“Doctors told to try and talk women out of epidurals to save NHS money” screamed yesterday’s Daily Mail headline. I could understand women reading that and being outraged and terrified.
Fortunately, this being the Mail, the truth is not as bad as the headline implies. Rather than being a miserly, deficit-busting ministerial directive, this is expert, evidence based guidance drawn up by the Royal Colleges of Midwives and Obstetricians with the help of the National Childbirth Trust. It aims to reduce the amount of medical intervention during childbirth because that’s best for both mother and baby. Nowhere in the guidance is there any suggestion that those who need epidurals, painkilling drugs or caesareans will be denied them. A respected charity isn’t going to risk its reputation by putting its name to a mere cost cutting exercise.
It is patently obvious that a straightforward delivery you can walk away from and go home six hours later is less risky than a surgical procedure with a six-week recovery time. All the evidence suggests that the alert, active participation of the mother in childbirth is best for a complication-free delivery. Injecting powerful narcotics, or spinal blocks which stop you moving can only interfere with that process and can make the baby very sleepy, so clearly if that can be avoided, it’s a good thing. We were told that in our NHS birthing classes in 1998. There is also nothing new about women being advised to try labour after a first caesarean.
Any announcement of pregnancy tends to lead to so-called friends feeling the need to scare you with birth horror stories. No wonder many women feel like they’ll need every analgesic known to humanity and a stiff gin to get through. As a State Registered Coward who doesn’t do pain, I was lucky to have an experienced friend to tell me that, yes, it would hurt, but it was manageable with a birth partner who knew what they were doing and a supportive midwife.
When my mother gave birth, she was expected to do what the doctor told her which generally involved lying in a bed for her entire labour. Over the last 45 years, women have been given much more choice but even when my daughter was born, I still had to hide from an over enthusiastic obstetrician who displayed indecent eagerness to hurry things up. I’ve had countless friends encounter everything from hostility to flat refusal when they have requested a home birth, despite the evidence showing that for second and subsequent babies at least, home birth is as safe as hospital so I’m glad to see that the guidance is supportive.
The Mail’s reporting is typically unbalanced. They quote a raft of senior medical people who rail against the guidance as denying choice to women. The voice in favour of natural birth is that of model Gisele Bundchen. She talked sense, but model v medical establishment isn’t really a fair fight, especially in a paper which generally portrays models as brainless idiots. There were hundreds of medically qualified experts they could have asked. They didn’t even have a quote from the NCT.
Women can rest easy that they will not be denied the pain relief they need, and that they will be given advice from the medical profession that is based on evidence and not financial considerations.
* Caron Lindsay is Editor of Liberal Democrat Voice and blogs at Caron's Musings
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17 Comments
Not being a woman, with not the best knowledge on this subject, it is a thread that I would not normally comment on.
I do feel though that their should be some caution from encouraging to many women not to have an epidural during labour.
Some women’s bodies do not produce enough of the natural hormones and endorphins released by the brain during labour, causing birth to be far more painful and sometimes traumatic.
Women who have suffered a far more difficult birth and have not been giving an epidural {maybe because it was to late to give} and their body has not produced sufficient endorphins are fare more likely to develop Postnatal Depression and in some cases PTSD.
Endorphins produced during labour is one of natures gifts, apart from pain relief it has an effect that tends to make the brain forget the trauma a woman’s body has just been through in giving birth. An epidural has the same effect.
I would be extremely cautious about discouraging women from having epidural’s during Labour, especially young women and first time mothers.
I do not think the risk of more women suffering from postnatal depression or PTSD is worth it, and the first few months to 1 year is vital in bonding between mother and child, and even daddy at home, it helps strengthen family bonds which is vital for children’s development during the early years.
Just my opinion, for what it’s worth.
@ Matt – “Endorphins produced during labour is one of natures gifts” .
Or just possibly an evolved response to pain? If the negative effects of traumatic childbirth are as you state, there is probably an evolutionary advantage for those with the endorphin.
Nothing new here I think. Having had an epidural during birth of our first daughter, my wife was keen to get the same in 2003 when no.2 came along, but the medical staff at Kingston Hospital could not have been more imaginative in the variety of evasions deployed to avoid this happening (and in the end they won – though my wife didn’t thank them for it). However I don’t think it was a cost-cutting measure then, and I suspect it isn’t one now either.
This advice is based on recent research =which has shown that the risks involved with having an epidural are higher than previously thought.
It is surely right that standard advice is changed to reflect research findings. The guidance doesn’t ban epidurals, it just reflects the evidence that there are risks associated with them.
Matthew, women have been giving birth successfully without medical intervention for as long as humans have been in existence. There are some occasions when there does need to be some help – women who would have died in the past can be easily saved now, which is a good thing. However, the process of birth doesn’t need to be so medicalised for everyone.
An epidural isn’t a guarantee against a traumatic birth – one intervention tends to another, all of which can make the experience riskier for both mother and baby.
Nobody is suggesting women will be denied pain relief if they need it, but it’s important that they are given evidence based information about the risks.
As someone who has just finished feeding our beautiful (but 1 month prem) 5 day old girl I can give a recent perspective. Certainly an epidural was not an option this time around, thanks to superb ambulance staff we reached the hospital just 10 minutes before our daughter arrived. That said 8 years ago when our first daughter was born my wife had an epidural after struggling for over 8 hours. The trouble we had was there were no anesthetists available for 90 minutes after the decision was taken which led to a second dose of morphine, something we would have preferred to avoid.
The real problem now, as told to us by the excellent midwifery staff at the hospital, is that they feel they have been cut to a level that is bordering on reckless. The midwife who delivered our baby had to rush to another birth within minutes. She was replaced by another who was discarding her gown having come straight from a c-section. All were shattered and moral was dreadful. Talking to her they had been so overwhelmed that even had we been early enough and wanted a epidural it would not have been an option.
After a couple of hours we were transferred to the transitional care ward (due to baby being prem). We had spent 8 days on this ward with our elder daughter when it had a 50:50 split between nursing and midwifery staff. This had been changed to a single midwife on shift who quite literally was run ragged. The nursing and nursery nurse staff were superb but did not have the skill set to provide some of the care the mum’s required.
Speaking to the staff they were of the same opinion, that the hospital were cutting midwifery at the expense of patient care. Several asked if we could write to complain as they had been made aware more cuts were planned in access to midwives on the wards.
Perhaps as older parents, both of whom working in healthcare we were opened up to more. Are these issues the fault of central government, yes and no is the true answer. The hospital wasted millions failing to get foundation status and is struggling. They are one of the trusts where regional pay is being mooted to drive down wages and recruitment freezes are common place. So bad local management is an issue. But some standards need to be centrally driven and resourced. Poor local management should not lead to worse patient care.
The staff of our NHS have been brilliant throughout. From the ambulance staff, who originally thought they would have to deliver to the delivery suite and transitional care teams I have seen nothing but care and dedication. But they are Lions led by Donkeys. I will write the letter they want, but it will begin with the praise that is due.
The trouble is the surveys the government (and their predecessors) like to quote regarding satisfaction are because of these lions. scratch the surface and all is not well…..
Does anybody have a link to the actual guidance? Caron and the Mail give different interpretations of the guidance, but neither of them provides a link or even a direct quote so it’s impossible to judge who is right.
The RCOG have supposedly (acording to the Mail) withdrawn the guidance from their website pending further consultation.
I think there needs to be more emphasis on the idea that this should be the mother’s choice, and that all childbirth experiences are different. I don’t find it helpful when people basically say: “Natural childbirth was bearable for me so it’ll be bearable for you too.” Before having our first child, my wife was as keen as any mother to have a natural birth. After a 36-hour labour, complete with epidural (over 24 hours in) and emergency section, she wasn’t quite so evangelical about it. I actually think that her determination to have a natural birth caused her to hold off from the epidural for much longer than she should have.
It’s all very well to refer to the fact that humans have been giving birth successfully for millions of years, but humans have also been dying in large numbers while giving birth for millions of years. Only very recently has this changed (in the developed world at least) thanks to medical advancement – which in turn has been one of the evolutionary factors behind the significant increase in human head sizes over the past couple of centuries, making childbirth potentially more painful for everybody. “Nature” is not quite so efficient at sorting out these evolutionary problems as people assume it is. (Another example is the prevalence of bad backs – caused in large part by our bodies not being fully adapted to walking upright yet.)
I would just like to point out that one of the reasons that this story has purchase is that there really are cuts and reductions in service going on as noted by the new head of the BMA (http://www.bbc.co.uk/news/health-19450474) This is occurring to a very large extent because your party was either stupid or malign enough to support the Health and Social Care Bill and ensure it became law.
Perhaps this is a false alarm but there are plenty of things to worry about out there. If we don’t stand up and fight we’re gong to lose the NHS. Thanks Liberals!
Up here in Cumbria it’s pretty hard to get an epidural, so it’s best to assume you won’t get one unless you’re a clear emergency or it’s Mon-Fri 9-5 and you’re in hospital and there’s someone spare. This reality sharpened my mind about preparing properly for labour so I got fit and went to NCT classes. Because I was well prepared I was able to change plan after finding that going into hospital didn’t suit me but I could actually cope better with the pain than I expected. Hence I had a very lovely home birth with my first and was tucked up in my own bed with my husband there to look after me half an hour later. Can’t recommend it highly enough! I had a ludicrously long labour and there’s no way I would have avoided intervention if I’d been in hospital.
But it’s the education regarding what’s possible and how to get the best out of a birth experience which is the most essential component of reducing the level of intervention, not removing epidurals.
@Rebecca
I am glad that you had such a wonderful home birth, but this was possible not just because you were physically and mentally well prepared (though I’m sure that helped a lot), but also because you were fortunate not to suffer complications.
When my wife’s first birth experience turned unexpectedly into a medical emergency I was very glad that she was already in the best possible place – the hospital.
This is not to say that I want to take sides here in some sort of hospital vs home birth debate. The opposite is the case. Every birth is different and every mother has to make the choice about what is right for her, there are no rights and wrongs until after the fact.
The issue raised by the Mail was whether mothers were being pressured to make a particular choice based on the worst criterion of all: cost. In the absence of the actual guidance, the jury is still out on that one.
@Stuart,
It’s important to look at the evidence and not to rely on your prior assumptions of logic.
Where is the evidence that home births lead to greater death rates of mothers or children? I know it seems logical given your experience but these things are not logical according to science as we know it Stuart. Birth and death are strange that way and it’s interesting to notice that.
So with my youngest I planned a home birth of course. When my contractions got to 3 minutes I felt I was ready for second stage labour and wanted to get into the pool. My husband agreed and called the midwife upstairs but she disagreed and said I was not in established labour and said she was going home for a break. We agreed as she was clearly tired – having come straight from another overnight birth – but warned her to stay close to the phone. We called her back an hour later, only to be told she’d been sent to another home birth in a monumental cock up. So we had to do a very late transfer into hospital.
Baby was big and had both hands up – so I had complicated internal tears and lost a litre of blood very rapidly. Home birth midwives are not good at stitches as I knew from first time round and the pool was the last place I should have been, but I delivered this baby straight into the hands of the midwife know as the ‘stitch queen’. I couldn’t have been in better hands – DH said she was incredible to watch – and I was out of hospital 14 hours later.
Co-incidence? Logically yes but the data seems to suggest otherwise.
Lack of epidurals in Cumbria are to do with cost (obviously costs are higher her because of the low population density) . As I said I’m not sure if that’s a good thing or not. But education and preparation for coping with birth and learning to making decisions under stress which are logical but also respect your instincts are definitely good things. My NCT classes were the first time I was in a situation where instincts were discussed as being something of value rather than something you need to bypass and I’m very glad I started the process of learning to use them wisely.
I am the research officer for the Birth Trauma Association, a charity which helps families who have been through traumatic experiences in childbirth.
The link to this article was sent by a lady who was rather upset by what she had read so I hope you will not mind if we put our charity’s position.
Caron Lindsay is absolutely right to say that it is entirely appropriate for women who want to avoid interventions to be given the opportunity to do so. The corollary of that, is however, that women who choose not to suffer the pain of childbirth should also have their choices respected. Indeed, there are challenges to the unequal treatment of women with respect to the pain of labour that are currently with the Equality Commission. Sadly, denial of pain relief IS an issue – highlighted by the Care Quality Commission, our postbag, and recurring posts on Mumsnet and other online forums which were recently reported in The Times.
Childbirth pain varies but can be one of the severest pains that humans can endure. The psychological consequences of unendurable pain can be devastating, – particularly where the pain causes the mother to totally lose control and dissociate from her body. It can lead not only to post natal depression but also the most severe forms of PTSD. We often hear from women who gave birth over 40 years ago where their experience of childbirth has haunted them and led to enduring problems in their relationships and mental health. Only a woman can decide how much pain she is in and whether she does or does not want pain relief ; pressure to ‘do without’ is unethical and unacceptable.
Can I just correct one or two points in the article. Caron says there is nothing new in women being advised to try labour after caesarean section. NICE does not recommend this. NICE only uses the word ‘advise’ where the outcomes are both better and cheaper. The outcomes for trying labour are cheaper but there is more morbidity. It therefore recommends the woman’s free choice is respected. Again, I do hope this is something the Lib Dems will support!
Caron also says all the evidence suggests that an active and alert mother is best for a complication free delivery. Complication free deliveries usually require little intervention and are the least painful so women are less likely to request pain relief. What is cause and what is effect is uncertain. Certainly, women who have straightforward births have generally good outcomes but equally elective caesareans have better outcomes than traumatic vaginal deliveries.
Unfortunately, women are having bigger babies, later in life and there is more IVF. All of these contribute to increasing risk for traumatic birth so it is important that individual women can weigh the risks for themselves.
It is really important that all political parties commit themselves to supporting the provision of accurate information and women’s choices. The strength of public feeling on this issue is overwhelming – the ‘best rated’posts condemning the restriction of epidurals were unanimous and approvals ran to thousands.
Historically parties of the centre left have been instrumental in advocating the rights of women and quality medical care.
I do hope the Lib Dems will maintain that tradition
I agree with all of the comments above saying that it is 100% the mother’s choice. Pregnant wome should be given all of the necessary information to make an informed choice, & then it is completely up to them! Women should not be pushed to have epidurals, not should they be denied them.
This article is WRONG. It is a FACT that women have been denied epidurals across the country. A quick browse of the comments on sites like mumsnet regarding this topic confirm this. And calling the National Childbirth Trust a ‘respected charity’? PUH-LEASE. This organisation has a known reputation for coercing, manipulating & outright bullying vulnerable pregnant women into doing things their way – that is, ‘natural’ childbirth (no pain relief, how dare a mother choose to avoid pain!), ideally a homebirth, followed by breastfeeding (never bottlefeeding, how dare a mother choose how to feed her baby!) – regardless of the mothers wishes.
I’m sure the NCT and the RCMO have the right reasons for wanting to reduce the amount of medical intervention in childbirth, and this may be the right policy overall, but that doesn’t make it right for everyone. Some people are quite comfortable with medical intervention, and this should be respected.
We wanted an epidural, but it was too soon, and it was too soon, and it was too soon, and then it was too late.
Zoe – this thread is 9 months old, so it is possible nobody else will notice your comment.
Ms. Lindsay, humans may have been giving birth without pain relief for centuries but that doesn’t mean they have particularly enjoyed the process. The average life expectancy in the 1700’s was 32 years. Shall we then abandon modern medicine entirely and go back to those times? Every medical and technological intervention in any area of life comes with risks. However, we as adults are free to make informed choices about whether or not we want to take those risks and whether or not the benefits of those interventions (to us) outweigh the potential risks. You cannot be a hypocrite by embracing technology in every sphere of life and then arguing to keep childbirth as primitive as it was in the good old days gone by.
If a woman would prefer an unmedicated birth, it is certainly her choice and more power to her. However, there are several women (like myself) who have no desire to bear the pain and would want an epidural despite the potential risks (which are nowhere near as high as the NCT make then out to be). Telling women that you know what’s best for them and “encouraging” them to forego the pain relief that they want is misogyny and medical chauvinism. Women are intelligent adults who can decide for themselves whether or not they want to have an epidural or not. The new NHS guidelines are not giving them this choice. If low risk women are forced to give birth in midwife led units, they will automatically be denied the epidural as those are only available in a consultant led unit. Furthermore, you know as well as I do that the agenda doesn’t stop at encouraging or informing. Women are often denied the pain relief that they have requested and the new guidelines will only make it more acceptable to do that.
Why is a woman’s pain so trivialised? I don’t care if it’s “natural”. It’s painful and to force people to bear pain is inhumane. That doesn’t change when it’s a woman in labour. 200 years back, even some surgeries were performed without anaesthesia and people lived to tell the tale. Shall we go back to those times and start performing vasectomies on men without anaesthesia? Surely if our ancestors could bear the surgery without pain relief then so can we? Do you now see where I am going with this?
As a woman and a feminist, I condemn the idea that women should be told how to give birth. I condemn the notion that pain relief should be withheld from women and that women should be denied their preferred mode of birth be it a home birth or an elective caesarian.
@Rebecca
You admitted that it’s hard to get epidurals where you live because of the cost, but you’re not sure if it’s a good thing or not?? Of course it’s not a good thing!
If men were the ones giving birth, I am certain that nobody would deny them pain relief because of cost.
This is the biggest women’s rights issue of our times- the right of pregnant women to be treated with dignity and compassion and to be allowed to make their own choices.
The NHS has money to treat drug addicts and alcoholics and in some cases even perform cosmetic surgeries for “psychological reasons”, but they don’t have money to help alleviate the pain of a woman giving birth? How can this not make people seethe with rage?
I was denied pain relief during the birth of my son
It was horrendous and took me two years to even talk about it
If this is a lib dem view on the subject you have just lost one voter