(Trigger Warning!!!) To think labour pain is not respected by healthcare professionals?

[Goldfishshoals]

Warning: you probably don't want to read this if pregnant/about to give birth!

Three weeks ago I gave birth. I had back labour - truly agonising. The pains started on Friday, but because they were about five-six minutes apart they were arbitrarily considered 'pre-labour' rather than actual labour (despite hurting as much as 'real' labour pains). They continued like that for four days, in which time I obviously got no sleep. I called the midwife for help several times and was fobbed off with 'take paracetamol', which unsurprisingly did bugger all for the intense stabbing sensation in my back every contraction. After one call in which I cried they let me come in (30 mins car ride there and back in pain!) and have a single dose of coedine (barely took the edge off) before sending me home.

On Tuesday my waters broke so I was finally allowed in the hospital for monitoring - I pretty much immediately begged for pain relief. 'of course you can have some!' said the midwife breezily before buggering off for fifteen minutes leaving me in pain. Then she came back and said she just had to ask a few questions then 'we'd see' about getting me some pain relief... I did eventually get given some gas and air.

My contractions never became more frequent on their own and eventually I ended up being induced with epidural - which wore off just in time for me to be fully dialated. First they said they'd get me more - then they said it was too late and gave me gas and air - which they took off me again when it was time for pushing. I begged for pain relief (for anything!) and was ignored. I struggled to push but the pain was overwhelming and stopped me being able to push fully. Baby eventually delivered with forceps, and episiotomy which I could barely feel in contrast to the agony I had been in.

I had third degree tear which needed stitching, and suddenly everything changed. I had an anaesthesitist numb me fully, and keep checking my pain levels for the theatre, I had a few days in hospital with three types of pain relief thrown at me, and I was sent home with boxes of unnecessary coedine etc, for the incredibly minor soreness of the stitches.

When I compare other hospital visits (for being run over by a car as a teen, and a more recent dvt) it's a similar story. My pain was taken a lot more seriously and I was given better pain relief much more quickly, despite them not being nearly as painful as my back labour.

I realise not everyone has back labour, and some people have much less painful births (lucky cows) but surely having high levels of pain isn't that unique? So why wasn't it treated seriously? The only thing I can think of is that labour pain just isn't respected. Aibu to think this?

From all the research I did it seems that choosing pain relief such as an epidural will increase the chances of a forceps or CS.
You may not mind that. But those on average have longer recovery and on average lead to more problems in subsequent pregnancies.
It doesnt mean that they will. Just are more likely to.

I also think we should as a society be having an honest conversation that having children later leads, on average, to more difficult births.

@minifingerz I think that's a really important point, and exactly where
I was coming from - I desperately didn't want lots of interventions, and I was concerned that much of the pain relief on offer has been shown to increase the risk of interventions.

Had there been an option which didn't involve drips, continuous monitoring, risk of further interventions, impact on baby, etc I would have probably gone for it. Even though I found labour excruciating, I'm still not sure I would do anything differently next time round, basically for want of a better option than a 'natural' vaginal birth.

Some of the posts here seem to sum up the original point about labour pain not being respected:

• I don't fully agree...and I don't think any kind of pain relief should be automatically granted at any stage/in any situation tbh Obviously if there is a clinical reason the medical staff won't be able to give an epidural etc, but what people are recounting here are stories of pain relief being refused for what appears to be a complete lack of belief that the woman is actually in pain.

• if epidurals were completely 'freely' available, you'd have some women at period pain stage labour choosing then after half an hour which would be stupid considering the risks they bring And why exactly shouldn't a woman with a period pain level of pain be given pain relief? Maybe I'm a wimp, but when I get period pain I take pain medication so why is it different if I'm in labour? And also different people can cope with different levels of pain for different amounts of time. Maybe this hypothetical woman with this level of pain has had it now for 10 hours and really needs a break from it so she can rest? And (shock horror) maybe she's capable of weighing up the risks and benefits and making a decision for herself.

• The patients wishes should obviously be considered but when someone's in the most extreme pain they're likely to ever be in, do you not think that it's possible they're not in the best frame of mind to be making such huge decisions off the cuff? So if the woman is in the most extreme pain she's ever been in her requests for pain relief should be ignored?

• If reducing pain in labour is more important to you than reducing the risk of surgery and instruments then it makes sense to choose to labour in a CLU. Sorry, but this is a rather unfair comment and fails to recognise the level of pain some of us experience. Maybe the writer of this comment was lucky and didn't experience a high amount of pain or perhaps was just able to cope better than others, but the point is there is nothing shameful in wanting pain relief.

• Women who use birth centres tend to be those who want to avoid the medicalisation of their births, rather than being solely focused on pain. Pain is a very valid consideration for a woman about to give birth and again this seems to imply that those of us who want the option of adequate pain relief are somehow focused on that and nothing else.

Scentofwater Your story is truly horrific and really puts things into perspective for me. I totally agree with what you're saying about birth centres. Great idea in theory, but awful if you need a higher level of care and that is just not predictable. I did not feel comfortable with the idea of being on a site a half hour (and that's not counting the time it would have taken to arrange a transfer etc) from the hospital level care it turned out I needed. I actually had very good care, but an awful labour (not as bad as yours). My lovely midwife told me at a later date that after she'd had to hand me over to a colleague she was extremely upset by everything I'd been through and it had traumatised her a bit (probably the bit when the epidural stopped working and I was screaming and begging them to just knock me out).

Sorry for going on, but the mental wounds are still pretty raw and talking about it does help.

One thing that comes up again and again on these threads is women being told they're not in established labour or they are hours away from delivering and the baby arrives 10 minutes later. At the hospital where I gave birth, a woman was sent home last week having been told she wasn't in established labour and then gave birth in the car park. I know all professionals make mistakes but this does seem to be incredibly common. In my first labour, I went from 2cms to fully dilated in an hour and I could tell the midwife didn't believe me when I said I wanted to push.

I wouldn't say I prioritised pain relief at all costs, I think I was trying to say that I feel like the concept that "interventions are bad" is not always helpful.

I had a very long latent phase with extremely painful contractions. I had an epidural as soon as I was 'allowed'. This thread is about hcp being dismissive of women in pain. During the latent phase I really felt ignored, like I was weak and not as tough as other women and basically a nuisance. My midwife also said some really stupid, unhelpful things to me during that stage. This has resulted in psychological issues for me. I'm terrified of giving birth again and I'm already starting to dread my DD birthday (coming up in a few months), which should be a happy occasion.

If this idea that interventions are bad wasn't held so dear, I wonder if I could have had an intervention earlier that would have prevented the psychological trauma. By this I mean if I could have had basically any form of pain relief to give me a break from the pain and a rest (I hadn't slept for 3 days by the time my DD was born). I felt that my psychological wellbeing wasn't considered a factor at all. Of course forceps are unpleasant and I wouldn't choose it, but those physical wounds have healed.

You're not being insane. There is maybe an issue about whether epidurals extend and complicate labour, which could be a reason to discourage them in some cases despite being effective pain relief. But there is no excuse for flat-out refusing one at maternal request (which has happened to two friends who gave birth in birthing centres and wanted to transfer out after labour had lasted for 24 hours +).

After my c-section I was shocked how quickly they removed the stronger painkillers. If it is major abdominal surgery, how can paracetamol + ibuprofen be adequate less than 48 hours later? After the birth of DC1 I had the ironic situation that my husband was knocking back codeine, naproxen and valium for bad but not serious back pain (prescribed by GP), and I was left with Boots own brand paracetamol for my sodding major surgery.

PS does anyone know if you get better / more pain relief after a c-section if not intending to breastfeed? I'm not sure how far the meagre paracetamol + ibuprofen regime is driven by breastfeeding/ the risk of opiates to the newborn (which I know can be substantial).

hops I wasn't breastfeeding, and I couldn't get hold of strong pain relief at all.

However, my midwife friend (who works in the same hospital) told me that it was probably because I didn't make a nuisance of myself enough, and that if I had been a pain in the arse they would probably have given me morphine She says it drives her crazy, the 'nice' patients are left to suffer but the difficult ones get their every whim attended to.

I think "letting you" is very patronising. However, things like morphine can't always be given freely because it depresses respiration. So you do have patients after surgery sometimes being removed the morphine drip for a while as to continue would put their life at risk.

I'm sorry you had such a hideous experience and poor care, but really nobody is saying that birth centres are 'the answer to everything'.

Women who use birth centres as a group have much higher levels of normal birth than similar women who choose an obstetric unit for birth, and they are more likely to express satisfaction with their births.

That's not the same as saying they are right for everyone or that care is always good there.

Hmm. You weren't saying they were right for everyone, but you did say that some of the epidurals needed in hospital definitely wouldn't have been needed in an OOH setting, and you just don't know whether that's true or not. Not in any meaningful sense.

Because you cannot extrapolate the experiences of a self-selecting group of women who clearly have particular views about desirability of epidurals in labour, and assume that's going to apply to other women who equally clearly don't share those views. And that's what you're doing when you say some women having epidurals definitely wouldn't have needed them if they were OOH.

From all the research I did it seems that choosing pain relief such as an epidural will increase the chances of a forceps or CS.

I don't know when you gave birth, but current NICE guidance is clear that the chances of CS don't increase with an epidural. So a desire to avoid CS isn't a reason for a woman not to choose an epidural.

As per NICE, there is an association between the use of epidural and instrumental delivery. But again, establishment of causation is an issue. Ie, is it the epidural or the things that lead a woman to want an epidural. In order to establish that, we'd need more research on women who ask for epidurals but don't get them.

By all means feel that even a correlation between epidural and instrumental delivery is reason enough for you not to want an epidural, that's absolutely valid. I'd go to the wall for your right not to have to give birth in a hospital for exactly that reason, if that's what you want. Same link doesn't apply for CS though.

morphine does bring about other side effects too - dreadful nausea and vomiting - which you sometimes can control with other drugs, side effects for those for some people can be agitation and dizziness...
I suppose my point is that it's difficult fully make someone aware of what they are signing up for with each stage because it's such a chain of events, that have so many unknowns in it.

I was definitely given and send home with something stronger than paracetamol bit I can't for the life of my remember what it was. I wasn't breastfeeding at all though.

Sounds similar to my own labour. Fucking paracetemol barely stops a headache let alone labour pain. They are so dismissive it is a disgrace.

As PPs have said, I also had PTS as a result of my second labour and even now, almost ten years on, it makes me upset thinking about it. It stopped me having any further children.

It does seem to be a particular feature of labour pain to try and tell women every possible negative of each drug before permitting her to have it. I'm not saying nobody should be advised but ime that's quite different to my experience in other situations. When I smashed my knee - see upthread - once they finally realised it was serious it was basically a case of "here take this". There was nobody standing there saying this is dihydrocodeine it might make you feel really sick or x or y or z. Just here take this.

Neither ideal tbh! But very noticeably different and I think that's because treating the pain is the number one priority if you've been injured - once stable of course-, but is actually pretty low on the list for childbirth

There is absolutely no excuse for women to be in unrelieved pain following childbirth.

Following a section, higher dose ibuprofen combined with paracetamol prescribed to cover the whole 24 hours (rather than written up for 0800 til 2200, so nothing prescribed overnight) should be adequate IF it's given/taken on time. Oramorph should be available to top this up when needed.

If pain is not adequately controlled by these measures we should be asking why not, and excluding other causes. If your pain is not controlled by theses measures a doctor's review is needed.

The same is true of instrumental/vaginal birth - pr diclofenac given after suturing followed by regular pain relief (including oramorph if needed) should make most women comfortable.

Again, abnormal pain should be investigated (haematomas have already been mentioned).

I am certain no-one expects to be completely sensation free after giving birth, but everyone can expect to feel comfortable when pain relief is given regularly and intelligently.

I agree
my first labour was back to back and progressed quickly. I was left without pain relief other than 2 paracetamol and a TENS to 10cm dialation, because it wasn't thought likely that I'd progress that fast, and the prevailing attitude was that I was making something of a fuss over nothing. I was so exhausted by the pain that I struggled to push effectively, which I think contributed towards an instrumental delivery and significant tearing.

With my second labour I was MUCH more assertive. Took myself off to the labour ward slightly earlier than recommended in the knowledge that I'd progressed quickly last time. I was encouraged to go back home, but very politely requested to stay to access gas and air, which was agreed. I progressed quickly again, and also requested diamorphine when the pain began to get hard to manage on gas and air. I was calmer, more focused, and had plenty of energy and headspace to push effectively. The delivery was much easier (despite DC2 being a 99th centiler).

It may well be that the outcomes would have been the same regardless of pain relief - I can't possibily know for sure. But I certainly felt a whole lot more empowered and respected the second time round (different hospital as well).

YADNBU I had five days of labour and was in agony the whole time. Then waited and waited for paracetamol and ibuprofen to be prescribed and sent DH to Asda to buy some in the end as I was beside myself. It was ridiculous.

This was following a section and I had zero pain relief for hours I was pacing and they kept telling me to sit down. Erm...nope.

I wasn't believed in either of my labours that things had progressed. It does seem awfully common that you aren't believed / are turned away very easily.

Am pregnant again. Currently midwives haven't decided if I'll be 'allowed' to homebirth. Am 3rd trimester but I think I've dropped off their list of things to think about. At this rate I'll be free birthing at home, because no chuffing way am I going to a CLU and I think you have to be booked in / registered with MLUs here. Staffing is so abysmal I do feel sorry for midwives in the NHS at the moment.

Post EMCS I had loads of oramorph but was told I couldn't be discharged while still on it. I stopped anyway as soon as I could, as I didn't really like it. Also I wasn't breastfeeding. I have definitely heard of women who were, who were denied morphine post CS for that reason though. Inadequate pain relief for bf mothers sounds like as good a way as any to put them off.

"There is absolutely no excuse for women to be in unrelieved pain following childbirth"

The 'excuse' is that in some hospitals there is a state of crises on the postnatal wards. My local hospital - 2 midwives to 48 patients (i.e. 24 mums and 24 babies). The midwives are overwhelmed and ground down, and this results in some really dysfunctional behaviour in some of them, maybe the ones who are more fragile or more stressed at home. I have seen women treated very unkindly. :-(

IT can increase the cs rate. Anything that increase the instrumental delivery rate in my case would have meant a CS. Some women don't want an instrumental delivery and would therefore op for a CS instead.

Choosing not to have an epidural and therefore lower your risk of needing an instrumental delivery (which by my maternal request would be turned into a CS) is therefore a logical choice as I wished to avoid a CS.

"It does seem to be a particular feature of labour pain to try and tell women every possible negative of each drug before permitting her to have it"

It's called 'informed decision making'.

"Because you cannot extrapolate the experiences of a self-selecting group of women who clearly have particular views about desirability of epidurals in labour"

I'd say that your feelings about the desirability of epidurals have bugger all impact on how painful your labour turns out to be.