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.

My pain threshold is through the floor. I am truly frightened to give birth in an NHS hospital.

I haven't RFTF, sorry if this had been said almost cetainly has

I thought there was concern about an epidural leading to a 'cascade of interventions', labour tends to progress quicker if the woman is able to move around. The epidural and just the fact you need a drip keeps the woman bed-bound so could delay things, and there is evidence that epidurals can be associated with more instrumental deliveries and c sections. The evidence is flawed as women who have difficult or long labours are more likely to request an epidural, but there is some clinical basis for trying to use less epidurals.

I also think midwives are rationing a bit. In a busy department the anaesthetist's time will be precious, this rationing can inch into routine practice and working culture even when it's calm. There's also not always a bed or capacity in the labour ward.

My waters broke, I was in pain I felt totally unable to manage, but only 1cm dilated even after 6hrs of 3-4 contractions every 10 mins. I begged for gas and air but was fobbed off by the midwife on the late shift, so all I could do if pace the corridor for hours as it was too painful to sit or lie down. When the night midwife came in I started sobbing and she gave me pethidine and gas and air, with virtually no effect. They needed to use syntoxytocin for progression and this was my opportunity to refuse it until an epidural was in. Baby turned out to be back to back.

I thought there was concern about an epidural leading to a 'cascade of interventions'

And? So what? Some of us are quite happy to take that risk for the sake of not being in pain. I'd take a c-section over the pain of childbirth. In fact I'd treat one as a sacrament. We don't all want a vaginal delivery.

For some of us slowing labour is not a negative. Surprise surprise we’re not all the same.

Also - the whole thing about it getting "too late" is clearly rubbish (unless the baby is half out). I was booked in for a c-section but went into labour before the date and the midwives decided I should try to have my extremely breech baby on my own for a day or so before asking for a theatre slot. I wanted all the pain relief in existence as I hadn't been expecting to labour at all and wasn't feeling empowered by it - I was told it was too late for an epidural but mysteriously four hours later when my son was thoroughly stuck and it all became a life and death emergency the surgery team had no difficulty whatsoever in administering one, even though I was contracting fast by then and couldn't hold totally still.

I haven't said epidurals are bad or unsafe. I had one.

And? So what? Some of us are quite happy to take that risk for the sake of not being in pain

The more interventions the greater the risk. I had an epidural and a EMCS, I'm not suggesting it is wrong to, but there is a (speaking very generally, using flawed data) a clinical basis. It is not just that midwives as a professional group have made an arbitrary decision to frustrate epidurals; although some individual midwives may do exactly this.

For some of us slowing labour is not a negative. Surprise surprise we’re not all the same

What's your point? Because some women want to slow a fast labour, epidurals are the best and safest option for all women? For lots of women a failure to progress leads to days of pain. A risk is a risk.

our bodies were literally designed to give birth way before pain relief even existed.

No, they're designed to walk on two legs, an evolutionary trade off is that the female pelvis is narrower and shorter than other great apes who knuckle walk or are arboreal. As a result the gestation period is shorter, the human infant far more dependent and weaker than other great apes at birth and higher maternal death in nature because even with these disadvantages bi-pedal locomotion confers greater overall advantage.

Almost tempted to start writing down the risks of a vaginal birth but I can't be arsed...

@WaitrosesCheapestVodka, I mean this kindly but perhaps you should RTFT, as I have posted numerous links from WHO and Cochrane reviews that refute the points you are making.

DS1 Told not dilated enough for hours and then next thing I know, I'm too dilated. I was dilating slowly while in established labour for 10 hours. They just didn't want to use it. Worst most horrific day of my life. I was so traumatised that I couldn't bond with my baby for over 3 months. I felt dead inside for the first year and still not over it a decade later. DS2 I got epidural and had much better experience. Women need real choice.

The lie that pain of childbirth helps you bond with your baby is the greatest lie in history.

For lots of women a failure to progress leads to days of pain. A risk is a risk. yes and for lots an accelerated violent precipitous birth leads to horrendous damage. My “point” since you seem to need it highlighted was that the “it will slow birth” factor is sometimes desirable. So perhaps don’t use it as the uniform reason not to administer absolutely appropriate support.

I grow so weary of hearing this crap trotted out year after year. It is NOT a life affirming magical moment to rip your perineum to shreds, nor something we routinely see people opting for. Nobody ever anywhere has wished for the pain of labour without the baby. So why should it miraculously become satisfying with a baby at the end? It’s nonsense.

I was told very early in that if your in an MLU you couldn't have an epidural. If you changed your mind then you'd have to be transferred to labour ward. That causes major delay and could lead to you not being able to have one

I was high risk for GD so on the ward from the start, with 1:1 monitoring because I was induced early and on an insulin drip. In fact it was 2:1 because there was a student with the midwife. An epidural was zero extra work for them in my case and I still had to press very hard to get one. Acting as gatekeepers for pain relief for women who’ve taken the time to educate themselves on what they want and the risks, and in some cases are having a far from “natural” labour in the first place is so far from appropriate it really pisses me off.

I just don't like the impression many people will come away with that midwives are on a crusade.

At this stage given all the reports that keep coming out, time and time again, about avoidable deaths and women’s experiences, I think there does need to be an examination of the attitudes and practices of the profession as a whole.

I encountered mostly excellent and respectful midwives in my pregnancy and labour. But there was absolutely an overtone of “natural is best” and my community midwife looked visibly disappointed when I turned out to have GD and therefore not be a candidate for either home birth or MLU. They didn’t give a shit once they realised I wasn’t going to be one of their “success” stories because I’d be having quite a medicalised birth.

If a woman has an epidural she has to have more regular observations which takes up staff's time.If there aren't enough staff to do the obs she isn't getting an epidural.I saw this as a nursing student and unfortunately experienced it in labour.

I agree. Yes of course there are risks. But I would rather be listened to and make up my own mind about the risk I'm willing to take than to go through that hellish agony again. The problem is we are not being listened to. We already feel frightened, vulnerable and out of control. We should have the comfort of what we want being heard not more or less laughed at as if we're pathetic. I can't even believe this thread is happening in this day and age

@headinthedrawer just wanted to say this would never impact a woman receiving an epidural. Women receive one on one care during labour anyway, the midwife will be with the woman regularly to monitor baby’s heart as per NICE guidelines. half hourly BP monitoring is neither here nor there in the grand scheme of things and wouldn’t impact the midwives workload greatly.

If you don’t have enough money/staff/compassion to do the job women want then why not just say so? Why pretend it’s “for your own good” or “best for baby” or “too late”. it’s like you’re so used to lying to justify your behaviour you don’t even know what’s true any more.

I (it’s seems) have been very lucky. I was induced at 12 days overdue, the care I received whilst the pessary in was fairly none existent as I was left to get in with it. Fine, I understand people are busy with more pressing issues however come 24 hours after when trying to examine me I was dilated enough to move round to the delivery suite. There I was advised by my midwife to have an epidural before the drip went up as it would be agony without. Despite a wait of a few hours as there were EMCS’ going on we got there eventually. 4 hours later baby girl was born after a lot of troubles but luckily pain free for me. I could still feel my contractions to push but I was far more comfortable. To deny women that right is disgusting.

What also made me feel like I was part of a horrendous horror film was when the 2nd year student midwife started stitching me up and was like " is that the right place? " whilst jabbing a needle around. We all need to learn but I can honestly say I have never felt so terrified given the fact they hadn't even asked me if it is ok for the student to "practice" on me. As someone who has student nurses myself I always ask the patients permission before allowing the student to do any procedure. Seems I didn't warrant this curtosy. Sorry abit off topic but I think still relevant given I wasn't asked about what I wanted ever

Having had a birth without then one with an epidural, I did feel the second time where my birth plan just said epidural, that they tried to put me off. They kept asking am I sure, you know you have to have a catheter. You did it before without. I DID do it before without and that's why I wanted it. I cannot recommend suffering, it's exhausting and giving birth is exhausting anyway.

I've had an epidural twice. Neither time did I have a catheter. Is that standard practice now?

@lou867 that's awful

Well ladies you all seem to have had pretty rotten experiences. When I had my first many many years ago epidurals were not common place. I attended anti-natal classes for weeks before hand learning how to breath trough contractions to pant etc. My waters broke and i got my 1st contraction about half an hour later outside the maternity ward, straight into full blown labour, there was no build up at all. I opted for pethadine but by the time it was administerd 2 hours into my labour and my son was born an hour later I was a bit too whoosy to push and had to have an episiotmy. I know the pain was excruciating at the time but I couldn't remember it too much afterwards. I reckon if I could remember the pain I never would have wanted to have another baby. My second labour was the same waters brroke and within half an hour into full blown labour with contractions every two minutes and a blue light ambulance to hospital. My 2nd labour from start to finish was two hours. I begged for gas and air but was with a student who wasn't allowed to give me anything. The midwives were rushed off their feet and when I was finally seen by one she said I was 7 centimeters dilated and of course I could have gas and air. My 2nd son was a much bigger baby and I begged the midwife to cut me but she refused. 2nd baby no need and I tore and was stitched up like a Buxted chicken! Both my sons were fine . I decided not to opt for any more! So it seems not a lot has changed over the years! I have been reading this post and have been thinking about all the women in 3rd world countries have multiple births with no pain relief at all!

This thread has been an eye opener and has terrified me for an NHS birth . Sorry for the horrible experiences had here....does anyone have any positive NHS birth stories? Or advice on how to make sure you receive the pain relief you want even if it includes an epidural?