The right to have epidural?

[London7]

Hi, I gave birth earlier this year and thought it was for certain that I would have an epidural but how wrong I was! My baby was large and the doctors thought it would be best to have an epidural in case I need an emergency C-section. When I went into labour, I phoned the hospital 2 hours in advance to tell them the docs recommended an early epidural. When I came in, I waited for over an hour just to be examined, another half hour for a bed and then the midwife was not available to stay with me if I was to be given epidural and when she finally became available, the anaestetist had to attend an emergency C-section! I ended up giving birth naturally, absolutely terrified that the baby would get stuck! All along I was being told there was nothing they could do...The midwife's attitude was that I don't need an epidural, it is only for wimps but I AM a wimp and I really really wanted one. I begged them right from the moment I arrived in hospital but nobody was bothered. I want to complain about being treated like this but is it worth it if what is done is done? Has anybody had a similar experience? Thanks.

[emsyj]

Have you been to the hospital for a de-brief? My local hospital offers this (a meeting with a consultant and midwife to discuss what happened at your birth) and it might be an idea to ask if you can have one at your hospital so that you can get clear in your head why they did what they did.

If you still feel that you want to make a complaint after that, then I would contact PALS to talk to them about the procedure.

I think there is a shortage of anaesthetists on labour wards generally (although this is a sweeping statement and I have no inside knowledge at all, so happy to be corrected) so if there was one anaesthetist available and he was called to an emergency c-section then he was being deployed to the person who needed him most. I had a crash section and no doubt that meant that I was taking up theatre space and a medical team that might have been wanted elsewhere but there are limited resources.

[GGgowiththeflow]

Well done for giving birth naturally!!! You must be so strong! Good for you! You are soo not a wimp! you got through it, you're baby didn't get stuck! You are amazing!!!

Sounds like the support you got in the hospital wasn't very sensitive? It sounds like you got a bit fixated on the idea that you wouldn't be able to manage. I say they should have been saying how amazing you were, how brave, how strong, making you feel like you were doing an amazing job, not making you feel like a wimp!

Rather than complaining that you didn't get the epidural you wanted I think you should complain about the inappropriate support. You sound a bit traumatised, and it didn't have to be that way.

[QTPie]

To be completely honest "lack of availability" of epidural was why I freaked out and opted out of the nhs (went private) at 14 weeks pregnant (I was terrified that it wouldn't be available....).

I think it is terrible, but it is by no means just an nhs maternity problem: my mother had a lobectomy (lobe of lung removed for lung cancer) in December and her acute pain was very badly managed post-operatively - horrendous getting an anaesthetist in to adjust the pain relief.... :(

[fruitybread]

Just out of interest - if you are being told how 'amazing', 'brave' and 'strong' you are when you are labouring without an epidural - but you really really want one, or are, despite what you are being told, truly desperate for one -

What are they supposed to say to you if you manage to get an epidural? Does all the 'amazing/brave/strong' language stop? In any case, it doesn't sound like the OP was interested in someone else's opinion about her 'strength' - she sounds like she really wanted an epidural.

OP, I am sorry you did not get the pain relief you wanted. I know women on this board have had problems getting epidurals both because of staff availability, and also because of MWs attitudes - hopefully someone will come along who has had similar experience and can help.

[DuelingFanjo]

does having an epidural mean you haven't given birth naturally GGgowiththeflow?

[straighttalker]

Hi -
I'm sorry you didn't get the pain relief you wanted. As an anaesthetist there's just a couple of things I wanted to explain, hopefully might be of help. Maybe some of these things were a factor in your situation.

• It's not possible to prebook an epidural when you're not in the hospital, we don't queue up the requests. We recommend an 'early' epidural for a lot of people - high BMI, cardiac disease, pre-eclamptics, but as you've found out, that isn't possible for everyone. The reason being that an epidural is almost never essential (in the purely life/health-saving sense of the word). I don't want to minimise your need or right to have pain relief but in staff-poor situations, it does take a lower priority.
  

• despite NICE guidelines, there isn't enough staff to provide an 24 hr epidural service where everyone receives their epidural within 'recommended' 30mins-1hr. The anaesthetist, unless it's a large unit, is likely to be covering general theatres and/or intensive care as well as obstetrics. If it is a large unit, then there may be an anaesthetist dedicated solely to obs but they may be in theatre most of the day/night with emergencies.
  

• Lastly, an epidural in situ doesn't mean that it can definitely be used for Caesarean section. Up to a third of epidurals just aren't good enough for pain relief for section and need to be taken out and a spinal inserted. If it's a real emergency, then there isn't time to use it, as it will take 10-15mins to reach maximal effectiveness for open surgery. So a 'big baby' or a high likelihood of section isn't an absolute indication for an epidural. In fact if I think someone is definitely going to go to theatre, I would much rather not put in an epidural as a spinal will be more reliable and less tricky than doing a spinal-on-top of an epidural.

[DuelingFanjo]

straighttalker may I ask a question please?

I was given a spinal and taken to theatre where I signed papers for a C-ection. I did ,manage to push my baby out before a C section was needed and had an episiotomy too. I had a de-brief with the doctor at the labour and he said that at no point was it an emergency situation.

Is it usual to give a spinal just in case they might need to do a C-section?

[straighttalker]

Hi. Yes, it's pretty usual to have a spinal for an instrumental if they're taking it seriously enough to do it in theatre. It means they can intervene more (high rotational forceps/vacuum) without causing you pain. And some patients can cooperate more with pushing/positioning if they're no longer distressed with contractions.

Most importantly if the baby gets stuck or starts exhibiting signs of distress, they can get it out within five minutes if there's a spinal already on board.

[spudulika]

London7 - how big was your baby?

When I found out my second baby was going to be over 10lbs I became desperate to AVOID an epidural. If you've got a massive baby to push out, the last thing you want is medication which stops you pushing effectively, and makes it hard for you to give birth in an upright position. Particularly when you take the risk of shoulder dystocia into account (which can be hugely more damaging to you and your baby if forceps are used - more likely if you have an epi before shoulder dystocia is identified).

I really don't think doctors or midwives should recommend epidurals to women having big babies without discussing this.

[lachesis]

I had to wait 4 hours for an epidural despite worryingly high blood pressure. The epi failed to bring down the pressure and I had to have some drug that started with an 'L'.

[GGgowiththeflow]

So there's no room for positive language here? I'll be off then.

[BlameItOnTheBogey]

GGgow, I don't think that's what anyone said; rather that the OP doesn't want to be told she is 'strong' which invalidates her feelings. She wants some real answers. I too gave birth without an epidural (not at all by choice) and get really hacked off when people tell me how strong I am. I'm not. I am a wimp but had absolutely no choice in the matter and was traumatised for weeks afterwards. How does being forced into that situation in any way make me strong?

[verybusybear]

While I don't think anyone in the hospital can really be blamed for this (if there isn't an anaethestist available then that's not their fault). However, this sort of story does scare me and I'm sure a lot of other people.

I have a friend who requested an epidural and got the feeling that she was being 'fobbed off' for literally hours until she'd gone past the point of being able to have one and had to give birth without it. Later on the ward she was told that it was probably because they were short staffed on labour ward and so there was no midwife available to be with her.

When I had DD I was induced and after about 8 hours on the drip, I admit I was a wimp and couldn't take it any more. Despite being a bit out of it I do certainly remember the midwife explaining that she'd do what she could but it was the middle of the night and there was only one anaesthetist in the whole hospital so if they'd been called off to an emergency elsewhere then they wouldn't be able to see to me etc etc.

I was actually very lucky - the anaesthetaist turned up within about 30 minutes and I had my epidural. Also luckily when DD's heart rate dropped soon after this and it turned into an EMCS situation, the anaesthetist was still around.

I guess even though my experience turned out happily, just thinking about what might have happened is a major reason for me wanting an ELCS next time rather than a VBAC. I know I will be a wimp!!