Get off the forum people! 'One born every minute' is on....

[Keef]

Thinking about it, perhaps it is nothing to do with pain threshold (although I still believe different people have different thresholds), but more to do with the pain that an individual is experiencing.

I'm not talking about a complicated labour, like a back to back, I just can't believe that someone who says labour is like period pain, or cramps, is experiencing the same thing as someone who feels like they can't carry on.

I also don't think it's possible for health professionals to judge the need for pain relief, because they are not feeling it. Yes, they may know that a woman will be okay in the end, but I just don't understand why she should have to go through all that first, when it can be dealt with. It's like women are expected to earn their badge of honour or something. All very odd.

[prm]

We live in a civilised country, even if it costs money to the NHS I think we should have the choice of having an epidural if we want one (unless there is a good medical reason why we shouldn't) But what I meant about the awful midwife is that she didn't seem to give a monkeys about her poor patient..she was there having a cuppa tea with her mates and telling them how her patient really wanted an epidural but she was not gonna give her one. I must say I asked for an epidural at 4cm dilated at Kings and they gave it to me swiftly and without trying to dissuade me, thank god!

[littleEDfamily]

Back to the programme, I don't believe the midwife in question was delaying the epidural in order to make her suffer; I don't think she believed the lady was in established labour (I'm sure she said that to her colleagues). I must admit I don't know the ins and outs of the optimum time to administer an epidural, but I believe that the time is once labour is in full swing.

Apologies, am in quite a grumpy mood today. Really not trying to upset anyone, but I do feel strongly that pain when it is in relation to a normal labour is something that cannot be simply 'dealt with'.

I do love that programme, emotional and hilarious simultaneously. And it's an excellent contraceptive for me.

[littleEDfamily]

Another question to chuck out there - do people think c-sections should be made an option for all? Some consider even attempting natural labour to be uncivilised...I think you know what I think of that, but interested in others' views, especially those who believe strongly in patient 'carte blanche' where labour pain relief is concerned.

[Ann]

From my observations it was still in quite early labour when the midwife said she couldn't have the epidural. The labour then cracked on I got the impression she reached full dilatation quite quickly when it did, which wouldn't be unusual for third baby. It's difficult to tell when it is carefully edited. I also got the impression that the midwife was surprised when the baby came face up, but I could be wrong. I would have thought there was a good chance she could have ended up with forceps with the baby in that position, if she had had an epidural.

I wouldn't from my personal experience describe contractions like 'period pains' in any way shape or form and envy those women who can.

I do like the way the couple are interviewed at home afterwards. It put the whole thing into perspective, a day in your life for a whole new life!

Congratulations Sally81. Looks like you've survived to tell the tale, hope it's going well for you.

[Keef]

As a man, my opinion is that every woman should be given the available options, and make an informed decision on what she wants, be it an elective c section, or to give birth at home without so much as a pain killer.

[Ruth_Baldock]

Couldn't agree more, Keef, except that...a lot of women think that because c-sections are so common-place, they're practically day surgery. They're not. Major abdominal srgery, quite risky really. I had PPH (post partum bleeding) so badly after mine that I had a transfusion etc. Surgeon had to keep trying to get his dr mates to calm down my husband who was convinced I was going to die (in surgery for 3+ hours, can't blame him really.) I don't think people realise they're Really Bloody Serious and think they're 'easier' than vaginal birth's. But, lets be frank. Having babies = NOT bloody easy at all, whichever way they come out.

[buggie]

(just catching up with sky+'d OBEM) The MW wasn't "gossiping" with her colleagues about the woman, she was doing as myself and my colleagues have done nearly every shift - stated what is happening/what her plan is - partly so that if they see the woman they have an idea of what is happening, but also to see if any of our colleagues have different ideas of what to do/approach the situation.

Could even be that she did contact an anaesthetist and discuss the woman with them (they may even have come to assess/discuss with her further) but that these bits were edited out/disrupted the "flow" the editors were aiming for.

The clips of the coffee room last no longer than 30secs (at most) so it can't be assumed they are sitting round drinking tea the whole time - only in the 30secs shown there (prob not showing longer clips as there often are people in and out/being called out/going to check on their patients). Wasn't until I was in my own A&E dept with my daughter I realised how as patients you really don't have a clue how busy the rest of the department/nurses and Dr's are - should think the same thing happens on Labour Ward (even more so as you're each in your own room.

I remember from my NCT classes being advised on how epidurals can slow the labour down/increase intervention and really, really aren't given until labour is established. Also, typically with an epidural you're then tied to the bed (not quite literally) and (as far as I know) you then have it till the birth - there's no going back from it so can understand why at 3cms the MW was discouraging.

Even if epidural is required then an needs to be called up to give it and the is a finate number of them around so may take time before they are available.

[buggie]

Agree with points Keef & RB make - especially regarding being FULLY informed.

Think some people think the biggest form of analgesia is the way to go when it really isn't suitable/the best in all situations.

[BellendenBear]

Although statistically epidurals increase the risk of intervention, there is definitely a time and a place for them. I firmly believe that having an epidural was what stopped me from needing a C section.

I had to be induced and after 24 hours, for over 12 of which I was having contractions every 3 minutes, my cervix remained tightly closed. At one point I was very quickly consented for a C section under GA because of fetal distress from the prolonged contractions. The obstetrician then decided to give it a couple more hours but strongly advised me to have an epidural as if nothing had happened by then I would need a section and at least I would be awake. Following the epidural I relaxed, fell asleep and within 6 hours was fully dilated and my baby was born an hour later.

Things aren't always black and white.

[Ann]

Agree BellendenBear.

To me pregnancy and childbirth is a unique experience for each woman in each pregancy. All the literature, ante-natal classes in the world can never predict those outcomes, you can merely prepare yourself as best you can.

[Belle]

Agree with Keef.

[buggie]

Induction is a whole different kettle of fish as the body is being forced into doing something it isn't ready to do itself yet (for whatever reason the induction).

There are unique details/things that happen with every birth (thus the level of interest in this series) but with each birth seen on OBEM we're seeing the equivalent of Gone with the Wind edited down to 30secs so really not seeing enough to make judgement calls on the treatment of the women, however, the discussion it generates/reading the experiences on here is fascinating :)

[sillywoman]

Ok, finally caught up on OBEM last night so feel equipped to enter the debate.

So, it appeared to me from the snippets shown that poor old want-an-epidural lady wasn't in established labour with regular contractions at the point where she was initially asking for it - hence the initial refusal. She was clearly given pethidine though to help her cope, so she wasn't left to labour cold. One of the known side effects for women who are fearful of labour and stressed (both of which she appeared to be) is to speed up the process of dilation. Pethidine, as a narcotic, sedates the woman which allows her body to physically relax allowing her body to get on with the job of dilating the cervix. At 10cms dilated an epidural will be of no benefit to a woman whatsoever as she is entering a different stage of labour, in fact it will usually be detrimental at this point that's why women who are fully dilated or are rapidly approaching it are 'refused' epidurals (possibly what happened to all your friends New Mother), and that was certainly the case here.

However, I do agree that curly haired MW could have been more compassionate, our lady was scared and frightened and said so several times. Not once did that midwife reassure her either with words or with touch - I thought she was crap actually. How much would it have cost her to hold the lady's hand and say "don't be frightened, there's no need. You are well and strong, your baby is well and strong and we are here to help you through this"? Why didn't she offer to put a mat on the floor, encourage her off the bed, get a ball out for her to use, show her some other positions that might be more comfortable, show her how to use her breathing to help her through a contraction? And, whilst I recognise that midwives need a break of course, I admit to being shocked at the sight of her having a chat & a cup of tea whilst leaving her scared and frightened woman to labour alone with her (probably equally scared and frightened) partner - she was so unwilling to help her that she was reluctant to leave the table to attend to the call when the buzzer went off, the image of her slow amble down the corridor is seared in my mind - that's not what I would expect from someone caring for me at such a vulnerable time of my life. Crap. Like others I thought the 2nd - older - midwife was much, much better.

The rights and wrongs of interventions such as pethidine and epidurals have been done so many times. Essentially I think Buggie, Ann & BB have the right of it. labour is individual to each woman and so each needs to be judged by it's own circumstances and patterns. there are definitely times when epi's, pethidine or Caesars are the most appropriate way for a woman in labour to go, but person best placed to judge that is the good professional midwife in conjunction with the woman herself. A good midwife will be 'with woman' will have a sense of how the labour is feeling for the woman and whether it really is moving beyond what that woman can deal with or whether, with the right support, other things can be done to help her through the difficult first stage.

I'm afraid I don't quite agree with Keef. To say 'let every woman have what she wants when she wants it' Is just too simplistic- women in labour are befuddled with pain of contractions and have a different consciousness, many just want anything that will stop it all. We don't necessarily have logical 'informed decision' making skills available to us at the point where we are begging for an epidural or Caesarean, or to be hit over the head with a hammer. Sometimes the professional caregiver does know best. It's interesting to note that as soon as the 'want-an-epidural' lady knew she was fully dilated and ready to start pushing her belief in her need for an epidural or caesarean went and she just got on with the job. Sometimes if you can just get a woman to the end of that first stage then she is better equipped to push that baby out more efficiently and with less risk of tearing. Consequently she has a better likelihood of a speedier recovery time and a more straightforward postbirth period. Consequently from that a better likelihood of being equipped for the rigors of breastfeeding a baby, coping with the complexity & demands of caring for a newborn, and less likelihood of postnatal depression and/or PTSD. Our 'want-an-epidural' Mum will probably have been able to go straight home from the labour ward. Because she didn't have an epidural she didn't have to have a catheter, she didn't have to have a drip, the baby didn't have to be born with forceps or a ventouse, Mum is less likely to have had stitches, and so less likely to have debilitating infections afterwards. They may have been able to choose for the cord to finish pulsating before it was cut leading to the baby having less risk of neonatal jaundice (though that depends on when she had pethidine). There are many, many considerations to having an epidural and you can be pretty sure that none of them were going through her mind at he point that she was asking for one, but many of them will have been going through the midwives mind. It's never about a 'badge of honor' it's always about what's best for the health of Mum and baby over the long term.

Nothing is simple, every action and decision in labour is interlinked and has longer term consequences. In my opinion it's not right, or fair to women & babies to reduce the complexities of the issues surrounding pain relief in labour to 'give every woman whatever she wants, whenever she wants it'. It deserves more thought than that.

[Keef]

I'm afraid I don't quite agree with Keef. To say 'let every woman have what she wants when she wants it' Is just too simplistic-

But I didn't say that.

[sillywoman]

Keef Wrote:

-------------------------------------------------------

> my opinion is that every woman should be

> given the available options, and make an informed

> decision on what she wants,

I'm paraphrasing your above post Keef.

[Keef]

Making an informed decision, based on knowledge of your options is a world away from walking in to the hospital and saying "I can't be doing with this, get a needle in my spine now!". "Paraphrasing" can be a different word for "twisting" or "taking out of context".

[sillywoman]

Either way, I believe the issue to be much more complex than your solution would appear to suggest Keef. It's very easy to spout 'informed choice' stuff, and whilst - yes - it is important I think that it's just the tip of a very big iceberg regarding decision making in labour.

[prm]

Sillywoman, thanks for describing my point about the "awful" midwife a lot better than I did! That is exactly what I meant. I agree that an epidural (or a c-section or "what you want") is not always the best for you. Most of us are not medical professionals so we need to take advice really, but that is what the "awful" midwife was not providing for her patient in a very sympathetic or caring way. Buggie don't compare yourself to the "awful" midwife in any way please..you are a wonderful caring person and anyone who has to go to A&E with their child will be lucky if they come across you.

[The Nappy Lady]

Finally watched this episode on 4OD.

My observations;

Totally agree that the first, curly haired midwife appeared to lack compassion and bedside manner. I felt she was making the right medical decisions, based on the stage of labour the lady was at, and 100% agree with the comments regarding the editing of the programme affecting our perception of what is going on. To be a truly brilliant midwife takes way more than simply outstanding medical knowledge and I find it surprising that there are as many 'emotionally cold' women in the role as there are. Thankfully I believe there are plenty more who have both the medical AND the emotional skill to do the job amazingly.

Sillywoman, I too found the image of her ambling down the corridoor after they couple pressed the button surprising and distressing.

Regarding 'pain in labour'. I can only speak for myself and a couple of friends I have discussed this subject with, but we agreed that the pain you experience cannot be equated to pain you feel when you are injured - e.g. a broken leg, migrane or whatever. My Mum always said it is 'Pain with a Purpose' and I found having the knowledge of what the pain was doing - i.e. dilation, or pushing the baby out was enough to help me embrace and deal with what I was feeling without pain relief - once I was pushing the baby out I vividly remember urging the contractions on as I wanted to meet my baby. I would say I have a low pain threshold in general, and yet I had two home births without any pain relief, not because I am brave, or for a badge of honour, but because I was lucky to have great births (primarily) and also I'm sure because I believed in myself and let my body do what it needed to do.

Personally a C-Section would be my worst nightmare, I can't imagine having that kind of major surgery by choice, I'd hate the 6 week (or more) recovery period, the scar it leaves, and the damage to my tummy muscles. I'm talking about elective C-sections here, not emergency ones, which of course have to be done - a totally different subject.

The moment in this episode that really made me cry was when the Back to Back labour lady said "Am I allowed to say I'm proud of myself?". I reckon in the end giving birth to that baby naturally will be one of the most memorable moments of her life - she even said in the interview afterwards about how special this baby was because she gave birth to her all on her own. If you are lucky enough to give birth that way it can be one of the most amazing, empowering experiences of your life - for me it was my version of climbing Mount Everest!

[new mother]

All, there is vast difference between an elective and an emergencey section, bear that in mind.

Molly, I wonder if you know anyone who has had an elective recently? Modern anaesthetic etc is very good. I was doing normal things on day 2, counting the big day as day zero. I still have a scar, it is true but it is seen by few people and doesn't bother me at all. I am not sure if my muscles have knitted - can muscles "knit"?? - or something but, each time, my stomach was concave before pgcy and automatically regained its tone easily.

So, in terms of post birth experinces, mine could not have been better.

THe only thing I would say is that I did far too much early on. I was running up and down stairs on day 2 each time with piles of washing, cartons of orange juice etc and I think, on reflection, that level of activity was illadvised.

[littleEDfamily]

I know quite a few people who have gone the elective route, and speak very positively of their experience. My personal view is that all those individuals did the right thing by going elective c-section as mentally for one reason or another they were not prepared for attempting labour.

Just out of interest, and understand of course if you don't want to share, but what made you decide on an elective section?

[LoisLane]

I watched OBEM for three seconds and it was enough to put me off.

I'm in my last week of pregnancy and to be honest, the last thing I want is to live the birth before experiencing it myself. Probably because I'm terrified!!!

:(

[littleEDfamily]

LoisLane - every good wish your way! As my wise midwife told me "the biggest obstacle to birth is fear". Believe in yourself and your ability to do it, and you will give yourself the best possible chance of a good birth. (puts cheerleader outfit away with a little woop and punch of the air!)

[Keef]

I an guessing here, but perhaps there are people that prefer the cold clinical midwife, as it makes them feel more secure in a medical environment. That could well be nonsense though.