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 never got to the Labour part, but did end upon a labour ward at 26 weeks when they thought I might deliver. I commented to the consultant about the horrific noise that was coming from the next room. He said “yes well, that’s what happens when you insist on having a ‘natural birth’ I don’t see what’s so natural about enduring unnecessary pain when we’ve so many safe ways to help ease it, you wouldn’t live with a headache, you’d take a paracetamol”

I made a mental note to tick the “lots of drugs” box!

The trouble is, as people have said, you feel so vulnerable in the alien environment of a hospital anyway and particularly when giving birth. This thread reminds me that 35 years ago I was denied an epidural on the basis that it was too late yet it was at least an hour (DH - a bit startled to be asked about DS’s birth all this time later- agrees ) Before DS was born. He had to have a doctor deliver him by what was then called Keilland rotation (is it still?) because he wasn’t lying as he should be. DH and I are both articulate professionals but if never occurrrd to us to argue

During my labour with dc1 I asked for an epidural. I'd been having a slow labour that by this point had been going on for 2.5 days and I'd only just managed to get to 5 cm. I hadn't slept at all in that time, I'd thrown up everything I'd eaten and I'd been on a drip for the last 24 hours because I couldn't even keep water down. I felt like a train wreck and could barely function from the lack of sleep and food.

The midwife was very reluctant to let me have one and kept trying to convince me to stick with gas and air which actually hurt my throat because I'd thrown up so many times and also because my mouth and throat were so dry from not being able to drink anything. I had to basically shout "no, no, no" at her for her to take me seriously and then she grudgingly said "well...seeing as it is your first labour I suppose you can have one".

First labour, second labour, tenth labour...it shouldn't matter. If you need/want one then it should be given to you. My second labour was far more excruciating than my first one and if I'd wanted an epidural then I should have been able to have one regardless of how many previous labours I'd experienced.

Costs shouldn't be cut when it comes to pain relief.

I agree, it's shocking that there are women who feel they were listened to in labour and their wishes were completely ignored.

However, let's not side step the valid medical reasons to avoid epidurals. It can slow a labour that's progressing well, contractions are not felt so it can mean intervention at the pushing stage; requiring an instrumental delivery and birth injury or trauma to mother and baby.
It's not a black and white issue.

That’s really interesting @Babdoc and I’d agree with you, I’ve definitely noticed a difference in ‘types’ of midwife. Age I’ve noticed is usually a factor, younger = better, receptive, understanding etc older = ignorant fire breathing dragons who seem to enjoy a woman in pain (I’m very aware that could just be mine own personal and not universal experience though)

They turn down the epidural now when you’re about to push. I could feel everything, no assistance at all.

They’re not the same as they were even 5 years ago.

I was denied an epidural with my first. I was only 7cm dilated, they said it was too late but I was still in labour for another 3 hours. Now I know they are liars

RevolutionofourTime that was really interesting to read. I however, wouldn't call that dispelling an epidural myth as they did state that the reduction in interventions post 2005 was likely due to modern approaches to epidural use i.e. lower concentrations used, patient controlled/ intermittent dosing vs continuous infusion. That's an important distinction to make and you would need to research how your hospital administers epidurals.

This is interesting as my experience as a midwife is women are always given one when they ask.

Can you think of any other hospital setting where a patient actively has to request pain relief when they are obviously experiencing pain? Both DH and DD have had surgery recently and whenever either of them were in agony, nursing staff immediately offered pain relief. Neither one of them had to specify a particular type of pain relief and rely on the medical staff to decide if it were appropriate.

The standard should be when a labouring woman is in pain, they are offered an epidural.

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

I had a home birth with my first and I received alot of stick. People worried something would go wrong. Telling me I would be in pain for hours. How hospital was safer etc

Reality was hospital ( when I had dd2. Complications meant a home birth was out)as unsafe as I've ever felt. They have monitors/belts so they can ignore you for hours.

Everything is too much trouble because u cant get this here or that there u have yo.go to X Y Z place. And if it's not In tune with arbitrary time lines you are fucked.

Instead of being someone they look at as a whole person . How you are behaving and how you say you are feeling and actual observation. It's just the human equivalent of plugging in a diagnostic machine and then the only interaction you get is when they realise they missed something and you are in trouble now.

Also from Cochrane:
Our meta-analysis involved nine randomised controlled studies with a total of 15,752 women giving birth to their first baby and found no differences in the risk of caesarean section and instrumental birth with early initiation [defined as dilated less than 4 or 5 cm] versus late initiation of epidural analgesia for pain relief during labour. Although the effects of early or late initiation of epidural analgesia on the duration of the second stage of labour are similar, we are unable to rule out early initiation leading to an appreciably shorter duration of labour. There was a lot of variation (heterogeneity) between the results of the studies for the duration of the first stage of labour. For the baby, Apgar scores and cord pH were not different. We conclude that it would appear to be advantageous to initiate epidural analgesia for labour early, when requested by the woman.

And

There is insufficient evidence to support the hypothesis that discontinuing epidural analgesia late in labour reduces the rate of instrumental delivery. There is evidence that it increases the rate of inadequate pain relief in the second stage of labour.

Each to their own but I've never understood why epidurals are so popular - I would always rather feel all the pain if it means I can also feel every urge to push and have full control over what position I feel I need to get into. Seeing women giving birth on their back with their legs up in stirrups unable to do anything but lay there and be told when to push terrifies me for the poor woman!

I wonder how many of you ladies are aware that you're not allowed an epidural for a stillbirth under any circumstances in some hospitals?

I'm giving birth at Kingston hospital in a few weeks, dare I ask the group if they have heard anything like this being true about their maternity unit? I wasn't planning on an epidural, but I'm considering just adding it to my birth plan and highlighting it. Just I case I do want one. Sounds like I'll be in for a fight though either way.

I've always suspected that this was true. It's terrible.

With both of my births the midwives tried to deny me an epidural. I kicked up such a tremendous fuss that they relented fairly quickly both times, at one point even demanding another midwife. I doubt I'll be allowed back a third time

My first birth i was induced from premature membrane rupture. I was essentially kept in a waiting room with a birth ball, I laboured with my husband until I couldn't take it anymore...transition...my husband nagged them every other contraction, shouting down the hall way etc while they drank tea at the station, I had thrown up paracetamol, and multiple other times and had been asking for more pain releif for 4 hours...my midwife said I wasnt even in avtive labour yet so couldn't have G+A, and she didn't want to examine me yet for infection risk as it's going to several more hours/days at least. I pushed for an exam and she was rather surprised I was 8cm. I was rushed to Delivery, helped onto the bed and in 2 pushes my tiny 5lb-er was born, 10 hours after my pessary and 18 minutes after my exam. That midwife who was dismissive and horrible sticks in my mind.

My 2nd was natural start, they were about to send me home when my waters went. I threw up about 10 minutes later, and when I insisted that meant I was 30 mins from delivery my midwife was nothing short of a superhero. She transferred with me, filled a pool, gave me gas and air, and gave us the healing 2nd birth we wanted. But that first gonger midwife with thick black glasses will always cloud my first birth

Each to their own but I've never understood why epidurals are so popular
Doesn’t matter , what matters is the choice to have one has been taken away from so many of us

@Floraflower3, the ‘myth’ aspect is that midwives still use the ‘higher risk of intervention’ as a deterrent against epidurals, even though there is no evidence to back this up for the last 15 years.

I suppose it’s possible that some UK hospitals still administer super strong epidurals like they did in the 70s, but that would really surprise me.

I don't see why anyone with a normal delivery would even want an epidural

Don’t you? Different people have different pain thresholds, different concerns about labour, phobias, anxieties, traumas.

I didn’t care about the pain. Didn’t worry me at all. I was terrified of physically getting a baby out of me, of strangers looking at and touching that area of my body, I can’t even cope with a speculum examination without sedation. I have a history of abuse and of traumatic gynae procedures. If I ever had to deliver vaginally I would not cope without an epidural.

It's not a black and white issue

Yes it is.
Here’s a procedure you may or may not choose.
Here’s an accurate list of the benefits.
Here’s an accurate list of the risks, and of the likelihood of those risks occurring in transparent language.
Do you want it or not?

It’s that simple. Every single medical procedure has risks. Every single patient has a different profile and a different attitude towards risk. In other areas, such as the prescribing of medication, risks are more likely to be minimised. When I have had surgeries, risks are reeled off quickly and always with a “but that’s very unlikely” caveat. Why is this procedure different?

This is not the only similar situation, given how many women are given hysteroscopies without a GA, despite a significant percentage of women experiencing severe pain and trauma.

Ever spoken to a woman who had an instrumental delivery without an epidural? I would honestly rather die. That’s just me. Others feel differently. That’s fine too.

This is a whole other world to me. I have had all home births and had some midwifes and HCP say I was crazy to do so (even though low risk and had 4 home births now, planning a 5th). Seems the other end of the spectrum (women wanting labour ward, medicated births) are also made to feel their choices are invalid. Are we all meant to have birthing unit labours then and any other choice is "wrong"? Seems although they offer us all this choice, really if we do not conform to what they want our opinions aren't really valued.

i was denied pain relief also, but to be honest was neglected by the midwives throughout my labour.

I gave birth with no pain relief and it was horrendous, i absolutely did want pain relief, and the really offensive thing is that when i needed stitches, i was offered gas an air.

It was a total shit show.

However, let's not side step the valid medical reasons to avoid epidurals. It can slow a labour that's progressing well, contractions are not felt so it can mean intervention at the pushing stage; requiring an instrumental delivery and birth injury or trauma to mother and baby.
It's not a black and white issue.

They don’t need to be side stepped. They can be discussed, including the interventions that might be required such as an oxytocin infusion or an instrumental assisted delivery.
There’s absolutely no reason for a midwife to just NOT comply with a woman’s request. If there’s no anaesthetist available because they are with other emergencies then that should be communicated to the mother. But it is NOT a midwife’s decision not to even call for an anaesthetist. It is power tripping and unacceptable.

I agree with Babdoc The first midwife I had the misfortune to encounter was simply a monster - absolute control freak. She had to pulled off me by my husband as she was determined to rummage about inside me, despite me telling her to stop. After that my labour was a catalogue of horrors. For the first 20 hours I coped okay, but the next 22 were simply me screaming and delirious with pain, begging my husband to kill me or find something I could use to kill myself.

I was given an epidural at the very end, so at least I was calm and knew where I was for the pushing stage - only because a doctor stepped in and took over.

I was subsequently diagnosed with PTSD (birth trauma). During psychiatric treatment for this (which made me suicidal at times) a doctor told me exactly what Babdoc has pointed out - there are caring midwives and then there are 'the others', the sadists who enjoy seeing women in pain, and the narcissists whose only concern is their own gratification.

And which type you get 'looking after' you is like the roll of a dice.

Luckily we never wanted a second child, so never had to deal with the conflict/trauma of going through it again. But if we had wanted another we would have paid for a private C-section. I would never let a bog-standard midwife anywhere near me ever again. If DD ever wants a child I will move mountains to make sure her experience is nothing like mine.

When I hear that someone I encounter or meet is a midwife my blood runs cold and I wonder which type they are - it's unfair but it really effects my perception of them.

My first labour I was put straight onto the ‘midwife led’ area of the hospital without being told (I think this is pretty standard in ‘low-risk’ women) but it wasn’t explained to me there were two separate areas and the differences between them. So after being taken to the room and getting settled I am then told ‘oh well you’ll need to be moved to the other ward are you SURE you can’t manage without now’ when I requested an epidural, so felt like I had to say no. I’d also been told to stay at home for a very long time and I was 7cm upon arrival, very stressed out from travelling in labour etc and care all-round wasn’t good. I was then told off and huffed at for screaming in pain after a drip was administered to speed everything up.

Second labour I was ‘allowed’ to come into hospital much earlier, had a fantastic lovely midwife who gave me so much choice, started on gas and air very early, access to birthing pool and a safe, secure environment. Didn’t feel the need to request an epidural and had a very calm birth.

Of course many women plan and choose to have an epidural in any circumstances and I absolutely support (and understand why) but I do think one element of ‘encouraging’ women not to have them is to really properly look after women in labour.

Can you think of any other hospital setting where a patient actively has to request pain relief when they are obviously experiencing pain?

Tbh yes, my father was in hospital a couple of years ago and we had to fight to get him pain meds during the night. In the end we had to get his surgeon to specifically tell the nursing staff to give him as much as he wanted within the correct dose and even then it was a fight.

I spent a moth in hospital and had to ask to see the pain management team as the nurses just didn't believe how much pain I was in. Pain management team hooked me up with a self administering morphine drip asap.

This news about midwives does not surprise me ONE BIT.