Epidurals in the UK vs USA

[YorkieMom]

I used to live in Canada, and was under the impression that pretty much everyone giving birth had an epidural. I had no idea there was any other birth positions other than lying on your back. I went to my first NCT class last week and was shocked to learn that only about 25% of UK women get an epidural. Why do you think this is?

Why is it normal for women in North America (both US & Canada) to get an epidural, while it's more normal for women in the UK not to get one?

Is it because Canada & the US don't offer Gas & Air? I've heard G&A doesn't do much anyway. I don't believe they really push Tens machines in North America, I'd never even heard of them until I moved here.

 

[torch2010]

I have never had an epi and never plan to have one either. G&A all the way from me. x

 

[YorkieMom]

I have never had an epi and never plan to have one either. G&A all the way from me. x

Why though? I'm just curious why they're so embraced in North America, but most women here wouldn't bother having them.

 

[torch2010]

I have never had an epi and never plan to have one either. G&A all the way from me. x

Why though? I'm just curious why they're so embraced in North America, but most women here wouldn't bother having them.

To be honest I feel that giving birth is just so natural, I don't have a need for the pain to be taken away. I want to be able to get up and out of hospital as soon as possible and get home with my new bundle of joy =)

 

[SparkleBug]

I don't know but your assessment is totally correct. I am Scottish but went to college nd lived in USA for 6 years and they are far more pro epis there. I wish it were th case over here I the uk but the medical assessment is that it carries risks to baby and mum. It typically slows labour down and can cause baby's heart rate to slow. You know one of the number one reasons women here are refused epis!? Staffing. When a woman needs an epi and is in a restricted staffing ward, not only can it be hard for her to find the anaesthetist readily available, but it means she is(supposed to) have what midwives cal 'one-to-one care' from when the epi is administered and this is no good when theyre short staffed. Theyll never say it's because they're short staffed but having midwives as friends I know this to be fact. In the uk our health service is free (but not really cause it comes from our taxes) but the USA u pay so it tends to be a lot more on your terms I think? I remember living there and having to really decide how bad a uti was before bugging my health insurance for another $50 deductible and how long I cud wait until payday, where as here you can have medical care whether facet face, on the phone or in the hospital for absolutely nothing....and our prescriptions are medicine are free now too. So maybe all that said, it's a money issue? Just my thoughts! Xxxxx

 

[SparkleBug]

P.s excuse the typos I'm on my iPad and I cannot type! Lol xx

 

[NOMORENUMBERS]

i think it is a couple of things that makes this so . . the sceptical people among us will be very much on that they encourage you not to and the main reason is because of the cost to the nhs. there are alot of stories of women requesting epidurals and getting told it is too early then asking later and funnily enough it is too late

i would say in part it is that but the other part is epidurals come with their own baggage, more likely to have a c section, not going to be able to get into all sorts of positions to help labour, also you can actually suffer from back pain for a long time after, i still get the odd ache because of it and my son is now 2.5yrs. women are empowered here to really push through and focus and keep going, lets face it although it isnt harmful for a baby it isnt exactly helpful to them either . . . i suppose it is seen as an unnecessary extra . . .

i was doing fabulous with only gas and air but they kind of forced me into having an epidural because my labour went from 0 -60 really quickly and my body went into shock apparantly . . .

 

[Ouverture]

That is a really interesting questions Yorkie!

I'm in the U.S. and have no interest in an epidural (planning a birth center/midwife birth out of the hospital), but with the exception of a few close friends every story I hear, every person I know did have one and would do it again (even one gal who had a severe spinal headache for two weeks after with her first baby and epi). We don't have G&A and rarely do I see tens machines. . .but waterbirth seems to be making a come back. I know in my State, only about 1% of moms have home or birth center births. . .everybody else is in a hospital. I'm in that 1%.

I think part of it is our medical community here - many of which would prefer you on an epidural because you then become not only more complacent, but easier to deal with (you have to be on your back = easier for the doctor, you can't get out of bed, you're not moaning and groaning = easier on the nurses) so they really push it. Not to mention the $$ they make off of you if you get an epidural and or pitocin and or c-section. (This is NOT to say that all OB's are bad, please don't mistake that. . .just that it seems to be a driving force in our Community among the OB's who ARE bad. We can't deny the rising c-section and induction rates. . .it IS happening, and it's frightening).

If you watch the birth shows from U.S. hospitals, you see the nurses saying 'are you ready for your epidural yet? Sure you don't want an epidural? We can get you an epidural now!' and so on, even to the moms who really just want to try natural. They restrict the natural birthing moms from movement because they have to be 'hooked to monitors' etc. and I think that also drives many to get an epi because they aren't allowed to move through some of the contractions. I think that is rampant in hospitals around the U.S., then the U.S. moms watch those shows and hear the stories and in their minds, it's (an epi) the only way to go.

Not to mention, the radical statements always made that having a baby is akin to getting teeth pulled without Novocaine, or like pushing a watermelon through your nose. Neither of which are a natural process, they do not compare. . .all those statements do is serve to frighten all the U.S. moms who have been raised since birth to go with the flow and do what their doctor says as far as medical care is concerned, never to question it.

Even at my 8 week appointment my nurse was already trying to feed to me how awful labor was going to be. . .part of the reason I switched to a midwife, because regardless of the fact that it will be painful or at least uncomfortable, scare tactics are NOT what moms need to prepare. . .and that too, I'm sure, contributes to the 50-60% usage of epidurals in the U.S. . .

 

[MoonMelody]

I'm American, but live in the UK and am in the midst of my nursing training. Birth here is far less medicalised than in the US, and it's really for the best. Giving birth on your back is not only uncomfortable and prolongs labour, it's also dangerous. It increases the risk of fetal heart rate dropping, fatal postpartum bleeding, and cesarean section. Being active during labour really helps with contraction pain, and giving birth on all fours or squatting encourages the baby to descend properly.
Epidurals can make it impossible to get off your back and push in any other position, so that goes against making birth as safe as possible for the woman. The general medical consensus is that if a woman can sit still long enough to get an epidural, then she has enough strength to focus on getting through labour naturally.

 

[tanya]

I think it's probably partly to do with the way pregnancy and birth is handled here and in the us, over here we vary rarely see a doctor during pregnancy as everything goes through the midwife, I've seen my gp once and that was to confirm pregnancy and refer to the midwife ( not counting consultant as I'm under consultant led care due to high risk, but thats not average)

In the US (correct me if I'm wrong I only know what I see in films/tv) pregnancy and birth seems to be medicalised alot more, I've not heard of many midwives but it all seems to go through ob-gyn doctors and it's doctors who deliver babies whereas in the uk you only see a doctor on the labour ward if something is wrong.
Basically what I'm trying to say (and waffling and failing to lol) is that birth in the uk is treated as a natural thing and women are encouraged to go naturally and not encouraged to have pain relie as much as in the US where it seems to be seen as a medical problem Wichita the doctor must fix with as little discomfort all round as possible, c-sections are much more popular in the US too I've noticed, try getting an elected c-section in the uk and they will look at you as if you have two heads!

 

[qt_nurse]

I'm not sure how to bring Canada into the discussion as Canada is very different from the US even though we are not that far away. This is my first baby so I'm not too familiar with the whole thing.

I would say Canada fits somewhere in the middle between the US and UK as far as attitudes towards pregnancy, labour + delivery and pain relief. It is common here to have a midwife, however there are not a ton of them around, so when I went to get referred to a midwife I was turned down as the midwife group had too many patients, so no room for me. So I stayed with my gp, who doesn't deliver, so at 32 weeks I got referred to an OB, who I am now seeing weekly until delivery.

My OB is pretty neutral as far as advocating for pain relief and intervening. He won't let me go more than 2 weeks late, as long as everything seems healthy etc, and he doesn't seem to lean towards epi's or natural, so he's pretty neutral.

A lot of the moms to be in our baby classes seem to be leaning towards getting an epi, I am going in with an open mind; if I can tolerate the pain, great, if I find it to be excruciating, I will look at the options available. In baby class tomorrow, we are going to talk about pain control, as far as I know, gas and air and other medicines are available, just not widely advertised or known about. When I was in nursing school I only got to see one labour, but she went natural because the anesthesiologist couldn't get there in time, and she had gas and air but it made her nauseated, so she went natural and did fantastic!

I am shocked when I watch all the baby shows on TLC, how much having a baby is medicalized. Inducing before due dates for no reason, or giving pitocin to speed things up without medical reason, etc etc.

If it weren't for this forum, I wouldn't have known about the different positions or the fact that moving around helps labour, as most of our TV content is from the US and most of the baby shows from the US show having a baby as something that requires medical intervention, and they mostly show women in labour stuck in bed on their back. Sometimes the shows have moms that are going natural, with a midwife or avoiding pain medicine and wanting to walk etc, but they make those women seem like they are out of the ordinary...

Canada's health care system is paid through taxes, similar to the UK, so its different from the states in that way too. Doctors tend to not intervene as much when not necessary, due to hospital policies and cost pressures, so you couldn't just go in and schedule an induction or c-section or get whatever you want because you are paying for it or the doctor wants to make more money.

Anyways, good question OP!

 

[YorkieMom]

Great to hear everyone's opinions on this. I'm really interested to watch One Born Every Minute USA tomorrow to see how different they are. Before I moved here, I had no idea about birth, and just assumed people were mad not to get an epi during labour. I didn't even know people still gave birth without them! Now I'm leaning more to a epi free birth. I'd like to try and make the baby come out using gravity, and different positions. In our NCT class our "teacher" showed us a model of a pelvis and it was really interesting to see how much smaller the pelvis got when you were in a laying down position rather than standing up. She basically said giving birth on your back is like pushing a bowling ball up hill through a narrower gap.

Like qt_nurse said, our medical system in Canada is different than in the US. We pay for it via taxes, so generally when you need medical care you get it - no questions asked. It's great, and I couldn't imagine living in the US and having to deal with insurance, and the high medical costs there - no offence! I too was just to accustomed to watching American TV shows in Canada, as that's mostly what we have there. I do miss all my American sitcoms though

 

[sequeena]

Seems more popular in the US probably because they don't have G&A but then again I'm not American so I don't really know how things works over there

ETA: I intend to not have an epidural if I can help it but baby may arrive sooner than we thought so I may need a c-section.

 

[abc123x]

Healthcare in the UK tends to go against epidurals because they cost money.

In the US, since you're paying for it(or your private insurance is), it's not as frowned upon.

 

[BabyRayback]

I'm from the USA (Oregon to be exact and I think it really depends on what part of the country your from as to what type of medical intervention is used. My doctor is very neutral and will go with whatever I wanna do unless something happens where I need intervention. But I remember when I first got pregnant how scared I was cause I watched all those TLC shows too and the "the buisness of being born" documentary which was all sorta terrifying! So at my first OB appointment I totally brought it up and my doctor was like "OMG that is NOT what its like!" He basically said I can do whatever I want, go natural or have an epidural. He does have I believe very AMERICAN versions of how LONG you get to be in labor though... My doctor said generally if after 20+ hours of harder labor I'm not making a whole lot of progress (dilating and stuff) they'll want to intervene to get my labor moving along. I don't know if that's how it is elsewhere, but it seems like they don't like to just let labor go as long as it wants to. I'm not too worried though and my doctor said that generally he notices that after the women's been in the hospital and in labor that long they don't really care, they're tired and want it to be over, which is how I imagine I might be... lol

I've also noticed that in the USA they don't have a "wait and see" mentality when it comes to labor and delivery. If the baby gives ANY sign of not doing well with contractions or mom is not doing well they will induce or c-section when labor could and would probably progress fine and just needs more time... So maybe we're just a little to overly cautious... which I totally think is true lol

 

[Blue12]

I used to live in Canada, and was under the impression that pretty much everyone giving birth had an epidural. I had no idea there was any other birth positions other than lying on your back. I went to my first NCT class last week and was shocked to learn that only about 25% of UK women get an epidural. Why do you think this is?

Why is it normal for women in North America (both US & Canada) to get an epidural, while it's more normal for women in the UK not to get one?

Is it because Canada & the US don't offer Gas & Air? I've heard G&A doesn't do much anyway. I don't believe they really push Tens machines in North America, I'd never even heard of them until I moved here.

I live in Canada - and I went to my prenatal class last night. The discussion was pain management. Half of the evening was going through natural options (positions, breathing, heat, balls, etc.) and the other half of the evening was medical options - including 3 (demerol for early labour, gas and air, and the epidural).

I have no idea though why it is more common here to have epidurals.

 

[Jessicax5]

I think if the US would offer gas & air a lot of women would opt to go with this option first before asking for an epidural. At least I would give g&a a go first before an epi.

 

[londonangel]

Hmmm, I don't know. Maybe it is just a cultural thing. They do seem quite keen to push other forms of pain relief here in the UK, e.g. tens machine, water, etc. And the good old gas and air! My mum had gas and air to have me (and my brother) and nothing else and said they were fantastic. My dad had gas and air when he broke his leg in two places and dislocated his shoulder (motorbike accident when he was younger than I am now) and apparently they had to wrestle it off him when they took him out of the ambulance!!! Also we have quite a lot of midwife led units now and they don't have anaesthetists which mean they cannot offer epidurals. I was going to have my baby in the midwife led unit but am now being induced tomorrow as baby failed to arrive, so I'll be on labour ward anyway.

 

[DarlingMe]

I just wanted to say that make sure you are reading info from the last couple years regarding epidurals. In the past few years they have stopped using as much medication for epidurals. This way mom can still feel to push and she has fast recovery after. I have heard of "walking epidurals" too where there is a low dose, to decrease the pain, but mom can still walk. I have not heard of a doc actually allowing women to walk after them though. Alot of the info out there is based on older use of epidurals or assumptions.

I would say about half the women I know who birthed were able to without any pain medicine or epidurals. But I dont know anyone who was induced with pitocin/oxytocin that was able to birth without an epidural! In the US you are treated as though you are "sick" when pregnant and birthing, even though bodies are made for this! Whatever you decide, make sure it is from current medical based sources. There are benefits/disadvantages to any birthing option so dont hesitate to choose whatever you feel most comfortable with!

 

[special_kala]

Birth is just more medicalised in the US then it is in the UK.

Also there is nothing else available in the US so its all or nothing which i imagine increases the amount of epidurals had.