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Childbirth questions

One child, did a hospital NCB, and will do the same for any future children, barring complications. I wanted to go natural since, based on the reading I did, epidurals can increase the risk of needing other interventions and can ultimately culminate in a c-section, which I wanted to avoid. In addition, the position you generally have to push in when you have an epidural (on your back or semi-sitting) is just about the worst possible position in terms of actually getting the baby through the birth canal. I did side-lying pushing and then sort of squatting on the end of the bed for the final part.

Also I did not want anyone sticking anything near my spine unless absolutely necessary!

Did it hurt? Yeah, it hurt. I had a fast, intense labour (6 hours from first contraction to birth), and transition in particular was pretty brutal. However, I've had IBS for years, and the worst part of labour was not as painful as my worst IBS attack. The prospect of pain didn't really scare me, and it turned out labour was painful, but totally bearable.

The other reason I wanted to go natural was that recovery is usually easier (again, barring complications like retained placenta or hemmorage). There's no drugs to get out of your system, and I was up and walking around about 10 minutes after delivering the placenta. And the high! My god, it was the like the best drug in the world. If they could bottle that feeling you could make a fortune. I'm not sure how much of that is due to the NCB or just to seeing and holding the baby, but my SIL (who had 2 births with epidurals and one NCB) said the feeling after the NCB was indescribably more intense than after the births with epis. Anecdotal, but it kind of makes sense that drugs to relieve the pain might also interfere with the hormones that create that feeling after the birth.

Oh, and we did pretty much no preparation, other than the hospital childbirth classes and some half-assed breathing practice. I tend to be one of those annoying 'power of positive thinking' people. I was sure labour was going to be fine, and it was.
 
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TobiasTheCommie said:
Well, stop being dissapointed, the series hasn't ended.

Season 5 starts next year. :D
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Wow, that's the best news I've gotten since I heard I had a baby coming! ;)

mommyrex said:
I figured an epidural wouldn't save my life, just save me some pain, so if I could find another way of dealing with the pain, an epidural would be unnecessary. Having made my decision, I did what I could to implement it.
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This is exactly the thought process my wife is coming from. Before I started pondering this issue it really seemed to me that she might as well spare herself the pain if she's able to, but it's becoming apparent from all the wonder posts here that the pain is an acceptable alternative to any of the potential risks of the epidural, no matter how remotely likely they may be.

rjh01 said:
My sister and I were both born at home. That was normal for the UK 50 years ago. Advantage is that there is no stress going to a hospital and a strange room. Of course if things go wrong...
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Just curious, but was there a doctor or some other experienced person present for the delivery of you and your sister?
 
ponderingturtle said:
This is unlikely, how highly trained are they? Basic EMT's are trained to deliver babies, and I would be suprised if the required training was that of an RN
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In the U.S., we have certified nurse-midwives (CNMs), which means they have an RN plus additional specific training, like a nurse anesthetist or a nurse practitioner.

There are direct-entry midwives, but I'm not sure any of them work as primary birth attendants at actual medical facilities (including freestanding birth centers). I think they may be licensed and legally practice in some states, but for the most part, the CNMs are the official, legally recognized alternative to a doctor for an uncomplicated childbirth.

Edited to add Wikipedia entry on Midwifery.
 
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mommyrex said:
In the U.S., we have certified nurse-midwives (CNMs), which means they have an RN plus additional specific training, like a nurse anesthetist or a nurse practitioner.

There are direct-entry midwives, but I'm not sure any of them work as primary birth attendants at actual medical facilities (including freestanding birth centers). I think they may be licensed and legally practice in some states, but for the most part, the CNMs are the official, legally recognized alternative to a doctor for an uncomplicated childbirth.
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I have known a nurse who was also a mid wife and hear of someone who was planning on going dirrect. I am sure that they would all know more than an EMT or Paramedic about this as that is a very small part of the course. The issue I was wondering about was alot about are they at all comparable to doctors and clearly they are not.
 
ponderingturtle said:
I have known a nurse who was also a mid wife and hear of someone who was planning on going dirrect. I am sure that they would all know more than an EMT or Paramedic about this as that is a very small part of the course. The issue I was wondering about was alot about are they at all comparable to doctors and clearly they are not.
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Ah, I see what you mean. Yes, they aren't comparable to doctors in training or in the range of services provided. But for an uncomplicated childbirth, they provide the same services (which is what I'm guessing the "doulas and doctors rolled into one" was intended to mean).
 
mommyrex said:
Ah, I see what you mean. Yes, they aren't comparable to doctors in training or in the range of services provided. But for an uncomplicated childbirth, they provide the same services (which is what I'm guessing the "doulas and doctors rolled into one" was intended to mean).
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And my point is that I am qualified for an uncomplicated birth as well, being a NYS certified EMT basic. The training needed for an assistent in such cases is very small. The point is that they can do less than doctors there are all kinds of things doctors can do that nurses or EMT's can't. It is the complicated things that you need the doctors for, and that is an issue here.
 
Midwives, however, are trained in much more than just delivering the baby. They also do all the pre-natal stuff, and they're very highly trained in recognizing when any complicated stuff is starting so they can transfer care to a doctor/hospital if necessary.
 
dissonance said:
Midwives, however, are trained in much more than just delivering the baby. They also do all the pre-natal stuff, and they're very highly trained in recognizing when any complicated stuff is starting so they can transfer care to a doctor/hospital if necessary.
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Mabey I am sure they know more about it than I do. I was just taking issue with compareing them to doctors
 
ponderingturtle said:
Mabey I am sure they know more about it than I do. I was just taking issue with compareing them to doctors
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Sorry, haven't been following this thread for a bit.

I was referring to the fact that midwives perform the role of an Ob/Gyn when it comes to actually delivering the baby. Our health care system covers the full cost of pre/post-natal and delivery from either an Ob/Gyn or midwife.

I was certainly not comparing them education wise, though I believe they would be similar experience wise when it comes to uncomplicated births. For complicated births, midwives are legally bound to surrender care to a doctor.
 
Ha! They do, don't they?

ysabella, your son is a major cutie. My daughter is 15 months, and I'm really getting that urge for another...

Stealpick, I forgot to say congrats! You've got a lot of fun (and lack of sleep) ahead of you. My husband didn't really understand why I wanted to forgo the epidural, but was a great labour coach anyway.
 
rjh01 said:
I know you are going to ignore me. But just in case I am wrong.

My sister and I were both born at home. That was normal for the UK 50 years ago. Advantage is that there is no stress going to a hospital and a strange room. Of course if things go wrong...
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I don't think there is any evidence that home birth for "low-risk" mothers is any more risky then hospital birth and given the level of antenatal care today the "high risk" mothers can be identified.

I was also born at home almost 40 years ago and my mother was attended by the midwife for about the last hour of labour, she didn't see her doctor until two days later when he called on her to see how she and me were doing.
 
Okay, just going to comment on the epidural part (as I'm somewhat more qualified than the average bear to do so).

1. Epidurals do not result in increased rate of caesarian section, if you believe the most recent data (which is quite good). There are two very good papers out right now, one from 2005 in the NEJM and another in the March Journal OB/Gyn (authored, in part, by an anesthesiologist I personally know) that support this. The problem is that, after the epidural goes in and the labor fails to progress, people tend to want to blame the epidural. When a women chooses not to have an epidural and the labor fails to progress, well, that's just nature. Point is, this is why we do randomized prospective studies. I believe the data. Most OB/Gyns these days do too. A lot of nurses and other sideline commentators don't, and there is a lot of "sabotage" (for lack of a better word) that still goes on.

CONCLUSIONS: Neuraxial analgesia in early labor did not increase the rate of cesarean delivery, and it provided better analgesia and resulted in a shorter duration of labor than systemic analgesia.
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http://www.ncbi.nlm.nih.gov/entrez/..._uids=15716559&query_hl=7&itool=pubmed_docsum

CONCLUSION: Initiation of epidural analgesia in early labor, following the first request for epidural, did not result in increased cesarean deliveries, instrumental vaginal deliveries, and other adverse effects; furthermore, it was associated with shorter duration of the first stage of labor and was clearly preferred by the women.
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http://www.ncbi.nlm.nih.gov/entrez/...uids=16522386&query_hl=12&itool=pubmed_docsum

2. You can place an epidural and not have it dosed until you're ready. Believe me this is an incredibly wise choice. In fact, I did this twice last week for two separate women. For the first, she wanted to have an epidural, but didn't want it turned on until she started having significant pain. The result? She paged me into the room, I started dosing it, and - I kid you not - that kid popped-out less than 45 minutes later. We were playing "catch up" with her pain. She swore next time she'd have it turned on earlier.

The second woman was having her second child, and she wanted to try it "natural". She'd had an epidural for the first child. After speaking with her, we determined that the best course would be to place a "dry" epidural (i.e., the catheter is placed, the test medication is given to ensure that it is functioning and placed correctly, but the main pain medication is withheld). This is where I had to navigate, in no other terms, attempted sabotage by the nurse who was taking care of her. Much of the conversation - unfortunately - took place in front of the patient. "You don't really want that epidural, do you?" the nurse would say. "We don't have to put the medicine in it now, but it'll be easier for you if I place it now so that you're not having to suffer contraction pains as I'm trying to stick a needle in your back," I'd reply. "But, you weren't really sure if you wanted an epidural at all, were you?" the nurse would shoot right back. I felt so badly for this poor woman. Being a doctor is more about being a technician anymore, and you have to battle with the occassional nurse who takes her role as "patient advocate", often armed with bad information and a personal agenda, a bit too far. Anyway, I put the epidural in, we left it "dry", and what do you think happened? About 2 hours later she started having severe contraction pains (this patient was hyperalgesic to begin with), the epidural was dosed, and about 3 hours after that the baby was born vaginally.

If labor fails to progress - for whatever reason - then you will be getting a spinal. That's the "standard of care" for caesarian section these days. A spinal differs from an epidural in that it is (usually) a single shot of medication directly into the spinal column that results in profound analgesia and motor blockade. Epidurals ("Epi-" on, "-dural" the dura) is where a catheter sits outside the spinal column and the medication bathes the nerve roots as they enter the spinal cord. Placing an epidural is a safe, routine practice that we literally do dozens of times a week. Even at this stage in my training, I've personally placed over 100. We even use Patient-Controlled Epidural Analgesia (PCEA) at our center for our epidurals so the woman (or man if it is a different procedure) is in control of how much additional medicine she (he) wants. To me, it's a no-brainer. But, I admit my bias. At least (I like to think), I have the best data on my side.

I respect that having an epidural is a personal choice. I don't push. If a woman clearly says "no thanks", that's it. But, a lot of times there is a lot of misinformation and misconception about what an epidural is and can do. Most women, once they've had one that worked well, never want to do it the hard way again. Anecdotally, this was proven to me just last week despite the best efforts of a particular nurse to interfere with my intentions to provide the best care for this individual. Fortunately, the patient made the best choice for herself.

-Dr. Imago
 
Question for Dr. Imago
Once a woman has had pain killers (such as an epidural) is she confined to lying on her back? If she has had no pain killers can she move around and give birth in any position she finds comfortable?
 
Dr. Imago, those two papers you reference - I have the impression from what you've quoted that at least one of them was comparing an epi in early labour vs. an epi in late labour - which doesn't address the issue of whether epis raise the c-section rate at all, because for that you need to compare epis vs natural. Does the other paper address that issue more directly?

Secondly, not to be contrary, but from what you wrote about the nurse and the patient you sound like the interfering one. You said the woman wanted a natural childbirth, and to me it sounds like the nurse was trying to encourage her to do that, while you were insistent she have the epidural catheter placed.

As someone who wanted a natural birth, it was incredibly annoying to be hassled about that stupid epidural everytime someone found out I wasn't planning to get one. A well-meaning doctor or nurse encouraging me to get one while I was in labour and vulnerable would have, in retrospect, pissed me off something fierce. Of course, that wasn't an issue for me because I'm a fast progressor and no one had time to offer me an epidural.

And most of the women I know who've done it both ways preferred doing it natural because the recovery afterwards was so much easier.

EDIT: This came out needlessly bitchy, sorry. Obviously, you have a lot more information about the situation you describe than I do, it's just well-meaning people often convince women who wanted to have a natural childbirth to get epidurals and then later on, after they've had time to process the birth experience, they're pretty pissed/unhappy about it.
 
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dissonance said:
Stealpick, I forgot to say congrats! You've got a lot of fun (and lack of sleep) ahead of you.
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Thanks very much! The excitement is very gradually building. The more my wife shows the more the reality sinks in, but I'm very much looking forward to this next stage in my life. And I'm much better at sleeping through night-time disturbances than my wife (she's always the one who wakes up when the dog starts sounding like he's about to throw up). Her maternal instinct will be to just let me sleep while she tends to the baby, right? :)

Dr Imago: Thanks very much for your input. I think your post and the ones that followed are at the crux of my reason for posting here in the first place. I'm really the kind of guy who likes to have as much data as possible and I like to look at research to help me figure out issues (as I'm sure the majority of the people here are). My two doctor friends (who are husband and wife) both echoed the points you made in your post. They've had two children recently (the 1st with and epidural and the 2nd without) and she still highly recommended that my wife keep the option open. So I found it difficult at first to reconcile the recommendations of doctors (who have delivered tons of babies) with the opinions of women who have actually gone through childbirth and chose not to get the epidural.

Obviously this is a very charged issue that many people are passionate about, but as you said, I think this one boils down to personal choice. I'd definitely feel more comfortable with pain-management options at the ready during the delivery, but I'm going to leave that decision in my wife's hands.
 
Ok, update on coupling series 5.

My information was very old, but as it stands BBC did commision a series 5, and Steven Moffat, who is now doing Doctor Who, did say he was interested in doing more.

But BBC have not been able to get the cast assembled.. Sorry for the false hope, i didn't know till know that it had bombed out(though the information has been out there for a long long time).

http://www.gallifreyone.net/forum/showthread.php?t=16931&page=4 <- reg required.
http://www.radioandtelly.co.uk/cgi-bin/forum/YaBB.pl?num=1111795177 <- less info, but no reg required.

Sorry guys, ed DAMNIT. :(

Note: in an attempt to salvage something a christmas special was in the works, but that too bombed out.

Steven Moffat have said some of what would have happened in series 5
http://en.wikipedia.org/wiki/Coupling_(TV_series)#Post-show_story_provided_by_Moffatt
 
Ripley Twenty-Nine said:
Sorry, haven't been following this thread for a bit.

I was referring to the fact that midwives perform the role of an Ob/Gyn when it comes to actually delivering the baby. Our health care system covers the full cost of pre/post-natal and delivery from either an Ob/Gyn or midwife.

I was certainly not comparing them education wise, though I believe they would be similar experience wise when it comes to uncomplicated births. For complicated births, midwives are legally bound to surrender care to a doctor.
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And my point is that for uncomplicated births, all you really need to do is play catch the baby. The weird experiance I had in EMT class was watching a video on how to deliver babies and they did it wrong(trying to turn the head instead of waiting for it to turn and getting the dirrection that it was going to turn wrong). ANd this was an educational video.
 
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