AIBU to expect a Midwife not to ignore a request for an epidural?

[OldRichandGrateful]

I have had an exciting day being a birth partner with my (a lot younger) DSis. Her husband is away in the forces and I was back up support. DSis had a beautiful daughter.

She had a tough time and this wasn't helped by the total lack of any help from the Midwife. My Dsis was in great pain and struggling to keep calm and focused. She kept asking for an epidural and the Midwife kept fobbing her off. The Midwife didn't stay in the room for very long and just kept disappearing.

I had my DS a few years ago and my Midwife was brilliant.

AIBU to think my DSis should get an epidural if she asked for one and to expect her Midwife to support and help her?

I apologise for my post Merlini. My 2nd and third births we a delight. They really were. I refused hospital care for both. Complications with DD3 saw me going in anyway but fully armed to threaten legal action if I was treated in the same way. It was all fine. I think midwife realised I was naive and young in first birth and Dr was pretty new and led by the midwife.

Vivalabeaver: do you mind if I ask you a question? Would you say that some midwives, when they tell women that there isn't an anaesthetist available, are lying, because they don't want the woman to have an epidural?

I haven't read all of this but 18 years ago I had a posterior labour - v painful. The midwives talked endlessly about how busy and under-resourced they were. Went to hosp 10am, great pain and no mention of posterior posn but told to go home; went back at 6pm - ha, ha, ha - not much happening; go and have a meal and come back later; waters broke in lift and went straight back to harrumphing. In great pain - but admitted to an open ward; given pethidine to quieten me down and told I didn't need to be in a labour room yet and didn't need a midwife. Eventually moved at 11pm and not dilated much. Insisted on epidural which came at midnight - midwife sent DH for a coffee then went for a sarnie herself. Baby's heartbeat disappeared; rang bell, midwife harrumphed and rearranged the belt; DH came back and it happened again (pushing now but midwife laughed - ho ho not possible - you were nowhere an hour ago); belt adjusted again - when it happened the third time DH demanded a doctor was called - midwife said don't be silly. DH shouted now and walked to get help. Chief midwife called, panic button hit; crash delivery team summoned. Baby was being strangled by cord and labour was posteriro. Snr Reg said give one huge push if you can whilst he got ready for forceps del ( baby too far out to go back for c section) the cord was cut before delivery. That last push got him out. He was brightblue and there was an air of deadly panic whilst he was resuscitated.

Was it because they were busy? Was it my backside! I was the only woman in labour and the staff (midwives) were busy giggling and talking about parties. It was xmas eve; ds was born in the early hours of christmas day. They were complaining about lack of resources then but there were plenty that day - they just didn't want to do the work.

Thankfully DH demanded a doctor was called when he did; thankfully ds survived with no lasting damage; thankfully we had private health care for my prolapsed bladder; thankfully another hospital was much better the next time; thankfully the next time I was clued up enough to write on my notes that I wanted an experienced midwife in labou; otherwise an elective CS where a doc was present and noted that if inexperiwnce or incompetence ensued, I would not hesitate to publicise and take legal action. Care was perfect.

Just not so sure about the resources argument - they were using it 18 years ago yet preferred to do bugger all than what they were paid to do.

Hackmum - I hope not, I've certainly never heard that said apart from when its the truth. Sadly I've had to tell women that before and I hope that they trust be enough/I show enough empathy, etc that they don't think I'm lying.

I can't get my head round why some midwives don't like epidurals. Yes its a bit more faff and paperwork....but no more work than trying to support a very distressed woman. So its six of one and half a dozen of another.

Actually I've just remembered a midwife who did lie to a woman about Dr not been available. I was a 3rd year student at the time. I went out the room with the midwife and asked her why she'd said that. She said she didn't feel confident looking after someone with an epidural (she didn't normally work on labour ward). I told her that I did feel confident so between us we'd do it, the woman got her epidural. Hopefully the midwife saw what needed doing for the next time she was on labour ward.....looking back I should probably have told the co-ordinator but its hard when you're a student. She should certainly have asked for support rather than fib to the woman.

We used to have a group of senior midwives who were against pethidine in their pro normality quest. If you came out a room saying your lady wanted pethidine you were told to go back in the room and support her better.....and made to feel bad if you insisted. I think such midwives forget that some women don't want a "normal" birth in the hippy midwife's ideal birth way. They want all the drugs they can get and if thats what they want then thats fine.

Chunder and Cabbage thanks for your kind words and no apols at all necessary! I am actually feeling more positive than I did about the last two. This baby is definitely OA and have had a v different pg. I have a feeling my waters may have started leaking so may have to put that positive attitude to the test quite soon

The whole situation does tend to fill,me with righteous rage though every time I think about it. I believe in informed choice in childbirth, and it is a mystery why we don't get it. There is an obstinate attitude among too many people that women must and should suffer during labour.

Quote Pitmountainpony: 'The truth is people do not experience pain in the same way and for some the pain of labour is unbearable.Epidurals should be readily available for those that want them as in France.'

YANBU on any account. I think the NHS is as crap as it is because British people all take this 'roll over and not make a fuss attitude, poor NHS is understaffed'.

If men gave birth there would be multiple dedicated anaethetists on Labour wards end of....ridiculous that so many women get fobbed off like this....just as reported by Esther Rantzen on That's Life (Consumer Programme) in the 1970s...

I certainly didn't have a midwife constantly present (1 to 1 care) after an epidural (OH was there) so find this another excuse to deny women a painfree birth.

None taken chunderella you'd have to work pretty hard to offend me.

I imagine the clinical reasoning is that life saving surgery takes precedent over pain relief, given that an emcs is acted on immediately?

My views on requesting an epidural for pain relief are that if a woman has had the risks explained to her, and she is happy that those risks are outweighed by the benefits of removing the pain, then she should not be discouraged.

With regards to the availability, this needs addressing. There shouldnt be so few staff available that one persons pain comes below another's.

I find it a little sexist in fact. There are many painful but natural processes a man can go through and I have never known a situation where one has been told 'but this is normal you don't need pain relief'.

My views on requesting an epidural for pain relief are that if a woman has had the risks explained to her, and she is happy that those risks are outweighed by the benefits of removing the pain, then she should not be discouraged.

With regards to the availability, this needs addressing. There shouldnt be so few staff available that one persons pain comes below another's.

I find it a little sexist in fact. There are many painful but natural processes a man can go through and I have never known a situation where one has been told 'but this is normal you don't need pain relief'.

I got fobbed off LOADS last time (in January). I had one ten years ago, and a homebirth in the meantime with no pain relief so knew what I was asking for.
It took ages before she finally went to get someone. By that time I was 20 minutes away from giving birth.

I'll go and read the thread now...

Several things occur to me. IMO there are patches of lousy pain relief in many areas of healthcare, male and female. I read a journal article about care in a burns unit a few years ago that was like reading about some hideous torture chamber... due to a culture of minimising pain prescriptions, 'managing' (actually ignoring - two very different things) pain and punishing staff who asked for more pain relief for their patients. I also strongly believe that both my husbands had rather cursory pain relief for their vasectomies. How many men scream and shout for pain relief the way that women do? I'm glad that we do, to be honest, but do nurses/HCPs treat men who are demanding about pain well, or do they make sexist comments about 'time he grew up' and 'manflu'? I've heard some do so myself.

Also IMO the great key to appropriate pain relief is ATTENTION. Is it Viva who says she is 'epidural happy'? Well, you pay attention - you listen to the request, watch the woman as she goes through pain, see her through the contraction, ask again, listen to the answer, and then go ahead. Quite different from poking your head round the door and refusing OR accepting a request without really paying attention to the person.

Lastly, what is the professional relationship between midwives and anaesthetists like, overall? I am a different type of HCP, also female dominated, and there is a lot of anti-doctor backchat among the profession. I'm old enough and ugly enough not to put up with that tbh, as either we are members of a team or we aren't. It's important that local seniors in both professions set an example of top quality professional relationships, and if they don't, that stuff starts getting in the way of decisions that are patient-centred.

I don't get the understafed bit either - whenever me or mine have been in an NHS hospital there has been lots of futile chatter at the nursing station and not much enthusiasm to do the job. A direct correlation I think to not raising an invoice directly. Would we have paid the bill after DS was born; would we heck as like. Would there start to be improveents if the NHS wasn't free at the point of delivery. Of course there would.

Long live the revival of proper nursing care!

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I suspect there ARE places (or rather pockets of places) where this occurs. It's not standard though and I never had time for futile chatter as a nurse. Far from it....it's been a long time though and perhaps things have changed.

In any case an epidural requires one to one care so understaffing absolutely CAN be an issue.

Having read back a bit....am shocked that some people here did not get one to one care following an epidural , wouldn't have happened in MY day I can tell you.

What I can say is that staffing generally appears to be poorer in all frontline areas. This does not mean there has to be crap care, when my grandmother had a stroke, the staff in the poorly regarded hospital she went to were fantastic. The nurses were supportive and caring and the doctors explained all her scan results and what we should expect. So short staffing is an issue but doesn't necessarily mean poor care.
However, if she had been sent in with her stroke at the same time as 10 other people with strokes then I anticipate the care would have been poorer and the communication less good.

Nursing and midwifery are pretty physical jobs. I don't begrudge staff not running, walking fast or actively being with a patient for all of their shift. In an office, staff manage working alongside coffee, chatting to colleagues and the odd bit of MNing. Personally I would be astonished if a nurse was on MN at work. Chatting at the nurses station is no different to a member of staff talking to their colleague whilst working on the PC. It is also part of building a cohesive team

I think the argument of staffing and urgent life threatening cases stopping women getting epidural care should only hold true for the very odd occasion. It shouldn't be as prevalent as demonstrated repeatedly on MN and chatting to women. What is prevalent is various attitudes of why women shouldn't get one That is why they are not prioritised. That's the reason.

But I didn't get 1:1 care after an epidural 18 years ago - and I was the only woman in labour. And our son nearly died. Until we made a formal complaint there was no apology either and even then it was NHS doublespeak - and we refused compensation because all we wanted was an action plan acknowledging the mistakes and confirming what would be done to prevent a recurrence. Even then they said they were busy and it was all down to resources. Er, no, it was down to laziness, incompetence and a lack of respect for the patient. Major SW London flagship hospital btw.

Thanks, Viva, that's interesting. I don't really understand why a midwife would deny a woman pethidine - obviously I appreciate that all pain interventions can have some undesirable side effects in childbirth, but if a woman wants it, what is the psychological cost of denying it to her? You wouldn't deny pain relief to a patient who was in pain after an operation, for example.

Jake: "In any case an epidural requires one to one care so understaffing absolutely CAN be an issue."

That's true, though of course all women are supposed to get one-to-one care in labour (according to NICE), regardless of whether they've had an epidural or not.

JoanofArchitrave - I didn't actually say I was epidural happy, I said I think colleagues may consider me epidural happy. I said the same as you, that I wait for the contraction to end, ask if they're sure and if they still say yes I sort it.

Hackmum - not sure why these midwives were so anti-pethidine. They were very pro normality so maybe the whole cascade of intervention thing? Have pethidine, labour slows down, go on synto drip and monitor, more pain = epidural, or ctg gives rise for concern. More chance of a section/instrumental.

Maybe they just felt its possible to do it without therefore everyone should manage without? At the end of the day its not their labour and birth. I do get that there is some satisfaction in going home thinking that you supported a woman to be able to labour without needing pain relief. But not if they're begging for it and you deny it just so you can go home deluding yourself that thats what you did.