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.

an epidural is regarded as a last resort form of pain relief necessary when a lengthy labour has rendered an exhausted mother incapable of coping.

Well that’s just plain wrong. Why don’t we also do knee surgery without anaesthetic then? Why stop at childbirth, a process that exclusively affects women?

I’m a retired anaesthetist and in my experience midwives fall neatly into two categories. There are excellent, caring, patient-centred ones, who listen to the mothers, and are happy for them to have whatever method of pain relief is required.
Then there’s.... the others. The ego monster power trippers. The birth is all about them, and their control issues, their wish to retain command of the situation, to demonstrate their skills in “managing” the patient’s pain by sheer force of will. They can’t abide epidurals because a) that involves a doctor and b) the mother is then pain free and in control herself of the top up button - she is no longer in agony and helplessly dependent on the midwife. This group are an absolute menace, and several PPs here seem to have encountered them.
Thankfully, they’re a minority, but that’s no consolation if you get one!
There is also the problem of “stand alone” midwife led birth units. They are often not in a hospital and don’t have access to anaesthetists or epidurals. The midwives there want to keep the numbers of births up to avoid closure - if you need an epidural, they have to transfer you to a hospital labour suite.
Our local one is 25 miles from the nearest obstetric unit. One baby has already died in transit. When booking your place of delivery, I’d advise all mothers to ask not only about availability of epidurals, but also transfer time to a properly equipped and staffed operating theatre.

When I asked for pain relief on the maternity ward (before delivery) and asked if they could check me (was post induction) they told me there was no way I could be anywhere near established labour, not ready to go up to delivery, so no epidural, and gave me paracetamol whilst I was bent the floor in pain. Wouldn’t check me over. ‘It’s too early.’ I asked another two midwives two times for something else. They ignored me when I told them I wanted an epidural in labour. TheN they said ‘oh you’ll probably feel differently’ and ‘you really won’t need one you know.’ Every single thing they could do to ignore me they did. When I made my husband go and get someone from the nurses station for the THIRD FUCKING TIME AND THIS TIME DEMAND IT, they finally took it upon themselves to check me, see I was 10cm and baby was stuck, my waters went with meconium everywhere and I was too late for an epidural as they crash trollied me up yo delivery.
Ended up with a spinal for theatre anyway for a csec but they managed to get him out with forceps.
I’ll never trust anything a midwife tells me ever again

Dd1 was back to back. 20 hours of agonising labour and I begged for an epidural.
I was told ‘the anaesthetist is busy...it will be an hour or so.’
In that hour, if I’d had a gun, I would have happily shot myself.
Found out later that the ‘anaesthetist is busy’ line was standard practise. The hope being (I suppose) that I would get on with it in the meantime
Is it expensive?

As someone who had severe tokophobia, and was in counselling for this and still experienced a lot of pressure to consider vaginal birth for my twins, I think it’s absolutely unacceptable to tell women that an epidural is unavailable when they want one. End of story. If the current system doesn’t enable this then it needs to. It’s not a nice extra, any more than anaesthetic for any painful procedure is a nice extra. Not every woman wants one - the facilities need to be there so that every woman who wants one can have one. It’s barbaric to force a woman who wants an epidural to give birth without one.

In that article, the professional body for anaesthesiologists is on record as saying that there are enough anaesthesiologists available to obstetric units to do this. Midwives say there aren’t. What’s the truth here?

And you can explain it away as lack of resources as much as you want, but there are unnecessarily traumatised women behind those statistics.

Oh yes and also why I’ll be avoiding the midwife led birth centre with no access to pain relief and a 30 minute ambulance ride to hospital for any pain relief, surgical or medical intervention.

Why do I have the feeling that posters pleading no epidurals because of our poor broke NHS are the exact same posters who used to claim no-one was denied an epidural?

I must be one of the fortunate ones was offered and accepted an epidural four times as soon as syntocin was started. My daughter was also offered an epidural as well only last year (she didn't accept), maybe our hospital is one of the good ones?

Highly doubt they would tell a man to "breath the pain away" while he was having a procedure ok his genitals.

If men could give birth it would be a sacrament and they would be all under general anaesthetic.

The midwives there want to keep the numbers of births up to avoid closure

Absolutely. One close to me is open 24/7 and had 9 births in a recent month. It’s a 20 minute transfer time. Most women can’t go to it, due to any sort of complication, previous c section etc. Those who do have about a 50% chance of transferring to hospital.

**on not ok

The NICE guideline states that it can cause prolongation of the second stage of labour and increases the chances of a vaginal instrumental delivery. Pain relief obviously shouldn't be withheld (situation dependent) but I can understand the reasoning for trying to avoid it.

I'm not sure how it works as all hospitals are different but I doubt there is a large team of anaesthetist ready to give epidural to whoever wants one thus the midwives aren't necessarily lying when they say they need to wait for someone to be available. I may be mistaken, but it may also be those anaesthetists assisting with EMCS and ELCS (and possibly emergencies outside of the maternity unit if extremely short staffed?). Staff shortages really don't help matters, it's so hard.

Due to negative outcomes for women regarding birth injuries, when my time comes I'm considering an ELCS.

Must depend on the hospital, with my first my midwife tried to force pain relief & an epidural on me and with my second she repeatedly asked if I wanted an epidural before starting the hormone drip to help my contractions

I quote ' Are you sure hunny, some women refuse to start the drip without the epidural first, if you change your mind just tell me and I will get him in straight away ' 🥴

Pain relief obviously shouldn't be withheld (situation dependent) but I can understand the reasoning for trying to avoid it.

I disagree. Tell women the reasoning behind it and let them decide. Making decisions like this on a patient’s behalf is not okay. Men would not stand for this.

Women are capable of making informed decisions (extenuating circumstances aside). Our views are not taken seriously, across all areas of medicine actually. HCPs know better than us. Want to be sterilised? No you don’t, you might change your mind! Want an epidural? Oh, no need, don’t be silly.

Fuck off with that shit.

Yanbu I was denied it with ds1 ended up a horrific traumatic birth whare I've had c sections can never have a natural birth .

When I researched it (after a difficult and long first birth) for my second, it seemed there is a window around 6-7cm when labour is well established, when it can be helpful, if it is planned in advance, it worked for me anyway, did not mean a 'cascade of intervention'. Normal birth

I don't see why anyone with a normal delivery would even want an epidural, I have delivered two kids without pain relief, it's quicker and you can keep mobile. Epidurals are not risk free either and if the anaesthetist is in theatre then you can't get one anyway.

@okiedokieme but it’s a personal choice isn’t it? Many women are happy to take the benefits over the risks. And that’s for HER to decide and not anybody else.

I just think the whole situation with Women’s rights in labour and childbirth is a bit of a mess. And these conversations about midwives never seem to open up discussion about women having better autonomy and being listened to- they just open up a debate about whether women should have natural or medicalised birth pushed on them.

Because women are different @okiedokieme? I had a dream of a labour/birth, absolutely textbook. But there is no way in hell that would have happened if I hadn’t had an epidural. I had a mobile one so I could still move/use the loo etc. It was amazing. And for women to be denied that right is not on.

I too had to beg and beg and beg for an epidural, I’m a firm believer in that nobody is there at the end of labour to hand you a ‘well done you did it without pain relief’ medal, so get whatever you feel you need!!

My first labour was back to back, the whole 25 sodding hours of it, it was the worse pain I’ve felt in my entire life. They would listen and like others ignored me, so I got my OH to phone my mum ex ward sister from back in the day to come help me. She tips up face like thunder, gives the midwives a proper dressing down and surprise surprise an epidural is magically made available. I went 14 hours without one, I’d been up for two days at this point and as soon as the epidural kicked in I went to sleep until it was time to push.

My second birth I was given an un-consented for internal examination, which I’m still in therapy for. And denied G&A despite the labour moving very fast and me being 7cm after only two hours. I ended up giving birth on my own pretty much, she crowned and I pushed out her head without any assistance other than the vague memory of what they said 8 years previously while having my son. Again because they didn’t believe me and then when they eventually arrived they said I’d got ‘a small graze’ which turned out to be a third degree tear that I had to have surgery to repair, only after they’d left me there 3 hours bleeding and in agony on the bed.

Had a home birth with my third, ended up with an emcs in the end but got treated like absolute royalty from the doctors. They couldn’t do enough to make me comfortable and reassured. Absolute angels in blue scrubs they were, it was obviously very scary but they were just so fantastic compared to the midwife led side.

And yes I absolutely agree men really wouldn’t be expected to put up with this. So many of the attitudes around birth and labour really are rooted in the idea that women can’t be trusted to make their own decisions and don’t need to be listened to.

This thread is a shocking read. Some of these stories sound like what my mum had to deal with, and given my eldest sibling is 45 it's appalling that attitudes to labour are still so bad. My mum also had to deal with midwives not listening and refusing to believe she was in labour when she was.
I count myself extremely lucky the hospital I gave birth in didn't seem to have these issues, I had pain relief when I asked for it and very prompt intervention when things were clearly not going well.
I'm starting to feel like my experience is the exception and that's incredibly sad.

With DD1 I got my epidural pretty much as soon as I asked for it. Mainly as she was showing signs of distress and it was easier to give me one at 6cm than having to give me a GA if we had to go to theatre.

By the time I asked for one with DD2, it was too late as 3 contractions later she was out.

I just wanted to add, the decision should absolutely come down to the woman giving birth as to whether they find the risks (of anything) acceptable/unacceptable.

I think there is a real issue with communication when it comes to labour choices. On one hand you have these women being refused epidurals being given incorrect information. Then you have women that have ended up with birth injuries from instruments etc. Not being informed of the risks either when they chose to have an epidural/ the risks of injury through vaginal delivery.

Even the anaesthetologist and midwife are giving conflicting information in that article.

For those who are interested in scientific evidence on the safety and effectiveness of epidurals, the Cochrane review is a good read. It also dispels many of the myths around epidurals.

See for instance:

Although overall there appears to be an increase in assisted vaginal birth when women have epidural analgesia, a post hoc subgroup analysis showed this effect is not seen in recent studies (after 2005), suggesting that modern approaches to epidural analgesia in labour do not affect this outcome. Epidural analgesia had no impact on the risk of caesarean section or long‐term backache, and did not appear to have an immediate effect on neonatal status as determined by Apgar scores or in admissions to neonatal intensive care.

www.cochrane.org/CD000331/PREG_epidurals-pain-relief-labour