Valerie Gommon Midwife’s Blog

Archive for the ‘epidural’ Category

Another guest blog by Sarah:

Harlow Zen’s Birth Story

Harlow is my third baby having had Rohan 9 years previously and Nayt almost 8 years ago.  With Rohan I was induced at 10 days late, in hospital, with an epidural given as I was told he was back to back and it would be too painful, I ended up after 17 hours flat on my back, with a nasty tear and a pretty miserable painful experience to tell but a beautiful baby nonetheless.  I had Nayt 16 months later and keen to never set foot in a hospital again, we used 2 Independent Midwives and had an amazing natural home water birth, in less than 4 hours with no pain relief, no stitches and 23 days late! I was out and about within days, a completely different experience to my first. Both babies were reasonable sizes at 8lb 13oz and 9lb 2oz respectively.

With Harlow, because he was my husbands first and I was a bit rusty having had a good few years off baby making, we decided to use another Independent Midwife as the 1-2-1 care is like nothing else, and gives you the confidence that you will get the best birth outcome and overall experience possible, as they really get to know and understand you.  As my pregnancy progressed it was clear this baby was going to be on the large size, which I had kind of expected. I was advised to cut down on sugar but with a massive cake craving, this didn’t really happen, so I tried damage limitation by continuing to ride as long as I could and towards the end to swim daily and keep up with walking the dog.

I think my confidence in giving birth was knocked a bit towards the end because I had to have a series of late scans to check the placental position, as was slightly lying low at the 20 week scan. This showed up that at 34 weeks the baby was the size of a full term baby. I am reasonable at simple maths, and that added up to one BIG bubba!!

Because of this, I was told to expect an early baby. Unlike my other two pregnancies where I had no pre-labour signs whatsoever, I was starting to get runs of proper contractions about 3 weeks prior to my due date. I had so many signs in fact that I have decided there are no signs until the baby is literally crowning!! Along with contractions, I was nesting, had a show,  had a permanently bad tummy, babies head engaged….never happened to me before labour with the other two, bump shifted down….and then my due date came and went…and my bump un-engaged and shifted up!!!

On Tuesday 18th May after my husband Adam had taken the kids to school I started to get decent contractions. I really felt like today was the day. By midday they had gone, and annoyed I took my dog on a hill walk hoping to jolt the baby out with some gravity! Nothing! I was really sure that was it too, as my dog Phoebe had been all over protective, following me around and sleeping beside me wherever I went.

They started again around 11pm, but having sent our midwife numerous ‘I think its started’ texts over the last few weeks, decided to sleep on it.  At 1.55am Wednesday 19th May I woke up with a jolt as my waters literally burst all over the place. I managed eventually to wake my husband up who had fallen asleep on the sofa downstairs and after a massive clean up operation we called our midwife Valerie and she came out straight away.

The contractions had stopped but restarted around 3am and were roughly every 3 mins, reasonably painful (a 5-6) but not lasting too long. We all tried to get some sleep at 6am, but the contractions slowed down a lot.  By the time my kids woke up and we had agreed they could take the day off school, they were back to quite painful and we all thought finally ‘this is it!’. By about 9.30am I got into the birth pool my husband had busied himself filling and my labour ground to a halt and slowed down. My parents came and took the kids out for lunch as it was my Dads birthday, and gave me a bit of space and peace. At 1pm-ish we asked Valerie to examine me and I was disappointed to find I was barely dilated, and all that pain and hard work had merely helped Harlow to get into a better position.  Valerie left for home and me and Adam went for a walk, had some lunch and then at 5.20pm decided to get some sleep.  My kids were sent off to their rooms to watch a film.

At this point I was feeling despondent and was sure my pain threshold was rubbish. I started soon after to get contractions every 8-9 mins, lasting almost 2 mins and they were really painful. The peaks seemed to last for 40 seconds before subsiding. By almost 7pm I was crying and convinced I was still about 3 cm dilated.  I got very emotional and was convinced I would end up in hospital with a c-section. Adam was amazing and really supported me. He suggested we call Valerie, who had just text me. She came out with the entonox and as soon as she arrived I was getting the urge to push. I was on all fours and could not move into any other position…how I got downstairs I have no idea!!!

I managed to get downstairs and Adam re-filled the pool which we had drained down partially earlier.  I got in, and contractions were very close, strong and the peak lasted ages. Adam was great and helped me get the gas and air when I needed it, and provided emotional support as well as an arm for me to dig my nails in (sorry Adam!!), and Valerie helped me to get past the panicky ‘I cant do this’ with encouragement that I could really trust in.  At 8.20pm I could feel Harlow move down and he was born in the birth pool at 8.40pm. Valerie had called my kids down and they both watched their little brothers entrance into the world.

Harlow was born behind me, so with some jigging I was able to climb over my cord and hold him.  He cried a little and had a feed quite soon afterwards.  He was covered in vernix and his skin felt so soft.  He looked just like 3d scan picture and apparently my first words were ‘Hello Harlow’.  Adam cut the cord after it stopped pulsating and Valerie tied the cord with a cord tie I made specially for the event, and as I delivered the placenta naturally an hour later, Adam, and the kids had all taken turns to hold Harlow and make their introductions. It was the most special sight ever and something they will never forget, nor will I.

At 10.30pm we sent the kids to bed, and after a glass of champagne with Valerie; myself, Adam and Harlow settled down for our first night together. Perfect.

We were all a bit shocked that Harlow tipped the scales at 10lb 6oz, and I got away with a tiny tear and a graze and no stitches!! It was a more painful labour than Nayts birth, and the longest overall labour, but an amazing experience that 5 days after the event makes me ask ‘when can I do it again’???.

I have just found an interesting article which says that drugs which are often routinely given to women immediately after birth could reduce their chances of breastfeeding.

www.walesonline.co.uk/news/health-news/2009/09/02/life-saving-childbirth-drugs-could-reduce-ability-to-breastfeed-91466-24586076/

The article is so interesting that I will copy it complete below.  My only query regarding the research is to question whether women who choose not to have syntocinon/syntometrine/ergometrine (the drugs routinely used to speed delivery of the placenta, and which many believe help to prevent haemorrhage) may be better informed – perhaps choosing homebirths or waterbirths where the use of these drugs is less frequent – and therefore more likely to breastfeed.

It should also be pointed out that whilst the vast majority of doctors and midwives believe the use of drugs to deliver the placenta to be beneficial there are others who do not believe that they should be used routinely (see Delivering Your Placenta www.aims.org.uk).

“A study of 48,000 new Welsh mothers has suggested the drugs, which can be life-saving, could also be linked to reduced breastfeeding rates.

Researchers from Swansea University believe the drugs, which are used to prevent bleeding after childbirth, may be the reason why so few mums breastfeed, with only 45% continuing within a week of the birth.

The analysis of the records of women who gave birth in South Wales found the use of the blood-clotting and other drugs were associated with a 7% decline in the proportion who started breastfeeding within 48 hours of giving birth.

Researchers believe the drugs may impede a woman’s ability to produce milk and say new mothers may need greater time and support from midwives if they wished to breastfeed their baby.

Dr Sue Jordan of the university’s school of health science, who led the study, said: “Our results highlight the need for further research and clinical trials. What we would like to see is extra help for new mothers trying to establish breastfeeding by making sure to allow enough time for the effect of drugs given in labour to subside.

“Our new findings could contribute to meeting the government targets of reaching that extra 2% of women breastfeeding per year.”

The study is the second link the research team has drawn between breastfeeding rates and drugs given during or after labour. Their previous research confirmed the link between epidurals and reduced breastfeeding rates which prompted revised guidelines for the NHS on the use of the drugs in labour.

Dr Jordan, however, supported the current medical practice regarding the use of the drugs saying: “The potentially life- saving treatments to prevent bleeding after birth must not be compromised on the basis of this study, but further studies are required to establish ways to minimise any effects on breastfeeding rates.”

Of the women involved in the study, who all gave birth between 1989 and 1999, 65.5% of those who did not receive drugs to prevent bleeding after the birth started breastfeeding their baby within 48 hours of giving birth.

This dropped to 59.1% among those given an injection of oxytocin, a hormone that stimulates contractions and plays a natural role in labour, and to 56.4% of women given an additional injection of ergometrine, given to stop bleeding after the birth.

In the study 79% of women received either oxytocin, ergometrine or both, as is routine in the NHS.

“The decline of 6-7% in those being breastfed could lead to up to 50,000 fewer British babies being breastfed every year than might otherwise be possible,” said Dr Jordan.

UK health surveys claim the results of bottle-feeding can lead to obesity and asthma as youngsters are not getting the natural benefits of a mother’s milk. Bottle-feeding has also been linked to an increased number of mothers being affected by breast cancer.

Rosemary Dodds of the National Childbirth Trust said: “Women need more support to start breastfeeding soon after giving birth and this study adds weight to that. A lot of women are not given enough information about the medications that might be given to them during childbirth, and women at low risk of bleeding may not need to take these drugs.”

Helen Rogers, leader of the Royal College of Midwives in Wales, said: “We welcome studies like this as it shows the important part midwives can play in breastfeeding. Unfortunately, with staffing levels on maternity units, midwives are looking after mums who need more medical care and attention rather than those who have breastfeeding problems and have no other ill effects from the birth.

“Also, mums are now keen to leave hospital, sometimes within six hours of the birth, and as a result they lose the midwife contact and support they may need if they have problems breastfeeding.”

Dr Jordan said the next step in her research was to seek funding for further research and clinical trials to measure the real effect of medications given during labour and the uptake of breastfeeding.”

ENTONOX

Also known as “gas and air” (50% oxygen and 50% nitrous oxide).

Self administered through a mask or mouth piece

Used to breathe in and out during contraction

Helps you cope with the pain and also acts as a distraction by giving you something to focus on

ADVANTAGES

Helps take the edge off the pain

Does not affect baby

Can not overdose

Can stop using it at any time

DISADVANTAGES

Can make you nauseous or vomit

Can make you feel “drunk” or out of control

MEPTID

A pain killing drug similar to pethidine.  It is given by injection either into your bottom or thigh.  It usually relaxes you a bit and takes the edge off the pain.  This drug has to be prescribed.  We give an amount proportionate to your weight.

ADVANTAGES

This drug helps some women

The effects on the baby are probably slightly less than pethidine

The nausea/”drunk” feeling may be less than pethidine

Can be given again after 2 hours

DISADVANTAGES

It can make some women feel nauseous and vomit

Some women do not to feel “out of control”

It may affect the baby’s breathing/ability to breastfeed if given shortly before the baby is born

Can not have meptid if having a waterbirth

PETHIDINE

A pain killing drug, given by injection into your bottom or thigh.  It takes about 20 minutes to take effect and lasts for up to four hours.  It usually takes the edge off the pain and relaxes you.

ADVANTAGES

Effective pain relief for some women and relaxing if nervous

Can help you to sleep

DISADVANTAGES

Some women do not like the “out of control” feeling

Can cause nausea and vomiting

For some women it has no effect at all

Pethidine crosses the placenta and can affect baby’s breathing/ability to feed (antidote is available)

Can not have if having a waterbirth

DIAMORPHINE

Similar to Pethidine – A pain killing drug, given by injection into your bottom or thigh.  It takes about 20 minutes to take effect and lasts for up to four hours.  It usually takes the edge off the pain and relaxes you.

ADVANTAGES

Effective pain relief for some women and relaxing if nervous

Can help you to sleep – long lasting

DISADVANTAGES

Some women do not like the “out of control” feeling

Can cause nausea and vomiting

For some women it has no effect at all

Diamorphine crosses the placenta and can affect baby’s breathing/ability to feed

Can not have if having a waterbirth

EPIDURAL

An epidural is where painkilling drugs are passed into the small of your back via a fine tube. It is called a regional anaesthetic, which means the drug is injected around the nerves that carry signals from the part of your body that feels pain when you’re in labour. The result will be that your belly feels numb, giving you very effective pain relief

ADVANTAGES

Good pain relief – especially if labour is long, or instrumental delivery is required

It can be used during a caesarean section and therefore avoids the use of a general anaesthetic

DISADVANTAGES

You need to remain very still whilst epidural is being sited

It causes a drop in maternal blood pressure:

You will need an intravenous drip to counter this drop in blood pressure

Drugs used pass through the placental barrier

Your baby will need to be continually monitored – in extreme circumstances the baby can become distressed necessitating an urgent caesarean section

You will usually need a urinary catheter to empty your bladder

It can slow the labour necessitating a syntocinon drip to get contractions going again

It restricts your movement – usually you will be confined to bed and it can be harder for the baby to get into the best possible position for birth, this can make the labour longer, and make it more likely that you need help (ventouse, forceps or caesarean section)

It may not be 100% effective and you can have “break-through” pain

There is a lack of sensation to ‘push’ in the second stage and this leads to an increased need for ventouse or forceps deliveries

The effects can take some time to wear off


What is the definition of Natural Childbirth?  A hospital might say that a woman whose labour was induced and who had an epidural was a normal birth; others might say that induction, augmentation, analgesia, episiotomies etc do not constitute a normal birth!

A more radical definition of a natural birth might be a labour that starts spontaneously between 37 and 42 weeks gestation, and progresses to a vaginal birth without any intervention or pharmacological drugs.

Natural childbirth has been given a bad press – women choosing natural childbirth have been described as “hippy types” and indeed there has been an item in the press this week about a midwife who suggested that women would do better to avoid epidurals that has caused considerable outrage!

Pregnancy and childbirth are normal life events, not medical condition; a woman’s body is perfectly designed to give birth.

Of course some pregnancies and labours will need medical help – but the vast majority of women will go through their pregnancy and birth without problems and this process works best when interference is kept to a minimum.

For example anything we do to interfere with this natural processes has consequences – if mother and baby are well I am suggesting that we (the medical profession) should not interfere!

One example of this is the huge number of women whose labours are induced – why?  In some areas women are induced at 41 weeks (interestingly in France a normal pregnancy is defined as 41 weeks!).

Induction is not an easy option.  It is usually quite a lengthy process which makes the mother tired.  It is also usually more painful and the mother is therefore more likely to need pain relief, possibly an epidural … the mother is then less mobile … making it harder for the baby to find a way through the pelvis and consequently she is more likely to need the help of a ventouse or forceps, or even a caesarean section.

We all know that although caesareans are very safe in this country, it is still far safer for both mother and baby if the baby is born vaginally.  A caesarean section is major abdominal surgery which will take weeks and months to fully recover from – and the mother will have a demanding baby to care for too!  Babies born by caesarean also have many more problems, and are far more likely to need to receive Special Care.  There are also implications for future pregnancies – so, although fantastic if needed, caesarean sections are far from ideal.  The World Health Organisation recommends a 5 – 10% caesarean section rate, but our rate is approaching 30%, and I believe 90% at The Portland private maternity hospital!

This interference in birth has been called a “cascade of intervention”, because we do a) we have to do b) and because we do c) d) is also necessary this is also described as “iatrogenic” or hospital induced.  Whatever we do has consequences, for example a woman with an epidural will need more careful monitoring, she will need an IV drip and also a catheter – so you can see this spiral effect, because we do this, we have to do that and so on …

I believe there are several factors that lead to this escalation of intervention in childbirth:

Our cultural conditioning, fear, poor health habits and medical intervention in normal birth (perhaps because of fear of litigation) that make birth difficult often requiring more intervention, including surgery.

With good preparation, much intervention can be avoided – women who have a midwife they know and trust are less likely to need analgesia.  With good preparation they should be in optimal health for the birth – complementary therapies they may have experienced acupuncture, homoepathy, osteopathy or any number of helpful treatments during their pregnancy which will help align their body and prepare them for birth.  They may also have practised relaxation or hypnosis techniques all of which can be hugely beneficial.  There is also much a woman can do to help herself: mobilization, relaxation, support, the use of water …

The satisfaction that a woman feels when she has successfully given birth is amazing – it is empowering and is a fantastic start to the parenting journey, and of course breastfeeding is so much easier when you haven’t got a caesarean section wound on your abdomen.

If things didn’t work out this way for you, remember that you did the very best you could at the time.  Some labours do need help and some mothers and babies wouldn’t survive without the help of our medical colleagues.  If this has raised questions or distress for you I am more than happy to speak to you please do feel free to email me info@3shiresmidwife.co.uk

A difficult or traumatic birth experience has long-lasting implications for both the mother and sometimes her child.  We don’t have many babies in our lifetime and it is important to get things as right as we possibly can!


There has been quite a bit of debate this week about whether women should have access to an epidural in labour.

Of course in the majority of cases women do have access to an epidural in labour if this is what they choose, however many maternity units cannot GUARANTEE that a woman will get an epidural when she requests one.  This may be for several reasons.  A woman who has an epidural needs to have one to one midwifery care to ensure the safety of both the mother and her baby.  If a unit is particularly busy or poorly staffed a midwife may not be available to give this level of care (it is well documented that midwives are often caring for two or more women who are in active labour), secondly, an anaesthetist may not be immediately available.

The debate occurred because there have been several articles in the media recently regarding the National Childbirth Trust’s (NCT’s) views on women’s access to epidurals following the publication of a guidance document, “Making Normal Birth a Reality”, drawn up by the NCT with the backing of the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. www.appg-maternity.org.uk/resource/Normal+Birth+Consensus+Statement+NEW+LOGO.pdf and www.nct.org.uk/press-office/press-releases/view/128

There was a very interesting debate on Woman’s Hour this week when Belinda Phipps, the Chief Executive of the National Childbirth Trust was interviewed opposite Smriti Singh.  www.bbc.co.uk/radio4/womanshour/02/2009_10_thu.shtml and

The programme highlighted that epidurals are extremely safe (and I say thank goodness for the fantastic medical care we have if it is needed), but I personally do feel that there are very good reasons for avoiding an epidural if possible.

Epidurals are not recommended until a woman is in “established” labour, that is that she is having regular, strong contractions and that her cervix is dilated (usually to 3cm).  The reason for this recommendation is that if the epidural is given earlier the labour could stop as labour may not be fully established.

By having an epidural, a woman is usually confined to bed.  She will need to have her baby continuously monitored by a cardiotocograph machine (CTG) as the epidural can affect the baby, she will also need an intravenous drip because the epidural can significantly lower her blood pressure and she may well also need a urinary catheter to keep her bladder empty.  Being confined to bed will not allow the normal active behaviour of the mother which will help the baby into the optimum position for birth, nor will she have the affect of gravity.  Epidurals occasionally allow the labour to progress more quickly, but more likely the labour will slow and an oxytocic drug (syntocinon) will be needed to increase contractions, and so the “cascade of intervention” continues.  It is also true that women are slightly more likely to need assistance from either a ventouse or forceps to deliver their baby as it is more difficult to “push” out the baby when you have an epidural.

Whilst being an advocate for my clients, and if (given this knowledge) a woman chooses an epidural I honestly believe it is my job to support her in this choice; this said, I believe that far fewer women would actually choose an epidural is they received appropriate one to one support, preferably from a known midwife during their labour.


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