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.

Sounds like they were full to capacity

They are totally overstretched and sadly someone who is low risk and suitable for MLU (even if they don't want to be there) is always going to have to stay there to make way for high risk when there is space shortage

I wonder if many of the epidural refusal cases are actually the exact same as yours which means the focus of the review needs to be that they need more space on labour wards.

Although in my hospital we were told that there's always a queue for MLU and people end up on LW when that wasn't their preference. So possibly a localised issue

I've seen a number of articles putting the pain of childbirth right up there with gallstones, severe burns, etc, yet we don't see people with those other conditions being told they're doing well and don't need pain relief.

I firmly believe misogyny is behind the idea that women must somehow grin and bear it in childbirth. It's truly ridiculous.

The midwives I saw during DD's birth were the worst NHS staff I have ever experienced.

When I arrived at the hospital she called me a silly girl for coming in after only having contractions for an hour (I was 30 years old, far from a silly girl) This was before she had done any examination of me at all.
I gave her the birth plan, which made her laugh, she then put it on the side and didn't look at it again.
I asked for an epidural and was told no - no reason, just no
An hour later I asked again for an epidural and was told it was too late.
DD was born 3 hours after I arrived at the hospital - maybe I wasn't such a silly girl, had I not gone in she'd have been born on the floor of the car!
Due to the unexpected very fast delivery I ended up with about a million stitches (I'd been left on my own for most of the time so they didn't know how I was progressing)

@RevolutionofourTime I can imagine your frustration especially if they didn’t seem to address your complaints. I have the same thing when trying to change guidelines in view of new evidence based research - there is always a resistance to change. This is where the local maternity voices committee are invaluable - all delivery units have to engage with them and getting them to highlight concerns that you have means that your voice is multiplied and they have to listen.

@flowerfairy6004 ok don’t compare it to dental surgery, though I’d argue that given it’s a labour ward you could be expected to be ready to deal with labour.. Let’s compare it to a much more random condition like kidney stones. Are you under the impression that pain relief isn’t provided when a patient presents with renal colic?

Thanks for the little ride into victim blaming, after all how could a midwife know her patient wanted an epidural in the face of her ASKING FOR ONE? it must obviously be her fault for not following the complaints procedure afterwards. The PATIENT is responsible for the women coming after hers pain and distress not their midwives.

@PrayingandHoping, same at my hospital - I know dozens of mums who wanted to go to the MLU but were sent to the labour ward because the MLU was full. Which makes my case all the more bizarre.

Regardless, it is not okay to send a patient to a setting where pain relief is not available, when the patient is stating very clearly that she wants pain relief. That is a breach of NICE guidelines.

Also, the MLU is not being candid about the fact that pain relief will be withheld. Their official literature states:
“ What happens if things don’t go to plan?
If we have any concerns about yourself or your baby in labour, or you decide you want an epidural, [the MLU] is located close to the main Delivery Suite where the Obstetric Doctors, Midwives, Anaesthetists and Paediatricians are based.“

They do not state that in fact, once you’re there you are trapped. That is very misleading.

Wow a lot of assumptions made about me from one post. The only correct one was that I do believe in intelligent design and always will. Snidey, sarky comments trying to belittle me for my beliefs are why I don't usually bother posting much. Takes all the fun of having a discussion away when people can't accept that not everyone thinks the same.

No it's not ok you couldn't be moved

They drill it into pregnant woman here that if you think u may want an epidural do not go to the MLU, they tell us a transfer would not be quick and you'd be in a queue of availability

That doesn't cater for people who are put in there when they don't even want to be like yourself!

@5zeds I’m not victim blaming at all - in fact I’m saying that what you went through is awful care however unless you complain it won’t change that Midwife’s practice. Keeping a woman in pain with no valid reason is unacceptable if they’re asking for pain relief. However kidney stones wouldn’t require an epidural - they’d give entanox and other forms of oral analgesia that once prescribed can be given by any qualified health professionals. Epidurals can only be given to labouring women by senior anaesthetists - therefore you have to wait for one to become available. There is not an anaesthetist available to every woman - just as there’s not a doctor for every woman that attends labour ward and sadly in some cases there’s not even enough midwives for every woman that walks into labour ward if it’s busy - therefore if it’s busy people have to wait. It’s the same in every department - unfortunately demand always exceeds supply. The NHS is underfunded and overstretched - it’s trying to do the best for as many people as it can but it’s never going to succeed in every way as it simply doesn’t have the resources. It can be better but that involves a lot more funding and people paying more towards it.

And they also withhold gas and air and pethidine, even though they are supposed to be available.

It’s like being forced into a cult.

I thin it's bollocks. Midwives work so damn hard and this sort of report just makes for an adversarial relationship. Epidurals are dangerous in some situations. And recovery certainly for my one experience was awful, couldn't move for 24 hrs. It was terrifying and nobody tried to dissuade me for 1 second. Midwives are all amazing, even the ones I don't really gel with (I've had a fair few kids)

@Enchiladas I do believe in intelligent design and always will.

I don’t think we’re going to find common ground here.

@nancy75 I guess we all experience quite similar situations differently. When I went in, the midwife was similarly bitchy and told me to go home. When I started crying she reluctantly checked, 5cm. My DC was born 15 minutes later, after the midwife told me I would be in all day. They had to wheel me through the hospital on a crash cart screaming at me not to push. And I consider the whole thing the most amazing experience of my life.

@Tootletum

Midwives are all amazing

This entire thread is proof that no, they aren’t ALL amazing at all.

It’s ridiculous, something to stop pain has been made available but it is refused within the nhs in so many circumstances. Women should have complete choice in pain relief.

Personally at my booking appointment (which they Were “too busy” to give me until 19 weeks) the consultant and midwife guffawed with glee and told me I wouldn’t be eligible for an epidural because I hadn’t had “bloods” done earlier.

I genuinely felt bullied by them and my husband did say if he hadn’t been in the room he would of thought I was exaggerating. They were both so incredibly rude and condescending. We were having none of it.

I travelled to London (from Edinburgh) to have a private birth - where it is indeed possible to have an epidural at any stage of labour.

I feel so lucky to have been able to have a pleasant experience privately but I will not be having another baby due to the travel involved to get to a private hospital.

I think the nhs is probably excellent for women wanting a non medicated water birth with no complications etc but if you want modern care
PAY - to guarantee your birth plan is taken into account.

@Dropyoursword yes there was an element of hyperbole in that statement, what I really mean is that they try their best with challenging resource constraints. Obviously not all of them are nice, they're a reflection of all of us. We're not all nice patients either. I just think the emphasis on epidurals and "traumatic" pain is tediius,. Yes, the pain is fucking awful, but birth injuries are far worse, and I've had my life a bit damaged by overdosing the epidural (got a clicker) and pushing when they told me not to because I couldn't feel a thing. When I went without I loved it, I loved feeling the crowning, the searing pain. I tore with all of them but nine as bad as the epidural. Realise it's just me experience but so is everyone else's who comments on here. Epidurals are a shitload more complex than comparable pain relief for other procedures, people forget that.

@RevolutionofourTime please remember it’s not all that do this it’s some - it’s terrible that it happens but not every midwife is doing it. Those that are need to be reported and re-educated to provide compassionate care. This is the same in every job there are bad apples in all walks of life - blanket statements determining a divide of usand them is quite demoralising for those of us that are working incredibly stressful jobs caring for people to the best of our ability with the limited resources available trying to give the best birth experiences we can. Most of my colleagues have worked without breaks, doing unpaid overtime in order to maintain the safety of the mothers and babies in our care. We certainly don’t do it for the money.

I do really understand where you’re coming from @Tootletum, so please don’t think I’m being snarky. Just that We're not all nice patients either - no-one has an obligation to be a “nice” or “easy” patient. As long as women aren’t abusive towards their caregiver they have no other obligation. Midwives ARE obligated to be kind and professional towards a woman.

It’s not fair to dismiss “traumatic pain” as tedious when there are women who literally have PTSD from their experience.

Also, I’m not sure obviously about your own experience with an epidural and your statement about overdosing (which doesn’t make sense to me as there are limits on the PCA, but again, without knowing your specific circumstances I can’t really comment) but risks are explained to a woman about epidurals. It’s each individual woman’s decision whether she accepts those risks or not.
I also understand that anaesthetists aren’t always available. I have had a couple of experiences where that’s happened when I have been providing care. But the women I was caring for were COMPLETELY aware of why there was a delay. I also had another occasion where the anaesthetist started the procedure and abandoned it because the woman was fully dilated, involuntarily pushing and could not remain still enough to site it. She was NOT happy, which I entirely understood, but her baby was born minutes later.
I am aware that it cant ALWAYS happen. But it is not up to the midwife to decide who should or shouldn’t get one. I will ALWAYS contact an anaesthetist if a woman requests an epidural. I will explain (and document) if there is a delay. It’s not up to me to make a decision on whether she gets one or not.

Midwives work so damn hard and this sort of report just makes for an adversarial relationship.

So even when there are report findings that midwives are withholding pain relief, women should just shut up for fear of making the relationship worse?

Try that advice on the relationship boards and see what response you get.

I went private with DS. No problem with having an epidural. No issues with pain management - I was encouraged to be as pain free as possible. Lovely midwives. Stayed in two nights and got excellent care.

Women being denied pain relief in 2020 is barbaric. I got a local anaesthetic from my dentist for a filling, I didn’t even have to ask, it was part of the procedure.

These discussions always seem to get very confused with people discussing the risks/benefits on epidurals when that’s not really the point- the point is that yes there are risks involved and there are valid reasons to not choose epidural but that should always be down to the woman and no HCP should purposely try to block access to one based on their views or beliefs.

Then the news articles become quite mixed up and unclear about whether it’s a case of stretched resources making epidural or quick epidurals unavailable or whether there is genuinely a culture of midwives who will purposely lie etc in order to stop women accessing an epidural that would otherwise be readily available.

@DropYourSword I think we mostly agree! I just don't like the impression many people will come away with that midwives are on a crusade. Maybe the more interesting thing is managing expectations. I found the few days of slow labour unbelievably traumatic, I had no idea and was terrified of the pain, it still upsets me that I wanted to die rather than bear any more of it, but it's nobody's fault except nature's. Just to clarify re the clicker, yes, correct it has a limit so I don't really understand it either. The anaesthetist was a friend and he said it was possible that the dosage was wrong for me, or that the top-up before they set up the clicker was too much, as it shouldn't have taken 24 hrs to wear off.

ridiculous, something to stop pain has been made available but it is refused within the nhs in so many circumstances. Women should have complete choice in pain relief.

Personally at my booking appointment (which they Were “too busy” to give me until 19 weeks) the consultant and midwife guffawed with glee and told me I wouldn’t be eligible for an epidural because I hadn’t had “bloods” done earlier.

I genuinely felt bullied by them and my husband did say if he hadn’t been in the room he would of thought I was exaggerating. They were both so incredibly rude and condescending. We were having none of it.

I travelled to London (from Edinburgh) to have a private birth - where it is indeed possible to have an epidural at any stage of labour.

I feel so lucky to have been able to have a pleasant experience privately but I will not be having another baby due to the travel involved to get to a private hospital.

I think the nhs is probably excellent for women wanting a non medicated water birth with no complications etc but if you want modern care
PAY - to guarantee your birth plan is taken into account.
Bookmark

but if you want modern care
PAY - to guarantee your birth plan is taken into account.

That is not acceptable. Having your wishes respected when it comes to such an intimate and potentially traumatic experience should not be the preserve of the wealthy.

I am glad you were able to experience that. What would have happened if you couldn’t afford it? It’s not okay.

I loved it, I loved feeling the crowning, the searing pain.

That's nice, dear.

I, OTOH, did not like it at all. I, and dare I say, most women, are not masochists who love a bit of pain.

If any other woman wants to give birth thinking she's a goddess who's doing something she was made, or designed to do, and that birth is some sort of mystical event where her spirit flows across galaxies connected to her ancestral mothers in the power of womanhood, and that the pain she feels is some sort of spiritual beautiful astral celestial magical sensation or some other sentimental/misogynistic bullshit, that's up to her.

The rest of us are simply females in pain, and as such, we fucking deserve pain relief in labour as we would in renal colic, a broken limb, or appendicitis.

Adequate pain relief was denied to me. Years on, I still remember everything. I was scared, in pain, and NOT in control of my own labour. I have no intention of ever getting over it because it was the worst experience of my life. Pain is not a good thing. That's why it's unpleasant. And no amount of whalesong, candles and hypnobirthing can change that. But pain relief can.

You can suffer all you want if that's your thing - whatever floats your boat, but don't tell others that they're somehow wrong for not enjoying the fucking agony of childbirth. I'd much rather take the epidural with all the risks attached (because I have the capacity to make this decision, a woman, even a pregnant one, is capable of these things), than suffer.

Anyway, as a non-masochist I won't ever have another child, so it doesn't matter.