Is the NHS channeling Lamaze International?

Lamaze International, as I’ve mentioned in this post, has (rather arrogantly, IMO) decided to define what “normal birth” is for all us women. Needless to say, most of us mere mortals (98% of American women, according to the survey mentioned in that post and despite the large majority of the women being pleased with their births) don’t measure up.

Now it seems – if the Times can be believed – that the British NHS is taking a leaf from Lamaze’s book, much to some OBs’ (not to mention their clients’!) dismay:

HOSPITALS are under attack from staff and patients for trying to stop large numbers of women from having epidural painkillers during childbirth.

An epidural, an anaesthetic injected into the spine, is seen by many mothers as a welcome and legitimate way of coping with the often extreme pain of childbirth.

However, under targets now being introduced into NHS trusts,epidurals are stigmatised as abnormal. One senior obstetrician condemned the implications of this policy as a “disgrace”.

The controversial restrictions, promoted by the “natural childbirth” lobby, aim drastically to reduce the number of women having epidurals, caesareans or other artificial procedures to 40%.

In some hospitals the proportion of first-time mothers now having epidurals is far higher at 60%.

The targets are contained in a guidance document, Making Normal Birth a Reality, drawn up by the National Childbirth Trust (NCT) with the backing of the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists.

The document argues that mothers and doctors are too ready to resort to medical intervention and that any such procedure brings risks. The guidance was drawn up 15 months ago, and NHS trusts are now striving to follow it – to the dismay of some of their own experts.

Kim Hinshaw, a consultant obstetrician at Sunderland royal hospital, said: “I have major concerns with this. I don’t think we will ever reach a figure of 60% normal delivery using this definition. For example, in Sunderland we have an epidural rate in first labours of 60%.

“This definition implies that if you ask for an epidural for pain relief, but go on and deliver normally after a six-hour labour, your birth was not ‘normal’. That is a disgrace.”

The rationale given is that epidurals have complications (mainly in the sense that they prolong labor and tend to lead to more forceps and vacuum deliveries). Ironically though, only two months ago, the NHS published its take on a recent study which assessed the risk from regional anesthesia procedures (among these also labor analgesia), which stated, “Epidurals ‘safer’ than thought”.

The Times continues:

The authors of Making Normal Birth a Reality argue that better facilities and access to dedicated midwives would make women more confident and less likely to request epidurals. In line with NCT teaching, they say that breathing correctly, assuming the right position and pushing at the right time reduce pain and the need for epidurals.

Breathing? Positioning? Looks like someone at the NCT (National Childbirth Trust) has seriously been drinking of the Lamaze Kool-Aid. And while the idea of better facilities and access to dedicated midwives sounds like a wonderful idea, wouldn’t it be more appropriate to first put those mechanisms in place, and only then discuss the diminishing need for epidurals? Or rather, only then assess the idea that facilities and midwives are an adequate stand-in for pharmacological pain relief to most women?

I hope one of my British readers can clarify this isn’t merely a cynical method of saving money. Because if I were a British pregnant woman, even one planning a “natural” birth, I’d be mightily pissed.

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13 Responses

  1. I had two very different births. The first time I was scared to death of the pain. I requested an epidural as soon as I arrived at the hospital (I was 6cm dilated at that point). I then spent 9.5 uncomfortable hours lying in a bed, hooked up to machines, waiting to have my baby. When it came time to push, I couldn’t feel when a contraction was coming and had to get the nurse to tell me. I couldn’t help but wonder if things would have gone quicker, more smoothly if only I had been able to move around during the birth rather than lying on my back/side the whole time.

    The second time, I had a natural birth in a hospital with an obstetrician, but with the support of a doula. This was a much better experience. Again, I was admitted at about 6cm dilation. This time, however, I could use the whirpool bath for comfort, I could use gravity to keep things moving along, and I could have my doula and husband apply pressure to help deal with pain. My baby was delivered within 2.5 hours of being admitted to the hospital and after only 10 minutes of pushing.

    I support everyone’s right to make their own choice, but I also can’t agree with any presumption that a birth with an epidural is more comfortable. That certainly wasn’t the case for me.

    For women that are hoping to have a natural birth in a hospital setting, it helps to be prepared. I put up a post with some tips in this regards recently:

    http://www.phdinparenting.com/2009/02/17/want-a-natural-birth-in-a-hospital-setting-10-questions-to-ask/

  2. As I read this I thought I am so glad I don’t live in the UK! When I had my son I had a natural birth with the support of a doula and my husband. I always had the option of an epidural if I felt I needed it. I’m now pregnant with my second child and am actually considering getting an epidural because of my experience after my first birth (I was so spent and exhausted after delivery I really couldn’t enjoy my baby!). I would be so angry if I was denied an epidural so I could have what someone else decreed was a “normal” birth (especially if it was really a way to cut costs at the expense of women’s healthcare!).

  3. PS- the Lamaze breathing techniques don’t do a thing for the pain! (at least I should say they didn’t for me).

  4. I had an odd labor experience–my water broke before my daughter had even dropped, and when I had not even had one contraction hours later, that and the meconium in the fluid prompted them to give me pitocin. It was excrutiating, and by the early hours of the morning, I was only dilated a little and exhausted already, so an epidural was a godsend. I got four hours of sleep and was able to do what was necessary just fine. I think that we would have both been in distress without it, and when it came to pushing and such, I think the epidural helped it go much more smoothly than it otherwise would have gone.

    I agree with the first poster: everyone’s experience is different. It makes me mad when people judge.

    • You really can’t often compare a first vaginal birth to a subsequent one in terms of needing pain relief. A labor with a proven pelvis is often shorter, the woman usually knows better what to expect, etc.

      I used an epidural for my first 2 births (the emergency CS and the 1st VBAC) but not with my last, and it had nothing whatsoever to do with a doula (didn’t have one) or being hooked up to machines (had cEFM and a heplock/IV) or moving around (which I could in a limited way with a ‘walking’ epidural anyway, but didn’t need for pain relief). It had everything to do with the factors above, however.

      I would have considered it cruel and unusual punishment to be denied or given a hard time getting an epidural with my first birth and VBAC (esp. with the former – which would have meant a far worse CS recovery after general anesthesia).

  5. FYI, here IS Lamaze’s definition of “normal” birth. According to Lamaze International, these six birth practices will help you to have a safe and healthy birth:
    • Let labor begin on its own
    • Walk, move around, and change positions throughout labor
    • Bring a loved one, friend, or doula for continuous support
    • Avoid interventions that are not medically necessary
    • Avoid giving birth on the back and follow the body’s urges to push
    • Keep baby and mother together – it’s best for the mother, baby, and breastfeeding.

    • Yes, Debby, I know. That’s why I included this link from Lamaze Int’l in the post above. All-too-normal pain in labor is a good enough reason to consider the most effective pain relief medically necessary, and its use should not render a birth abnormal. Nor are Lamaze’s “care practices” the be all and end all for having a safe healthy, and yes, NORMAL birth.

  6. maddening. so glad i’m not british.

    has it even been truly established that epidurals increase the risk of assisted delivery? i thought it was still possibly a correlation–malpositioned babies are more painful to labor with, and more likely to require help getting out. i know my first was posterior, and the back labor was horrific. ever seen the movie misery, when she breaks his ankles with a sledgehammer? that was what it was like, a sledgehammer to my back every 90 seconds. denying me an epidural would have been torture. literally.

  7. I was thinking about this again on the way into work this morning.

    I think there is a time to educate pregnant women about the benefits and risks of various options for dealing with pain during labour. That time is during her prenatal care leading up to her delivery. That time is not when she arrives at the hospital to have her baby or during the course of her labour there.

    If a woman arrives at the hospital and states a specific choice with regards to dealing with pain, that should be respected unless there is a specific medical reason why the doctor would recommend a different course of action.

    With my first birth, I announced on arrival that I wanted an epidural and the nurse tried to convince me that I would be a good candidate to go natural. I wasn’t really the most receptive person to that message at that point in time, but if someone had talked to me about it a few weeks or months earlier, I would have perhaps considered it.

    With my second birth, I had a birth plan that said I wanted a natural birth, I was aware of my pain medication options, and did not want anyone to offer me any meds (I would ask for them if I changed my mind). That wish was respected, but I know many women who didn’t spell it out as clearly and had nurses or doctors trying to push an epidural.

  8. It’s a combination of crazed money saving and ideology. You saw the summary statement–they really got some loons to sign on, such as the Association of Radical Midwives. I do wonder how they got the RCOG as signatories! A sizeable proportion of UK OBs are in line with their American colleagues on a lot of issues (refusing to do VBACs, for example). There’s long been a very authoritarian streak when it comes to birth in Britain and when you wed that to “pain is good” it’s not pleasant.

    It’s daft though–Entonox and opioids are “normal”, but epidural is not? And some people wanted to say active management of 3rd stage is not “normal” which would exclude most births as the NICE guidelines recommend it (IIRC).

    If it were just about improving support, midwifery, etc that would be fine–but the entire statement came off as very high handed and arrogant. The target would, like all NHS targets, going to result in distortion. Hospitals would deny epidural to meet the target. I’m seriously considering complaining to the NCT–I was a member and did my antenatal classes with them.

    It won’t get implemented, though. The government already said it won’t fund more midwives for home birth so it won’t be funding more midwives to ensure 1:1 support in hospital.

  9. I’ve never given birth in the US or the UK, but my impression is that for most women in the US, their choice is between an epidural and nothing. In the UK, as is also true here in Denmark, there is also the choice of laughing gas. I’m not sure what else the UK might offer, but I was offered something called “bee stins” (no idea if that has a more savory English name). The laughing gas and bee stings, according to my midwife, don’t affect the baby whereas the epidural may. Just in case someone is thinking that “no epidural” means “no pain relief at all.”

    That said, getting an epidural was by far the BEST part of my otherwise traumatic birth, and the next time I am in labor, I will NOT be waiting nearly so long to ask for one if I am in that much pain again.

    And FWIW, being on my back was the only position that was comfortable to me, much to my and my midwife’s surprise, AND if I had followed my body’s urges to push I’d probably have killed my baby if not also myself in the process. Lamaze can kiss my lily white bum if they have a problem with that!

    • In the US you can have IV opioids such as Demerol for the pain as well. That really gets to the babies, and has never seemed a very good option for pain control either (at least according to the women who’d had it that I know).

      They have laughing gas here (Israel), but it’s not widely used and you have to know it exists to ask for it. I tried it during one of my labors (on the advice of a British-born friend) – it did nothing for the pain and just made me very, very disoriented to the point I was having a hard time cooperating with the midwife. My husband said it reminded him of a time I was delirious with fever.

      “Bee stings”, IIRC, are when they administer shots of saline into the skin of your lower back. The pain of the shots helps, somewhat like a TENS machine, to distract you from the pain of labor. I can’t imagine it’s anything as effective as pharmacological pain relief, though.

      BTW, with my last birth (no epidural) I did the second stage flat on my back too. I think it saved my perineum and was quite comfy as well…

  10. I’d been reading about laughing gas on British parenting boards prior to having my baby and asked my OB about it. He said that, in my area at least, laughing gas was only used in one hospital (not the one where he delivers at). He suggested that it was a hospital storage and liability issue, the tanks being big and clunky. He had trained with it and said that he wished he still had it in cases where the woman was going natural and would be, like, 20 minutes away from delivery, but starts to grow weary. He felt that the little extra bump would get her through to the end.

    That said I found the epidural fabulous, so you won’t find me looking for a tank of nitrous should I decide to go through the birthing process again.

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