To feel vindicated by the D of H report, which confirms midwives are withholding epidurals?

[RevolutionofourTime]

www.theguardian.com/lifeandstyle/2020/mar/03/women-in-labour-being-refused-epidurals-official-inquiry-finds

I was denied pain relief during my first labour for no reason whatsoever. When I complained to the head of midwifery, she encouraged me to try a home birth next time. 🤨 I have also witnessed other women in maternity ward being denied pain relief.

Despite this, I have seen it argued here time and again that midwives are not acting as gatekeepers or withholding proper pain relief in labour.

This report confirms what many of us know.

I will be curious to see if this will lead to changes- more specifically, to adherence to the Nice guidelines that it’s never too early and never too late for an epidural in labour.

This has happened to me twice. The last baby was 9lb10 and back to back....

I had every pain relief possible with my 1st including a spinal. I was in labour for 32 hours. I was pushing for four and nothing was happening. I told the obstetrician who came to examine me that I was in a lot of pain and was told I was’t and it was impossible I was so they couldn’t give me more epidural. Eventually my DH had to stop them examining me as I was arguing with the consultant as she tried to wrestle me into stirrups. He told her to stop and that if I said I was in pain then I was in pain.

I wasn’t kept well informed about my birth at all so no idea what was going on really at that stage. I was supposed to be pushing at that point but nothing was happening. Eventually I was given a spinal by an anaesthetist who confirmed that I could feel everything so I wasn’t lying to the bloody obstetrician! 😡😡😡

This was with a known spinal condition by the way and it noted on my notes that there may be issues with epidurals.

I was essentially forced into going to the standalone midwife unit for my first (and only) birth, despite my reservations about it all the way through my pregnancy.

My concerns were totally dismissed, time and time again by the wretched midwives I had the misfortune of dealing with. Telling me 'you'll be fine' 'you're low risk' 'stop making a fuss ' and when I asked about the lack of pain relief available, was told again 'you'll be fine'

Surprise, surprise, it wasn't fine. I ended up being blue lighted to hospital after a fast labour but unable to push the baby out as back to back. No pain relief offered and the gas and air machine wasn't working apparently. The midwives who came with me in the ambulance were laughing and joking and ignoring me whilst I was in unspeakable pain. It was the most horrendous experience of my life, I genuinely felt like dying.

When I arrived at hospital the midwives were again brisk and uncaring, as was the doctor who insisted on doing yet another internal examination despite the fact that I was crying in pain by this point and begging her not to. She had a very shitty attitude too.

The baby was finally delivered with forceps. Huge blood loss and internal/external injury. The after care was also extremely poor, aggressive midwives including one who threatened me if I didn't go to the toilet after having my catheter taken out. I was petrified as it felt like my insides were falling out.

I was honestly as compliant and reasonable as anyone could have possibly been on that day and perhaps I just had the misfortune of dealing with a really shitty group of people.

Anyway the experience landed me with PND and over a year in therapy. I will never have another child as a result, so traumatising was that experience.

IMO standalone units should be banned. There also needs to be a huge overhaul on the attitudes of staff towards labouring women. It makes me so angry to think that so many have suffered so badly.

I'd sue if an epidural was withheld from me. I don't want to experience natural birth and never have. I soon got one when I said that.

What is a natural birth? Give you a wooden spoon to bite down on and send you off to the fields?

Fuck that. Give me all the drugs.

I have two children.
My first (7years ago) I had a pretty awful time, I called at 2am (contractions started at 8pm the previous day) I was told to breathe and have a bath which I did.
I then called at 5am saying that I want to come in and to expect me. They said no, don’t come in and they will send someone out in an hour to examine me. 7am and still no one came. I called and they said they were really busy but someone would be with me shortly. 11am I was taken to hospital and delivered my baby girl. I was so angry. The aftercare is another story.
My second was quicker, contractions started at 5am, called at 6am and they said I had ‘hours left’ I went to the maternity unit at 9am in agony asking for pain relief - just has and air. They refused until they examined me. I had gas and air half an hour before they said that they only pain relief I will get is to ‘get the baby out’ I begged for pethadin or something stronger and was refused.

I’m thankful to have two healthy children but no one took what I said seriously

@puuurple literally the same experience! Aside from the non midwives at the hospital were great in surgery.

I've not read the thread but many years ago a mn actually linked midwife forum.

The disparaging, degrading way they spoke about women at their most vulnerable was despicable.

It was cultist.
The candle and feel good hormone brigade dominated it.

@Springinsight tbf I’ve also seen similar on forums for student obgyn drs and other HCPs working with birthing women, unfortunately a lot of people have really crappy attitudes towards labouring women. I’m glad I never delved through these corners of the internet before childbirth though and I’d certainly feel very wary about having students or anybody not completely and totally necessary present/involved in the process.

I note someone asked if midwives are no longer qualified nurses who do midwifery conversion that's right. They do direct entry midwife training now. No nursing skills other than placements in training. The change probably goes hand in hand with slippage of standards

Direct entry for midwifery has been the norm for over 20 years. There’s very few conversion courses these days.

I’m a direct entry midwife. 3 years of on the job training. We had 2 nurses join us half way through. So I had 3 years of caring for women in labour, etc before qualifying and they had 18 months......but hey, they could already run a drip through, do a drugs round and take obs. You know what....so could I after 3 years!

Guess they might have experience of some different medical conditions than someone who hasn’t been a nurse but both said they didn’t feel ready to qualify and wish they’d had longer. Not sure why being direct entry or not has any bearing on “standards” and certainly no bearing on withholding/not withholding epidurals.

I agree with all thid. I was upset when a nurse told me off when my canula fell out...that is nothing compared to what some of u put up with.

I have but one child. He was late breech and had to be delivered by elective c-section. When the consultant told me this, I was actually massively relieved.

I have never wanted to be in labour and do not feel I have missed anything at all; particularly when I read threads like this one.

The ‘too late’ thing is bullshit - I was fully dilated and pushing for an hour when a doctor came in, saw how distressed I was and asked why in earth I hadn’t been offered an epidural - I heard the midwife say ‘she wants a natural birth’ - I had no birthing plan, never said such a thing and had been asking for an epidural since 6cm. Absolutely true that they withhold them.

Even worse, in the notes after, midwife wrote that I had wanted to practice my hypnobirthing techniques - totally untrue.

I can only go from my experience but I did get epidurals and God did I need them by the end. My midwives were supportive.

My midwife talked me down from diamorphine and an epidural. I had a long but uneventful induced labour with the hormone drip, on gas and air. I don't regret it, and it probably was the right thing for me, but then (unbeknown to the midwife) I have a high pain tolerance. I do think they should have given me what I asked for, although I'm grateful she didn't! I'm about to do it all again and reading the article has given me serious fanny daggers. 😩

Not sure why being direct entry or not has any bearing on “standards” and certainly no bearing on withholding/not withholding epidurals I don't know either but 40 years ago I never heard any of this stuff, my midwives were all wonderful and all my friends felt the same. They did have 5 years training if you add the nursing and the midwifery so I assume they must have learned something.

I had to press fairly hard for my epidural. I’d done all my research before labour and knew the risks and all my options, but still got a lot of “are you sure, don’t you want to try x, y or z first?” and warning me that I’d have to wait for ages and that it would slow things down (neither of which were true).

And that was as an induced birth with syntocinin in the hospital ward with drips already in my arms and lots of monitoring (I had GD). So I can believe it might have been much harder for women who would be getting transferred out of a midwife led unit or from home to hospital for one.

I really don’t think there’s ‘too late’ - I really didn’t want one but ended up being recommended one by lovely obstetrician so he could try and rotate my back to back baby; choice was mine and he took the time to explain fully what he hoped would happen and what else might happen.

Anyway, epidural placed when I’d been fully dilated and pushing for 2 hours and it worked so well I asked the anaesthetist to marry me when it took effect

I had an epidural as soon as I got to 4cm and was in "active labour" I was lucky that I was the first Epi patient of the day.
I was in Kingston?

What hospitals are they trying to deter you from it ?

YANBU OP and I too am glad to read this report.

I had my daughter 4 years ago and too was denied an epidural when asked.

I arrived at the hospital after my waters had broken and the contractions ramped up in pain but because they were still about 7 mins apart, the midwife kept me in the waiting room for another hour, without checking me once.

When eventually seen, I was already fully dilated and they had watched me writhe in pain on the floor of the waiting room in tears for that length of time.

I was denied an epidural despite pushing for 5 and a half hours. Yes, you read that correctly! Midwife kept saying I didn’t need ‘one of those doctors’.

Eventually, after 6 hours, a doctor came in and was pretty angry I had been left to push for that length of time with just gas and air and no other intervention.

20 minutes later, I was getting an epidural. 10 minutes later, my daughter was born with me pushing her out and a bit of help from the doctor. So really, that report is correct and it is NEVER too late to have an epidural!

That experience threw me into many months of nightmares and depression.

I haven’t had another baby.

Well I was born 40 years ago and the midwife slapped my mums leg and told her to “stop making all that noise”

Guess she learned that compassion in her 5 years of training. 🤷‍♀️

There's an article on the Guardian about this report and on the issue of it being either too early or too late to have an epidural, apparently that's outdated nonsense, to quote:

"Dr David Bogod, a council member of the Royal College of Anaesthetists and a consultant at Nottingham University Hospitals NHS trust with a special interest in obstetrics, strongly disagrees. “All that stuff about ‘too early’ and ‘too late’ is nonsense that’s not supported by evidence and specifically runs counter to national guidance that says women should be given an epidural if they want one,” he says"

www.theguardian.com/lifeandstyle/2020/mar/04/i-asked-three-times-for-an-epidural-why-are-women-being-denied-pain-relief

@ukgift2016
I am a midwife. Yes, it can be too late to give someone an epidural when they're 8/9cm dilated.

I have cared for MANY women who were 4cm dilated and pushing literally minutes later. It could be unsafe to offer a woman who has had children before an epidural at 8ish cm. They're usually pushing minutes later. So if you're a pregnant woman who has had a normal birth before and you know you want an epidural this time, my advice to you is to go to hospital as soon as you start labouring or it may well be too late since second labours can be only 2-3hrs long.

It's important to know that it takes a good 20 minutes to set up and administer an epidural and that's only if:

• there is an anaesthetist and ODP available
• the woman can stay very still
• she has a normal BMI so her spine can be palpated easily
• she has a normal shaped spine ie. not scoliosis
• the anaesthetist is very experienced
• you have a midwife who is qualified to care for someone who has an epidural in situ
• blood results have already checked ie platelets and full blood count

It will usually take longer than that because the woman needs to inform the midwife who then needs to inform the anaesthetist, who may be part way through a c-section.

There are lots of things to consider, so no, not all midwives deny women epidurals, but there is a time and place where it is not safe to give a woman an epidural despite her insistence.

Why is it unsafe to administer an epidural at 8/9 cm or if a woman is about to push?

Sorry if a silly question, just generally interested!

I’m a midwife. I’d happily fetch the anaesthetist for a woman at 9cm, even 10cm....even if she’s had a baby before. Some women will subconsciously hold off pushing until they have one. If the anaesthetist comes and the woman can’t sit or lie still then that’s different. But she knows we tried and hopefully won’t feel fobbed off/not listened to.