an infection it would definitely have shown up on his cultures - she never told me about the false positives!

How the hell does one get "reliable" information eh?

Well, will be trying to avoid artificial pain relief again thsi time around, one can only make one's own choices based on one's own experiences, it seems. I would just hate anyone to go through what I went through, and of courese, I was rather lcuky in that at least DS1 survived.

[handlemecarefully]

Dinosaur,

But how do you know it was the pethidine and not for example an undetected strep infection?

[handlemecarefully]

OOOh our posts crossed!

[handlemecarefully]

Your midwife was wrong on that count - the NHS test is known to be unreliable. That's one of the reasons they don't do universal screening (no point when the test is unreliable). It was my hospital attached midwife who gave me the leaflet for the privately available enriched culture method.

I despair alongside you re how the heck do you get reliable information!!! Its all so contradictory.

[dinosaur]

Yes

I did insist on having a swab for strep B when pg with DS2 and will be doing the same this time around.

But that is another example, I had never heard of risks of Strep B when I was pregnant with DS1!! More "ignorance is not bliss"!

[dinosaur]

Could you email me through contact another talker with more info about this enriched culture thing? Or post it on here, if you don't mind?

[handlemecarefully]

There is 'Group B Strep Support' a UK charity who provide an informative website : www.gbss.org.uk

Omnilabs are the lab who do the enriched culture method. Their website is: www.omnilabs.co.uk

They send a pack out to the patient with a request form which you get signed by your doctor or midwife. Then either a health professional (or yourself) can take a vaginal swab with the swab kit and transport medium that they send you or you can do this bit yourself(basically you can do it yourself because its not a complicated procedure - just rub the swab around in your nether regions). The test result takes 3 days and the result is sent back to the health care professional who signed the request form for you.

You however are required to send a cheque for £18 with the request form and swabs.

Swabs should be taken between weeks 35-37 of pregnancy. I've got my pack and I'm doing mine next week (I'll be 35 weeks next Monday)

The telephone number for requesting a pack from Omnilabs is 020 7908 7000

[dinosaur]

thank you very much hmc!!

if the result comes back positive, does that mean you have to be on intravenous antibiotics when labour commences?

[handlemecarefully]

I believe that's so - yes.

[dinosaur]

thanks for confirming - I thought that was the case