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.

I know this happens but I have personally never seen this happen although heard stories from colleagues. I am a recently qualified midwife. However, I have had an anesthetist refuse me once to do one when I was student, I ended up calling the consultant on call but the woman delivered her baby in the meantime so was too late. I was horrified and made a complaint.

I have seen women who request them not get them but this has been due to the anesthetist not being available due to a queue of women waiting or emergency in theatre. Then baby is born before their turn. Unfortunately in these cases the midwife gets the blame as they are the one in the room. Only time I have ever felt threatened was due to an instance like this.

In my experience we actually encourage them before syntocinon is commenced.

I try and have honest and open discussions early on (if possible) about pain relief in labour with risks and benefits and let the woman know she can change her mind at any point (unless she is pushing or unable to stay still enough for it to be sited). Pain relief is there for a reason, you aren't a better mother because you opt for it. 100% the woman's choice. We have it for all other painful procedures so why are we so against it for childbirth? I myself was anti epidural when I had my own child. No idea why!

When I had my son it was actually the opposite. They were pushing me to have an epidural that I didn't want as I said I needed to push and refused me gas and air as 'no way you are more than 3cm, 1st baby it's too quick, it's just the drip and position of baby making you feel you need to push' and they refused to examine me due to infection risks.

In the end I agreed to the epidural but unable to stay still, involuntary pushing and it was the amazing anesthetist who was trying to site it made the midwife examine me as I kept begging and she refused. Funnily enough I was fully dilated and his head was right there so he gave me the gas and air and wished me well and he was born 16 minutes later (unfortunately I ended up in theatre for my placenta to be removed so met him again for my spinal and he was so lovely and apologetic).

Horrible to hear these stories and I am so sorry to all those women with these bad experiences. Part of the reason I wanted to become a midwife was due to my own poor experience, I wanted to make any difference I could.

Instead of demanding epidurals, why not get up off your back and let gravity help deliver your baby.

ODFOD.

If I responded to this statement honestly, I’d get banned.

Just.... FFS.

The report said the most common reason for lack of epidurals is midwife shortages. So we can’t always blame the midwife for getting the job done the best/safest way they can (hats off to anyone who will take on the modern task of midwifery) The statistics for the amount of women keen to go pain free when it is accompanied by risks, and delays in labour is also rising yearly, I wonder if its psychological - expecting an epidural - not expecting pain.

I'm a rape survivor and was petrified of internals and interventions. I had epidural asap on my birth plan agreed by my psychologist because of PTSD. Midwives refused and told me natural birth would be cathartic. I ended up under primary mental health services postnatally where they were horrified but how I'd been treated.

@Vintage2020 why can't midwives be honest then? Instead of trying to dissaude women or make them feel like they're stupid and weak for requesting one; just have enough respect for them to say, sorry we are short on staff. Not overly reassuring, but saves numerous women wondering what they did wrong, why they were ignored and maybe people will start to push for change.

I’m actually surprised that women are offered a spinal block for caesarians. I’m sure some people out there would love for women to be sliced open with no anaesthetic. I was told by one midwife that it’s God’s will for women to suffer during childbirth as punishment for Eve.

And that the mothers aren’t important - only the babies matter. Women are merely a vessel. Very Handmaid’s Tale.

they have a negative effect on the baby, effectively knocking it out for hours on end and interferes with feeding sorry, but this just b*. Comments like this aside, I think this thread just about says it all in pages and pages of individual testimony. Give all women a choice - natural childbirth types who enjoy a bit of pain can do it their way, but don't make that the default position for the rest of us.

Is that your experience @Shandied?

My experience was the opposite actually... I wanted to feel what it was like so I didn’t want an epidural. I was induced in hospital and just had gas and air, long story short I gave birth in the theatre (because they thought they we going to do a c-section but didn’t) and the midwives and (especially the) anaesthetist was really trying to push an epidural on me. They were asking me mid contraction so in the end my partner asked them to leave me alone. I wasn’t ‘being a hero’, it didn’t feel as painful as I thought it would (lucky me!)... plus I was properly caning the gas and air! If I’d asked for an epidural at any point, they would’ve given me one.

Oh extra info, the anaesthetist did say it can be ‘too late’. They said it takes about 40mins to kick in, so if baby’s coming, there’s no point.

My mother was a community midwife, and would have been horrified by this. Even back then (30+ years ago) the natural childbirth lobby were trying to force their views onto everybody else.

I was denied an epidural. I went to the hospital and was told I was 3cm, I was permitted to stay but they said they wouldn't provide any pain relief until I was 4cm as I wasn't in established labour. I laboured for hours alone with DH in a room, he went out multiple times to the desk to ask midwives to come and check me as I was in severe pain (and my birth plan was clear that I had no intention to labour without pain relief but did want a step-up approach by trying the pool and G&A first and if they didn't cut it then diamorphine and then so on). A midwife finally came to examine me about 5 hours after my first exam and I was 8cm. They offered me G&A which I wanted, I tried it but couldn't use it because it was just instantly making me vomit. I then asked for an epidural and they said I couldn't have one as I wouldn't be able to sit still long enough to site it. They really pushed diamorphine on me which I had and honestly it was really helpful. However I resent the decision being taken away from me! I got moved to the delivery suite after that and asked my new midwife there who said the same thing. I raised this at my birth debrief and the consultant midwife said that no request for an epidural was documented anywhere in my notes despite me asking twice to two different midwives and trust policy is to document all such requests! I had a instrumental delivery with an episiomty in the end, by which time my diamorphine had completely worn off and the pudendal block and locals for my stitching didn't work at all as turns out I'm one of those people who the anaesthetic almost immediately just goes into the skin. If I'd had an epidural the incredibly painful birth and stitching, which gave me birth trauma as a result, would have been painless. Therefore I am really angry and gutted about this.

It horrifies me the way birth is treated in this country, in no other scenario would you be expected to endure agonising pain when you didn't need to.

My last birth was a back to back labour, third baby so they were all 'oh the baby will just fly out!' but it was so so so much more painful than my other labours. They wouldn't even give me fucking gas and air when I was crying my eyes out with the pain. It's monstrous.

For me they would give gas & air until I was 4cm dilated. The thing was I went from 4cm dilated to the baby in my arms in five minutes, so I had suffered for ages up to that point for nothing.

They gave it to me for the (many) stitches though...

Alot of women who have epidurals are high risk. Women with high BP are encouraged to have it as it lowers BP. Women who have the syntocinon drip have it most of the time. These things mean babies are at higher risk of becoming distressed or a problem occurring and delivery needing to quicker either with assistance or an EMCS. People then say "oh it is due to the epidural" no it wasn't, it was due to the baby becoming distressed due to xyz. Very few assisted deliveries I have seen to women with epidurals are due to ineffective pushing, maybe 2? Most of the time it is due to something entirely unrelated.

The epidurals we use in my trust mean that women can be semi mobile. I always encourage women to get on their knees and lean on the back of the bed to help gravity assist when they are pushing. Just because someone has an epidural it does not mean they can't be upright.

Yet men having a hernia operation are given all the pain relief they need! Women are discharged 24 hours after a Caesarian with a couple of paracetamol.

Instead of unreasonably demanding a general anaesthetic for your leg amputation, why not bite on this bullet?

Instead of accepting IV antibiotics for that festering wound, why not allow your body to fight the infection naturally?

I mean seriously. Women are perfectly capable of weighing up the risks and benefits of medical procedures. HCPs should not be gatekeepers and cause unnecessary trauma.

I definitely think there's a pervasive, strong attitude among HCPs that it is better to go without pain relief. I got so many approving comments from both doctors and midwives about only having had a little bit of G&A - I'm sure they would have said if asked that of course they didn't look down on women who had epidurals, but it was very clear that they thought I'd done the 'right' thing.

Ok so the midwife who looked after me during labor was amazing. She checked regularly how I was doing, if I was managing, of I needed to step up the pain relief ( I was induced) after what felt like a million years ( was prob 10 hours) I was only at 2cm dilated and there was talk of a CS which I didn't really want. I asked for an epidural at that point purely because I had been awake for 2 days and thought I was having a section anyway and an hour later I was 10cm and my daughter was born with no issues at all.. I honestly cannot fault any of the care I received at all. I got really well looked after.

My friend begged for an epidural and didn't get one. She was told at pre birth classes just to ask and if they person was available then she would get it. She didn't. Midwife told her she was doing well, try the ball, pethadine, etc,

I had my first baby in NI where you could only get an epidural if you happened to go into labour between 9am and 5pm, as they didn’t have anaesthetics on call for maternity ward. Of course mine was in the middle of the night, so it just wasn’t an option. 😔

Well, I’m a labour ward midwife and I can absolutely assure you that as and when one of my ladies asks for an epidural, off I trot to call the anaesthetist and prepare for the epidural to be given.... It is not my labour or birth experience to project my opinion upon and it is absolutely not my job to do this.... Midwife literally means “with woman” and that is what I am.... I am her advocate.... I’m lucky to work in a trust where 9 times out of 10 an anaesthetist will be on L/W within 15 minutes but there is the odd occasion where they can be delayed but this is rare... I am disgusted reading this thread that any midwife would disrespect a woman’s autonomy and choice regarding her birth.... there are no medals given out at the end of labour; whether it is achieved through hypnobirthing, paracetamol, Diamorphine or the whole bloody works.... all we can hope for and strive towards is for a woman to feel empowered through informed choices, with dignity and safety first and foremost.... I am so sad to read of the distrust many women have towards midwives because of their experiences... and I am also lucky to be able to say that our trust has a very effective multi disciplinary approach to caring for women; positive working relationships between midwives and doctors are imperative to facilitating safe birth. There is no ‘them and us’ culture. We, in partnership with the most important person in the room, the woman, aim to achieve a safe, memorable and positive birth experience.

It’s exactly why I lied about having type 2 Tokophobia in order to have an elective csection

Thank you Guiding. I work with midwives and fortunately most I encounter have the same attitude as you. It’s a terrible shame that others destroy women’s trust in the system. Thank you for advocating for women.

I was point blank refused an epidural and I have never got over it. That was 14 years ago and I still think about the midwife, Rosemary Gosden. I had to have a hysterectomy because the birth was traumatically fast although I was told I couldn’t have an epidural because it was too early, and I ought to pull myself together because I was in for a long labour. I still wake at night feeling anxious about it.

These stories are just awful.

It totally resonates with me what a previous pp said about the war between midwives and doctors. I experienced the same in my birth (slightly off topic) - I had a pessary induction (failed) and constant monitoring as baby wasn’t moving well. I was then left overnight (in retrospect I wish I had screamed the place down about this) before having my waters broken.

Anyway, it was all a bit awful because baby’s trace was so bad but it culminated in 10 people having a row in my room about whether I needed a csection or I should be left to labour but have the baby blood prick tests. It was so bad they left to have the fight in the corridor as they realised me and DH were watching them!

I was then given an awful decision about whether to go for an emcs with a spinal block or have the blood test with an epidural and risk needing an emergency section without the epidural having had time to fully work....... who would chose the latter? When I said I wanted to go straight to a section as I was really scared for my LO the senior midwife literally huffed at me and walked out.

All the while the poor anaesthetist was hanging around behind me wondering whether she needed to give me a spinal or an epidural!

I later found out that you can only labour for three hours after the blood tests (one per hour for three hours max) and if you haven’t delivered by then you have to have a section. Given the asked me at 3cm dilated I would never have made it to a natural birth!

Turned out my LO had a severe cord tie and had swallowed a huge amount of meconium, she had really low agpar scores and needed suction for 30 mins before we even saw her. She had been in distress for some time.