how common is it for the anesthesiologist to refuse to give an epidural?

[Anonymous]

Having had a horrible Vaginal and then a comparatively easy C, I would absolutely take a C over an unmedicated vaginal.

If I had known then what my vaginal delivery would do to my pelvic floor - consequences that will affect me for the rest of my LIFE, I absolutely would have taken the C.

[Anonymous]

The poster who is arguing that women shouldn't think or be told they need pain relief in order to handle labor: I don't think you understand what happens during a pitocin induction. Pitocin (synthetic oxytocin) inhibits the body's production of natural oxytocin. Natural oxytocin is what took the edge off the pain during your unmedicated labor and helped keep it manageable for you (I had this experience myself, so I hear you).

However, if you had been receiving pitocin then it's much less likely you would have been able to manage that level of pain on your own. Meaning, contractions would have felt much more painful to you (Pitocin contractions can be more intense). Even women who don't get any pitocin may also have lowered production of natural oxytocin especially if they are extra stressed or scared (adrenaline and cortisol also interfere with natural oxytocin production).

Epidurals can also be helpful to calm down, get necessary rest during a long labor, and relax a tense pelvic floor. They aren't only for pain management.

I really get what you're trying to say but I think you are looking at it through a very narrow lens of personal experience.

[Anonymous]

Anonymous wrote:The poster who is arguing that women shouldn't think or be told they need pain relief in order to handle labor: I don't think you understand what happens during a pitocin induction. Pitocin (synthetic oxytocin) inhibits the body's production of natural oxytocin. Natural oxytocin is what took the edge off the pain during your unmedicated labor and helped keep it manageable for you (I had this experience myself, so I hear you).

However, if you had been receiving pitocin then it's much less likely you would have been able to manage that level of pain on your own. Meaning, contractions would have felt much more painful to you (Pitocin contractions can be more intense). Even women who don't get any pitocin may also have lowered production of natural oxytocin especially if they are extra stressed or scared (adrenaline and cortisol also interfere with natural oxytocin production).

Epidurals can also be helpful to calm down, get necessary rest during a long labor, and relax a tense pelvic floor. They aren't only for pain management.

I really get what you're trying to say but I think you are looking at it through a very narrow lens of personal experience.

Yes! I'm a PP from yesterday who was induced after PROM. My midwife recommended the epidural in the hopes that it would relax my body so I would start to dilate, which wasn't happening even with hour after hour of high-dose pitocin. The epidural wasn't recommended solely for pain relief.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The poster who is arguing that women shouldn't think or be told they need pain relief in order to handle labor: I don't think you understand what happens during a pitocin induction. Pitocin (synthetic oxytocin) inhibits the body's production of natural oxytocin. Natural oxytocin is what took the edge off the pain during your unmedicated labor and helped keep it manageable for you (I had this experience myself, so I hear you).

However, if you had been receiving pitocin then it's much less likely you would have been able to manage that level of pain on your own. Meaning, contractions would have felt much more painful to you (Pitocin contractions can be more intense). Even women who don't get any pitocin may also have lowered production of natural oxytocin especially if they are extra stressed or scared (adrenaline and cortisol also interfere with natural oxytocin production).

Epidurals can also be helpful to calm down, get necessary rest during a long labor, and relax a tense pelvic floor. They aren't only for pain management.

I really get what you're trying to say but I think you are looking at it through a very narrow lens of personal experience.

Yes! I'm a PP from yesterday who was induced after PROM. My midwife recommended the epidural in the hopes that it would relax my body so I would start to dilate, which wasn't happening even with hour after hour of high-dose pitocin. The epidural wasn't recommended solely for pain relief.

I’m another one! It took eight hours of pit (once I was contracting) to dilate a cm to 4, then after the epidural it was 45 minutes to get to 10 cm. I would never have made it to a vaginal birth without an epidural - that I asked for. Nobody forced that one me.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:doing something that women have done for millennia, and continue to do, without intervention

To be blunt, what women have been doing for millennia= dying of complications of natural childbirth that are readily preventable with modern medical interventions. By itself, the Zavanelli followed by a splash and slash crash C-section probably saves thousands of lives a year.

And the Gaskin maneuver has probably saved just as many women from your charmingly named “splash and slash.”

Look, there are definitely mothers and babies who would not be here (or be doing as well as they are) without medical intervention. But there are also many who were subjected to excessive interventions, one-size-fits-all approaches, and other attitudes and habits that were not exactly evidence-based, and sometimes downright harmful.

Ahh yes, lets trot out Ina May, who is neither a CPM or CNM, who has no medical training, who makes racist comments about black mothers, who advocated for rubbing women's clits in labor to help them relax in older versions of Spiritual Midwifery, who says that toxemia (preeclampsia) can be prevented with a good diet--a fact which has zero evidence supporting it, according to the Preeclampsia Foundation, and who stole a maneuver from traditional midwives in Belize/Guatamala and named it after herself. For every woman who loved her birth guide, is a woman who was left feeling like a failure when her body, was, in fact a lemon and needed help to give birth. Go listen to her Longest Shortest Time interview.

[Anonymous]

I forgot to add, she practices without a medical license, had a dead baby in her own homebirth, and used to be in a polyamorous relationship with 3 other people. Is this really the midwife the world should be looking up to?

[Anonymous]

Anonymous wrote:I forgot to add, she practices without a medical license, had a dead baby in her own homebirth, and used to be in a polyamorous relationship with 3 other people. Is this really the midwife the world should be looking up to?

Do you ask your medical care providers about their romantic relationships? Of all the things to care about...

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I used to listen to the Birth Hour and there would occasionally be someone on who would note they couldn't have an epidural, but they usually knew that in advance. Seems odd that this wasn't communicated to your friend until after the induction was started when they could have strategized to avoid her being in so much pain. That sounds like bad coordination/communication on the part of the medical team. Epidural analgesia can have serious side effects even among totally healthy people so I have to think it's not unheard of to risk someone out.

CRNA here from above. This is somewhat rare. Usually complications/conditions that take epidurals off the table are discussed during pregnancy. However it could be that the anesthesiologist on call that night was a little more conservative and didn't feel comfortable doing it despite her getting epidurals in the past. It could be be a condition that tends to worsen with each pregnancy so maybe its something that would get an OK the first time around but not for the 2nd or 3rd birth. Its really hard to say. I have made a few calls that are contested. I immediately call my boss who always backs us up. I had one woman call the head of the hospital (as in the CEO…not even a DR) who then called me and apologized but felt like he "had to try." I am a mom, I am a care provider, I want you to be comfortable but I mostly want you to be alive. As someone who has given birth with and without epidural I realize how much relief it can provide BUT that relief has to be compared to possible risks and I can't make you a good candidate because a.) you know "people" b.) you have had one before c.) Dr. ABC and Dr. XYZ said it would be fine.

Can you please share some conditions that would make you refuse an epidural? Who would be a candidate for a no-epidural decision if you were making it?

Also, what are the other options for pain relief? GA?

If I wanted medical pain relief and couldn't have an epidural, I would make sure I delivered at a hospital that provided nitrous and that it would be made available to me. I would also hire a doula to provide other pain relieve techniques such as positioning, massage, pressure, heat, ...

I've also had fentanyl during labor but wouldn't chose to do that again or really recommend it. It gave me a chance to rest but it also made my loopy right as the Pitocin was kicking in and labor became really painful (it's just been long before that).

I've had 2 with no medical pain management and had fentanyl and pit with my 3rd. I asked for an epidural but progressed too quickly after starting the Pitocin so never received more than a hole in my spine.

I’m a person who knew in advance that she couldn’t have an epidural during labor. In my case, it was due to low platelets caused by an autoimmune response and made much worse with pregnancy. It was too risky for the anesthesiologist to do an epidural due to the risk of bleeding in my spine. As I knew it was likely in advance, I did everything possible to prepare. I took Bradley classes, tons of prenatal yoga, signed up with midwives, and hired an amazing doula, and felt totally prepared. Let me tell you, it did nothing compared what labor was actually like. I ended up with an induction due to preeclampsia and was on full dose pitocin for literally days, including the last day with my water broken. I had a morphine (I think - I was so out of it at that point) shot at one point but it did nothing. The experience was like torture and I finally begged for the c section I was trying desperately to avoid. I was ultimately able to get a spinal because the anesthesiologist determined there was a lower risk and lower platelet threshold for doing so; otherwise I would have had to go under general anesthesia.

Even though I wouldn’t have wished that on my worst enemy, I completely understand and respect the anesthesiologists’ position and I’m glad they didn’t take any unnecessary risks.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I used to listen to the Birth Hour and there would occasionally be someone on who would note they couldn't have an epidural, but they usually knew that in advance. Seems odd that this wasn't communicated to your friend until after the induction was started when they could have strategized to avoid her being in so much pain. That sounds like bad coordination/communication on the part of the medical team. Epidural analgesia can have serious side effects even among totally healthy people so I have to think it's not unheard of to risk someone out.

CRNA here from above. This is somewhat rare. Usually complications/conditions that take epidurals off the table are discussed during pregnancy. However it could be that the anesthesiologist on call that night was a little more conservative and didn't feel comfortable doing it despite her getting epidurals in the past. It could be be a condition that tends to worsen with each pregnancy so maybe its something that would get an OK the first time around but not for the 2nd or 3rd birth. Its really hard to say. I have made a few calls that are contested. I immediately call my boss who always backs us up. I had one woman call the head of the hospital (as in the CEO…not even a DR) who then called me and apologized but felt like he "had to try." I am a mom, I am a care provider, I want you to be comfortable but I mostly want you to be alive. As someone who has given birth with and without epidural I realize how much relief it can provide BUT that relief has to be compared to possible risks and I can't make you a good candidate because a.) you know "people" b.) you have had one before c.) Dr. ABC and Dr. XYZ said it would be fine.

Can you please share some conditions that would make you refuse an epidural? Who would be a candidate for a no-epidural decision if you were making it?

Also, what are the other options for pain relief? GA?

If I wanted medical pain relief and couldn't have an epidural, I would make sure I delivered at a hospital that provided nitrous and that it would be made available to me. I would also hire a doula to provide other pain relieve techniques such as positioning, massage, pressure, heat, ...

I've also had fentanyl during labor but wouldn't chose to do that again or really recommend it. It gave me a chance to rest but it also made my loopy right as the Pitocin was kicking in and labor became really painful (it's just been long before that).

I've had 2 with no medical pain management and had fentanyl and pit with my 3rd. I asked for an epidural but progressed too quickly after starting the Pitocin so never received more than a hole in my spine.

I’m a person who knew in advance that she couldn’t have an epidural during labor. In my case, it was due to low platelets caused by an autoimmune response and made much worse with pregnancy. It was too risky for the anesthesiologist to do an epidural due to the risk of bleeding in my spine. As I knew it was likely in advance, I did everything possible to prepare. I took Bradley classes, tons of prenatal yoga, signed up with midwives, and hired an amazing doula, and felt totally prepared. Let me tell you, it did nothing compared what labor was actually like. I ended up with an induction due to preeclampsia and was on full dose pitocin for literally days, including the last day with my water broken. I had a morphine (I think - I was so out of it at that point) shot at one point but it did nothing. The experience was like torture and I finally begged for the c section I was trying desperately to avoid. I was ultimately able to get a spinal because the anesthesiologist determined there was a lower risk and lower platelet threshold for doing so; otherwise I would have had to go under general anesthesia.

Even though I wouldn’t have wished that on my worst enemy, I completely understand and respect the anesthesiologists’ position and I’m glad they didn’t take any unnecessary risks.

Ugh that is awful! Apart from that being a torturous experience to put you through, I don't understand the logic of letting an induction go on for days when there is a serious health issue like that. If it's serious enough that you need to deliver sooner than later, then how can you also afford to wait 3 days to deliver, you know?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The strand of midwifery that fetishizes "natural" childbirth is unscientific, anti-feminist quackery.

And I beg to differ. I think those theat medicalize childbirth, procedurize it, and make women feel like they are incompetent to handle it, are anti feminists.

Making women feel powerless in doing something that women have done for millennia, and continue to do, without intervention is the problem. Hey, you want interventions... that’s your choice, but you should not be forced into them, either.

medical care is anti-feminist?

No, convincing women they cannot do it without medical care is anti feminist. Many women are terrified of the prospect of birth, and that does us a disservice.

But I can already see from the responses, it’s medicalized birth all the way with this group.

?? How is it anti-feminist to say, "You are about to give birth - let's make sure we have all the resources necessary to make sure that we can get you and your child out of this alive, if necessary"? You're living in some kind of fantasy world where good thoughts about birth somehow reverses the biological reality that birth is the most dangerous day of an infant's life, and can kill and injure the mother as well. Do you also think seatbelts and carseats are needless scaremongering?

[Anonymous]

Anonymous wrote:

Anonymous wrote:doing something that women have done for millennia, and continue to do, without intervention

To be blunt, what women have been doing for millennia= dying of complications of natural childbirth that are readily preventable with modern medical interventions. By itself, the Zavanelli followed by a splash and slash crash C-section probably saves thousands of lives a year.

Ouch. I thought the Zavanelli was uncommon?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:doing something that women have done for millennia, and continue to do, without intervention

To be blunt, what women have been doing for millennia= dying of complications of natural childbirth that are readily preventable with modern medical interventions. By itself, the Zavanelli followed by a splash and slash crash C-section probably saves thousands of lives a year.

And the Gaskin maneuver has probably saved just as many women from your charmingly named “splash and slash.”

Look, there are definitely mothers and babies who would not be here (or be doing as well as they are) without medical intervention. But there are also many who were subjected to excessive interventions, one-size-fits-all approaches, and other attitudes and habits that were not exactly evidence-based, and sometimes downright harmful.

Well, modern medical care has greatly reduced the infant and woman mortality rate, so I think I'll take our "medical interventions" overall as a great improvement to humanity. Of course there are issues with overtreatment and iatrogenic harm -- in all of medicine. But I seriously doubt anyone wants to give birth in a mud hut.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I forgot to add, she practices without a medical license, had a dead baby in her own homebirth, and used to be in a polyamorous relationship with 3 other people. Is this really the midwife the world should be looking up to?

Do you ask your medical care providers about their romantic relationships? Of all the things to care about...

Well, she was actually in a cult that worshipped group marriage and childbirth, and discouraged birth control. So really, that's relevant to how she would practice as a midwife. They also believed that marijuana and LSD were sacraments; I'm convinced that in many of the births she describes in her books the women and midwives were high or tripping. Groovy!

I went to jr high and high school with a kid who had grown up on The Farm. Nice guy, but looked like he had fetal alcohol syndrome, and was doing drugs at a very young age, and just seemed scary adult for a 13 year old, in restropsect.

https://en.wikipedia.org/wiki/The_Farm_(Tennessee)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:doing something that women have done for millennia, and continue to do, without intervention

To be blunt, what women have been doing for millennia= dying of complications of natural childbirth that are readily preventable with modern medical interventions. By itself, the Zavanelli followed by a splash and slash crash C-section probably saves thousands of lives a year.

And the Gaskin maneuver has probably saved just as many women from your charmingly named “splash and slash.”

Look, there are definitely mothers and babies who would not be here (or be doing as well as they are) without medical intervention. But there are also many who were subjected to excessive interventions, one-size-fits-all approaches, and other attitudes and habits that were not exactly evidence-based, and sometimes downright harmful.

Well, modern medical care has greatly reduced the infant and woman mortality rate, so I think I'll take our "medical interventions" overall as a great improvement to humanity. Of course there are issues with overtreatment and iatrogenic harm -- in all of medicine. But I seriously doubt anyone wants to give birth in a mud hut.

The hilarious part in your rant is that ANY intervention,including pain control for the mother, can result in iatrogenic harm. They can decrease respiratory rates, ability to move and push, and while host of effects.

So interventions may have decreased mortality rates, but we need to look at which ones, and why they are being administered.

No one wants to talk about the hazads to the mother, until the mother is truly in dire straights, it sounds easy (eg. “Epidural”, until something goes wrong end there are complications).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:doing something that women have done for millennia, and continue to do, without intervention

To be blunt, what women have been doing for millennia= dying of complications of natural childbirth that are readily preventable with modern medical interventions. By itself, the Zavanelli followed by a splash and slash crash C-section probably saves thousands of lives a year.

And the Gaskin maneuver has probably saved just as many women from your charmingly named “splash and slash.”

Look, there are definitely mothers and babies who would not be here (or be doing as well as they are) without medical intervention. But there are also many who were subjected to excessive interventions, one-size-fits-all approaches, and other attitudes and habits that were not exactly evidence-based, and sometimes downright harmful.

Well, modern medical care has greatly reduced the infant and woman mortality rate, so I think I'll take our "medical interventions" overall as a great improvement to humanity. Of course there are issues with overtreatment and iatrogenic harm -- in all of medicine. But I seriously doubt anyone wants to give birth in a mud hut.

The hilarious part in your rant is that ANY intervention,including pain control for the mother, can result in iatrogenic harm. They can decrease respiratory rates, ability to move and push, and while host of effects.

So interventions may have decreased mortality rates, but we need to look at which ones, and why they are being administered.

No one wants to talk about the hazads to the mother, until the mother is truly in dire straights, it sounds easy (eg. “Epidural”, until something goes wrong end there are complications).

C-sections decreased mortality rates on a population level until they got to a rate of 15-20% of all births. That's when the neonatal mortality rate leveled off. When CS rates got into the mid-20%s is when maternal mortality rates started to slowly rise again.

Inductions have been shown to have no effect on the neonatal mortality rate, nor prevention of stillbirths, despite routinely being used for that purpose.