Printable View
LOL *he* doesn't need the promotion, he doesn't get paid any more as stated.
If women are so anti-epidural they won't read the book and they won't have one. If they are only not having one because they are scared off then they may read it and be reassured. So actually, I did exactly what I wanted to do. I was never trying to convince those soooooo against it they can't see the other side.
Once again, respect goes both ways. My original very respectful post was shown none. Interesting.
Calling people liars is hardly respectful... And yes it is interesting that you see it the way you do :)
I'm puzzled as to why you think people here are "anti-epidural". I don't want one because I've never needed one. I enjoy drug free labour just fine. I'm not going to buy a book I don't need about a procedure I will in all likelihood never use. I'm happy to read the research (independently of Dr Grant's interpretation) should you care to cite it.
But then I'm a liar who spreads deceit and propaganda, so what would I know, right? ;)
i think this is just going to go on and on if we all keep responding.
You're probably right.:
Fatmama, it cannot be said much more plainly that your original post was not written in a way that was respectful (whether you intended it to be disrespectful or not). Without exception, you have accused those who advocate for or choose natural birth of spreading lies and deceit, and by referring to the risks of an epidural as mumbo jumbo and propaganda you suggest that those who choose not to have an epidural for whatever reason are credulous and incapable of reasoned decision making.:
Once again, respect goes both ways. My original very respectful post was shown none.
I do question the assertion that Dr Gilbert gains nothing from writing this book or does not benefit from the promotion of it - my credulity does not stretch to think that he did not receive payment for writing it and will continue to receive royalties or other benefits from its sales.
FM, any woman giving birth in Australia can access an epidural if she wants one, and for the most part, within a reasonable period of time (and any undue delay is considered a failure of care). That's as it should be. A woman giving birth at home, or in a birth centre, who eventually decides, 'stuff this, I want an epidural', can transfer to hospital, and access one.
As a doula, I have supported at least one women (she actually planned a homebirth) in which a timely epidural was the appropriate use of technology, and it helped her avoid a c/s. Every midwife knows that the appropriate use of epidural, in difficult labours, can occasionally help avoid an unwanted or unnecessary c/s.
Any obstetric intervention carries risk - as the seasoned obstetrician who assisted my homebirthing client pointed out to her, as he carefully discussed with her her options (after 50 hours of labour which did not progress beyong 8 cm at home -hence we tf to hospital.)
Women don't need to fight for an epidural. It's on offer. Check out the peri-natal stats and see how many women who give birth in hospital end up having one.
Yet research and experience combine to demonstrate that for many low risk women, continuous emotional support, continuity of care from a known, self-chosen midwife, and access to a deep birth pool to labour in, greatly reduce requests for epidurals.
Australian birthers can easily access epidurals. Women in Australia cannot easily access:
- continuity of care from a known, self-chosen midwife
- midwife-led care by midwives who are autonomous professionals, who not reduced to 'obstetric nurses' and are actually enabled to practice the midwifery model of care, as defined by Marsden Wagner.
- birth pools
- continuous emotional support
- freedom of movement and mobility (this varies from institution to institution)
- privacy (ditto)
- funded homebirth.
How I wish all of the above was as esaily accesible, and actually ON the menu of birth choices for Australian women, as epidurals!
Needing an epidural is a perfectly valid reason to have one. So is wanting one. And you can have one. Usually the anaesthetist is in your room within half an hour of the request.
Try asking to labour in a birth pool. Or for your own midwife. Or for there to be no changes of shift while you give birth. Or for funded homebirth. Or for practicing rights for your two homebirth midwives in the event of a transfer. Or the right to have a VBAC labour in a birth centre.
% of women in Australia who have an epidural: 28%
% of who have a homebirth: 1.7%
% who have use of a birth pool in labour: 3%
FM, you're hardly the persecuted minority being hounded or pressured in any way by the 'tenacious midwife lobby' (otherwise known as consumers who have found through personal experience that there is ample support for the obstetric model of care - but if you want to know about natural birth options, be prepared to take responsibility to find out for yourself, and to fight for your rights.)
Not sure what your agenda is. Have you ever experienced difficulty on obtaining an epidural in the Australian hospital system?
It's not epidurals that aren't getting a far rap, it's natural birth. And natural birth hormones. As explained so well here.
By the way, I really enjoyed the three labours I experienced without epidurals. I mean, I really enjoyed them.
Thank you for giving real content to your reply JulieDoula, as that, unlike just opinions and rants actually adds to the discussion.:
To respond briefly:
1. Totally disagree that anyone can have an epi, even less within a reasonable time. I have 10 (just counted them off) friends who between them have had 34 children and none of them got an epi when they asked, or anything near it. Many asked for it as soon as they arrived in labour and were yelled at, ranted at, pressured and generally stonewalled for hours. Some occasions they missed out as they got to transition first. Also, there's a shortage of anesthetists in many Australian obstetric wards so c-sections obviously get and deserve priority and people are missing out on requested epidurals. Then there are those who are conditioned to "hang on" as long as they can, then end up getting one on request. Many of those feel they shouldn't have been pressured to hold on but should have had it sooner. I also have 1 friend who is a midwife in a public hospital and who reports to me that for public patients midwives are encouraged to discourage epidurals as a cost-saving measure. Which, frankly, IS a failure of care as you rightly point out. So "ending up" with an epi isn't the only thing that matters, but getting one promptly on request and being fully informed that it is not adverse to have one sooner and you don't have to "hang on" unless you really actually want that. It is a common misconception capitalised on by public hospitals imho.
2. As for the figures - those are not numbers that interest me. And that brings me nicely to my "agenda" though I'd say its more my passionate commitment to full scientific information and choice. I wouldn't matter to me if 100% of births were homebirths (I'm hardly against them if that's what people want with no indoctrination), or if 100% were epidural users, or if 100% were c-sections even. What matters to me is how many were DENIED the birth they wanted, either by not knowing enough, or by actual denial by the people supposed to care for them, or by active misinformation about the dangers/safety.
That goes for homebirths too. I wouldn't want a woman who was a good candidate for homebirth and really wanted one to not have one. But I suspect that happens less than being denied epidurals precisely because so many want epidurals - most, if not all - who ask for an epi get less than they ask for and are entitled to.
And yes, since that would be my choice (even if I didn't need one) I care about women being denied that especially. I know how wonderful they can be.
Thanks for your post anyway. I really think the rest of the thread has not engaged with the real issue and has engaged in mere ad hominem attacks. I respect your different opinion on what an ideal birth is, but I don't think we actually want anything much different for women. I'm just *more* concerned with the denial of epidurals which I'm entitled to be. That doesn't mean I want women to be denied homebirths. They're not incompatible.
FM-Do you have any stats for women who 'are being denied' an epidural? I was given one as soon as I asked.
I never actually asked for one. The mw and ob talked me into it. I have discovered that you are not in any position to make decisions when you are in labour so you just go along with things.
Very true MantraRay, the only thing my mw said to me was "but you said you didn't want one, are you sure?" I ended up having two, both didn't work! :doh:
No, and they aren't even collected! Isn't that terrible? And denied or grossly delayed would be the accurate measure with grossly delayed being more common anecdotally. I've actually talked with many more mums than the 10 personal friends I mentioned, but that's a fair anecdotal sample (across 2 cities) of women who got less than they asked for in the epidural dept.:
I got huge pushback from the nurses and I'm not even counting me because it wasn't an Australian hospital. They look at you like you're a leper. Then they say "ooooh not yet dear you can hold on" then they patronise you, then they say "soon" and finally when I (and several women from my moms group later told me too) say we'll go outside the LDR and make a fuss they "give in".
Sadly this is not uncommon. It may or may not be x% of epidurals given, but frankly ANY experiences like that are totally unacceptable and I know personally of many many more than several.
BTW I find the "you said you didn't want one are you sure" unacceptable also, in any situation unless it was because you needed to be informed that IF you wanted one later it would no longer be available due to the shortage of anesthetists. Then I could see how checking would be sensible (but still bad care to have the shortage in the first place).
But I have never known someone personally who was pressured into one. Only the reverse. Maybe I just mix in differerent philsophical circles to you, but you surely can't deny that if there are at least a dozen women (and more than double that in pregnancies overall) I know who in the last 5 years have had the denial/delay I described that is appallingly bad care. I would really like to know if you can with a straight face say that is not appalling.
That suprises me, I haven't heard of any woman being denied one. Sorry you were treated this way at the hospital.
Thank you. It means a lot to me to have people who are anti-epidural say that. Really. I sincerely mean that. Mostly they just tell me I am better off.:
BTW denial or delay is the more accurate term. I got one in the end, from Dr Grant and it was heavenly but only after 4 hours of total "wish I were dead" agony - NOT what I wanted on the day my child was born! - and finally begging. Then another hour of agony waiting for the IV to be properly adminsitered (do you see a pattern of incompetence here?) and then an hour for the IV to go in before I could have the epi.
When Dr Grant arrived he was blissfully unaware as he'd only been paged 5 mins before (told me 10 mins later as it kicked in and he waited for it to check it did). And yes, he is unashamedly my hero for taking that agony away. And for demystifying and reassuring me and others on the safety through his book. I was pretty chuffed to get him personally which was just chance.
The reason my mw asked if I was sure was because on my birthplan I stated I wanted it as a last resort, she knew what I wanted (but as we all know what we want before labour begins and during labour can be completely different) she didn't want me to be dissapointed with my decision.
When did I say it wasn't appalling? All I said was that I haven't met anyone who has been denied one.
FM, which country did you give birth in?
Sheesh, if you're talking about USA, that's a totally different ball game. Deep breaths. Don't even get me started!
As far as stats concerning women's experience of birth, a huge flaw in Australian services is that there is no systematic collection, collation and analysis of feedback from the consumers of maternity services at all. QANTAS and McDonalds do this more that obstetric services do. Unlike New Zealand, where the Birth Review is mandatory. So, we're told what's good for us. We have no voice to assert what WE think we want and need. Hundreds of submission to the Maternity Review have been utterly disregarded because Pesce and Mourik et al get to dictate what Australian birthers want.
I'd like to see questionnaires like this Birth Review offered to all consumers of maternity services in Australia.
Personally, I would hope that only a minority of women would request an epidural purely because they feel the contractions are painful. To me, that would be like running or cycling and expecting to feel no sensations. That comes back to my view that it's not epidurals that have a bad rap, it's normal birth: society has distorted what normal birth is, and attached so much fear to normal processes, that fear adds much pain to the normal pain of a normally progressing labour. Every possible environmental factor birthing women need to enhance the optimal flow of their natural endorphins is stripped from them in the average obstetric environment. Hence, they need epidurals more. FM, if midwives try to support women more and discourage them from getting an epidural, they are doing the right thing, as a general rule. That's what they should be doing. However, if your birth plan is, I want my epidural in by 3 cm done my research thanks, weighed the pros and cons and that's my decision, and that's written in your birth plan, I would imagine you'd have a pretty good chance of getting that respected.
My midwife mother once supported a woman in labour who had experienced sexual abuse. The trauma was triggered during labour. She ended up with three midwives sitting with her on her bed, asking, "What do you need? How can we help?" She said "I need to not feel anything down there." They organised an epidural for her, and she was able to give birth to her baby vaginally. This is an example not just of a success story of epidural technology, but of emotional support and personalised care also.
Hi Mamallama :rolleyes:
I've been a party to quite an indepth discussion about this particular book on another site.
In the course of that discussion, after some research it turned out that the study this author based his book on was comparing women who had epidurals with women who had other forms of pain relief - mainly opiates. There was no data comparing women who had no pain medication with those who had epidurals.
After that, I pretty much stopped listening.
Perhaps you would be so kind as to post a link to that study so that others may read it for themselves. Since it formed the basis for his whole book and all.
You might find a willing audience for your propaganda elsewhere. But you won't find it here.
Julie, I couldnt agree more that Australia needs to offer women who give birth a questionaire in regards to their experience and collate the data from that like in NZ. I agree with you that it is best for a mw to try and get a woman through without intervention where possible and if other intervention is not requested by the woman as this in the majority of cases (with low risk pregnancy) is safer for the mum and baby.
I had the best midwives in the public system who knew that as a young, fit healthy woman with no complications could get through this without intervention. Yes it hurt, but I expected it to. I was lucky enough to have the perfect birth for me which was no epidural.
I think (and this is my opinion) that a lot of women have epidurals, and the majority that have them are not for medical reasons, just for pain relief which is why midwives want to try and get you through labour without the epidural.
Fatmama- I read your other thread on your complications and why you would need an epidural and I am sure that would be respected by an Ob and midwives at whatever hospital that you go to. Your life would be at risk without one.
gee I hope I made sense, dont have time to read over as DD is crying.
im not scared off by them...i've had 3 myself lol:
I appreciate the ideal 'natural birth' senario , but lets face it, birthing is not easy or pretty or mystical in any way...its damn hard and in the years before the C-section was used, women died. Many women died during childbirth.
I did try to do it naturally, but my body wanted no part of it so it became a matter of 'just get the baby out'
the epidural was like being in heaven after a solid 28 hours of labor!
*sound of crickets chirping*
Gee. Awful quiet in here all of a sudden.
~E~
x
The thing that I found, was that I didn't have the right information going into the birth. I seriously didn't even know that lying on my back would be the worst possible position in terms of both pain and speedy labour. I mean after all, they're always on their backs in movies and on TV!
So when I was told to lie on my back for an internal and then got a contraction (the first one that hurt, I wonder if that's a coincidence), then they said "it will be at least 8 hours more of this pain and the anaethisist is about to leave - have an epidural now or you won't have a choice", and then badgered me when I was uncertain - well I believed them and had it. And later regretted it.
I think what would be really useful for women is to have birthing positions and active labour explained to them, and the pros and cons of pain relief better explained. Sure I was told there were risks with an epidural, but no-one told me how much more likely intervention was going to be, no-one told me that I would have pain for weeks afterwards because I would need an episotomy due to forceps use, no-one told me that having an epidural makes you feel like an invalid after the birth, rather than fantastic and invincible like you do after a drug free birth. I was also told of the "1/100" risk of severe headache. After the epidural was in, the anaethesist told me that I would have been that 1/100 with a less experienced doctor, as I had a very small space and he nearly missed it. Very reassuring!
For what it's worth, before this thread started (and finding out my Papp A score is low thus maybe necessitating a c/s), I admit that I was one of those gals who always imagined herself screaming for "drugs, more drugs" during labour.
Now however, after reading some of the comments from others, I am off to research natural labour and birth techniques.
Probably not the outcome FM was hoping for, but again, it's all about choice. And the thought of an episiotomy due to forcep use that wouldn't even be necessary without an epidural honestly scares me more than any pain associated with labour does.
Plus, after doing some Googling of my own, I'm not sure that the studies in this book have been presented in a completely forthcoming and relevant light.
I swear, if any of those people close to me could read this post where I state I'm debating giving up my adamance of being drugged to the hilt if I feel I'm in 'too much pain', I honestly think they'd suffer severe shock. I'm still hell-bent on having a bit of lip gloss on and cute jammies but that's about it.
And this is another example why I finally stopped lurking and started posting. I love this site and all of the invaluable information and sharing of experiences that it contains.
Shari xo
maybe it was the particular hospital that you went to. i had an epi for first birth which the mw recommended that i have! second time round when we were discussing pain options the i was saying no i want to see if i can get away without it but the more we were talking the mw said, it sounds to me like you kind of do want one so we can organise an early one if you want? i asked for one at 5cm got it in and hooked up within half an hour and then started pushing so didnt really need it after all as i dilated so quickly towards the end. so i havent found my hospital to be anit epi or have a delayed response to giving them.
Hi Fatmama,:
I have to say i disagree with you on your first point. i"ve had 3 children in 3 different major city hospitals (Paddington Womens in Syd, The Mercy in Melb, The Royal Womens in Melb) None of these hospitals made it difficult for me to obtain an Epi.
Actually, they were all fantastic and the midwives and doctors had no hesitation in getting me what i wanted.
Can i ask which hosp you attended where you got this treatment?
When it comes to an ideal birth, I want it pain free all the way ;)
but i can see where you are coming from. there seems to be an unspoken rule that a drug free 7 intervention free birth is the only good birth. That may be well and good for those women who can birth naturally, but not all of us can. I do get a little peeved off when I'm told of the virtues of natural birth and drug free births and everyone should do it and if you dont then you are some kind of cheater. That annoys me.
But your preference is supported. And in the public system, it is paid for by the government. That's good, that's as it should be.
However, women who actually don't want the gas, peth or epi, and actually would really like privacy, a birth pool, and continuity of care from their own midwife ... can't access that as easily. Homebirth is not supported and funded.
It's great that your choices are supported, but what about these other women? Their preferences are no less reasonable, according to research.
Also, your preferences are on the increase, dramatically, throughout the world. It is natural birth skills that are at risk of dying out.
Not 'everyone' should have a natural birth, but why should those who actually do want to, have to fight tooth and nail for an unhindered birth? Or have to pay for it from their own pocket, without even any subsidy? How is that fair?
Julie i understand what you are saying and i believe you are right...there should be the home birth option supported by govt funds:
but who administers it? Independent midwives?
No matter how you try to achieve it, the administration will still have to be carried out in a bureaucratic fashion, they will have to impose rules and legislation on how the practice is managed and financed and this will lead to the inevitable involvement of hospitals and obstetrics.
If anyone wants to home birth they can do that right now simply by not going to the hospital when they go into labor. It seems though that the vast majority dont want to do this which is why all the funding and administration is going to the hospitals. Until more women choose to home birth you'll be hard pressed finding funding.
So if the issue is really about choice, then nothing is stopping any women from birthing at home.
If it can be achieved in other countries, then it can be achieved here. We don't have to follow the USA. There are other countries with successful homebirth services.
Hospital birth is funded. Homebirth is not. Actually, finances do prevent some women from accessing homebirth. That's not right. It should be funded as is it in New Zealand - where there really IS choice - or at least subsidised as in most other developed nations (except USA).
But until homebirth is properly resourced, funded and promoted (not slandered), then women will continue to find it extremely difficult to access homebirth, especially in rural areas. That is not free and equal choice.:
Until more women choose to home birth you'll be hard pressed finding funding.
Many more women *want* to have homebirth as an option than those who are making the statistics.
The successful models of homebirth on other nations of course involve the back-up of modern hospitals. Homebirth does not mean you *never* use obstetric services, it means that you do it when necessary, not as routine.
Quite a few things prevent women in Australia from homebirthing if they want to - it is not a free and equally supported choice. I've heard so many women tell me, "Oh I would have loved to have had a homebirth, but .... didn't have the money/ didn't know any midwives / GP frowned on it."
This has been accomplished in other countries. The recent research of 530,000 homebirths speaks about having the back-up of a modern hospital system, and the proper empowerment and support of midwives who provide homebirth services. (We actually have one obstetrician here in Melbourne who attends homebirths.) People who desire homebirth aren't against the involvement of hospitals and obstetrics - but only when necessary. Not as the only default option. The cooperation of both models, and the funding of both models, is a given.:
the administration will still have to be carried out in a bureaucratic fashion, they will have to impose rules and legislation on how the practice is managed and financed and this will lead to the inevitable involvement of hospitals and obstetrics.
You're right, - we don't want anything much different for women. We both want women to be empowered to have choice and basic human rights. We can both see ways in which this is just not the case in the current system. Like you, I find it confronting that women who desire an epidural are made to 'hang on' due to cost-cutting measures. That is not right - especially in an environment in which a woman is likely to be deprived of every other coping mechanism she needs to reduce her pain. Such as::
- privacy
- quiet
- access to deep water
- freedom of movement
- continuous emotional support and physical care, such as massage
- continuity of care from a midwife she knows and trusts, or at least a doula.
How ironic that women would be deprived of a requested early epidural for cost-cutting reasons - but also deprived of home birth options that are spectacularly economical. Go figure??
The problem I have is that the net result is women getting a hard time and sub-standard care, made to suffer needlessly, and being subject to coercion, regardless of whether they want to give birth in a birth pool at home, or have an epidural at 3 cm. Money is not the only reason women aren't getting their choices honoured in such scenarios. If it was, home birth and birth centre birth would be supported because it's cheaper. It's also about power. I understand your outrage, I feel the same. I want a better deal for birthing women. It's not that hard to achieve.