Midwives, No pain, no gain (BBC2)

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Anyone watching?

I watched this last night. When the mw said "By the time the anesthetist gets here, this baby will be delivered" made me want to punch her inn the face. I had similar said to me and ended up with a spinal block and forcep delivery of a back to back baby an hour later.
The 2nd time they said this (when I was having ds2) I actually told her she was a lying bastard and she was to get the anesthetist right now.

Talking about debriefs - I paid for an IM to go through my notes with me. It was very important for me to do it with someone not connected to/employed by the hospital
I found it really helpful, mainly for exploring whether or not the disaster parts were really avoidable or not, IYKWIM. It also helped me to decide what to do for the next baby, as the first was the bad one
I just didn't trust the hospital enough to be honest

I think some midwives go into the profession for their own needs, and this came across in the programme.
They want to "form relationships" with women, and want the satisfaction of managing births without any interference from Drs, epidurals etc.
A woman in labour is very vulnerable and can be manipulated into agreeing with things she might regret later.
As has been mentioned on this thread, most of us couldn't care less about making a relationship with the MW, as long as they're professional and do their job. And if women want pain relief they shouldn't be made to feel they've failed or disappointed the staff.

Probably going to get flamed here... I read half this thread yesterday and then watched the show last night. I feel like the reaction is very harsh and that on the whole the MW were professional, albeit largely inexperienced.

She did say that noone wants to give birth at home but she meant in an unplanned way and I would agree with that.

The high risk women would have been classed as that before they even went into hospital and that is how they're taught to deal with high risk labours.

The midwife I wasn't too keen on was the lady who complained about finding the low risk birth boring whilst the couple were in the room - I found that unprofessional.

They were discouraging epidurals because of the increased risk for intervention. I would like to know the stats on intervention without an epidural for comparison though.

I agree it's odd that the women were labouring on their backs. The experienced midwife changed that and the baby was born quite quickly afterwards.

I have to say that, when the midwife said, "...no-one wants to give birth at home...", my first reaction was - what about all the women, like me, who choose home births? But I quickly decided that what she was actually saying is that no-one wants an unplanned, unattended home birth, and I think that is probably true.

The epidural, intervention stats strike me as being almost impossible to figure out honestly. As other people have said, if your labour is going quite quickly and the baby is descending in a good position, you're probably more likely to not want an epidural BUT also to not need intervention.

Very long labours or those with the baby in an awkward position and probably more likely to see a woman ask for an epidural to manage the pain and/or exhaustion, BUT are potentially more likely to see intervention needed anyway.

Just from personal experience, I was so bloody exhausted and out of it by the time I asked for an epidural that, ignoring the fact DD turned out to be ill, I suspect I would have been more likely to have needed intervention such as forceps without an epidural, as I would have had no reserves to push with. An epidural looked placed to give me the rest I needed to manage the next stage.

I don't see how they could ever work that one out.

TheGriffon

My thoughts exactly. I think I said upthread that I couldn't have cared less about 'forming a relationship' with my MWs. I just wanted them to do the job they are paid to do which is to monitor my pregnancies and assist in the deliveries in the most appropriate manner at the time.

Women are not there to fulfill them.

I have done a brief search, and found this article about the cascade of intervention:

"Epidural analgesia can provide very effective pain relief during labor. It also increases the risk of experiencing a sudden drop in blood pressure, a longer labor, difficulty moving about, difficulty urinating, difficulty pushing the baby out, fever, and other undesirable effects.

A variety of interventions — such as continuous electronic fetal monitoring and intravenous fluids — are widely used with epidurals to monitor, prevent or treat these effects. And others become more likely, including use of synthetic oxytocin to strengthen contractions, use of a urinary catheter to empty the bladder, and use of a vacuum extractor or forceps to help move the baby out. These in turn may have side effects that lead to the use of other interventions.

The impacts can also extend to babies. For example, epidurals increase a woman’s likelihood of developing a fever; if a mother has a fever, caregivers worry that her baby may have an infection. Though few babies whose mothers have an epidural associated fever do in fact have an infection, as a precaution these babies often have blood tests and are treated with antibiotics just after birth. They may also be observed in a special nursery, which can interfere with bonding and breastfeeding."

This Australian article states that nearly 50% of women who have epidurals go on to have an instrumental or operative delivery. That has to be higher than the number of instrumental deliveries following on from other forms of analgesia, surely? It also increases your risk of having a C-section by 160%, and is linked to longer labours, according to this article.

No one is saying it doesn't increase risks, but that those with straight forward births are less likely to ask for an epidural so it is difficult to calculate how many interventions are due to the more complicated nature of the labour as opposed to the epidural itself.

I think there have been some harsh comments about the MWs. I thought for the most part they were good. In many cases I think they are damned if they do and damned if they don't.

I certainly know that I needed my MW to tell me to stop panicking, stop screaming and focus! I also needed her to practically force feed me toast to give me the energy I needed to push. I needed her to not soft soap me, and to tell me how it was, and be forceful and no nonsense.

But boo that is different from making value statements about how women choose labour intervention. And we were trained not to use particular phrases such as 'coping' because they are value judgements and ascribe weakness/strength to a person.

They seem to have forgotten this part of their training.

Waffling on about supporting and empowering women whilst implying or expressing value judgements about their decisions deserves commenting upon.

Harsh comments I agree!

I wanted, needed my midwife to be slightly bossy when needed, she help me keep a lid on it when I was panicing/freaking out a bit. She asked me what I wanted and I told her this, eg: when I was panicing about the crowning she just calmly said, "this is ok, you can do this, you must relax and breathe and listen to me" so straight forward and she was great. She was also very supportive without speaking, so I think midwies are a combination, not snouty or timid.

I definitely did not want sing songy wishy washy midwife,

Just watched this on iplayer and thought it was quite good. Don't know why people are so outraged about first woman not getting epidural- she was in transition ffs! It would have been pointless at that point. She had clearly said she didn't want epidural and coped amazingly well until then. I think midwife was entirely correct here and don't know why everyone is flaming her. I had a similar experience with ds2- coping well, progressing then hit transition, said I couldn't do it etc. They gave me morphine injection and ds2 was born about 12min later so no time for it to take effect. I was then so out of it, puking etc for next couple of hours that I could barely even hold him.
It would have been so much better if, like the midwife on programme someone had talked me through transitional stage.

Loved Tatiana, and agree unprofessional of water birth mw to say she thought normal births not exciting!

I was disappointed with this. I've had 3 deliveries in that hospital and do not have a bad word to say about any of them. I'm hoping the worst of it is down to editing.

I've never heard anyone that delivered there be refused an epidural.

Also agree that Lydia is hugely popular in Cardiff atm.

Watched tonight's episode and simply do not understand the "logic" of British system, of sending out a midwife to someone's home to do checks, and then when there is a problem (in this case the mother-to-be had black discharge) send them to a gp who presumably will know less or have equal knowledge to midwife. Surely they should be sent to obstretician/gynaecologist? This doesn't make sense to me either medically or financially.

That woman had 17 miscarriages and the mw sent her to a gp. Utterly unbelievable.

She should have been sent to the EPAU

I think the woman with the discharge issue had just had a baby

She was a student MW, not a RM.

Exactly mig, she wasentqualified yet give her a break

Yes, I omitted that from my post for brevity's sake Mignonette. I don't think that makes any difference though tbh - assuming a midwifery student near graduation is there for a purpose and not just for an objectiveless exercise.

And whether woman was pregnant or in post-delivery phase, I still think that she should have been referred directly to an ob/gyn either to investigate potential miscarriage or retained placenta or some sort of post-delivery infection (whichever the scenario).

Presumably a gp, as a generalist, isn't particularly experienced or skilled in treating either of those things and even if they were, would end up referrring her to a specialist anyway.

I'm not getting at the student midwife btw - I thought she was good - I'm criticising the fact that there was no-one else for the woman to be referred to than a gp.

That woman had 17 miscarriages and the mw sent her to a gp. Utterly unbelievable.

I think there is some misunderstanding of the system here. The GP isn't going to treat her, he/she is the one who can refer the woman to the early pregnancy assessment unit, where she will get an early scan and have the bleeding investigated. In that area midwives probably are not able to refer to EPAU, which is the really ridiculous part of the system. As pointed out there is no point in wasting time and resources by having an additional appt with the GP!! However, the unfortunate fact is that there is almost nothing that can actually be done at this stage (it was a booking, so she was in the early weeks), and nothing an OB could do. If she is going to miscarry again, then she is going to miscarry. Medicine hasn't progressed far enough to be able to prevent early miscarriage.

Also, she will likely be referred to be seen by an OB at some point for investigation her obstetric history. They just didn't show that part of the process.

Thanks for the explanation Bue. That makes more sense.

The programme was edited. She consulted w/ her mentor back at base because her RM mentor has to countersign her students notes and decisions and it is her registration on the line, not the students.

There was a lot more that you did not see. A STNM would not be allowed nor expected to make this decision without referring back to base. As Bue stated, this decision has a clinical basis.