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.

These stories make horrifying reading

I'm a grandparent now so my birth experiences are from a long time ago

Mine may be TMI

Dc 1 - horrific - no pain relief at all for the entire night.
The day shift gave me pethadine - twice all in all, but no gas and air.
I needed an episiotomy - i had a local anaesthetic for that, which was ineffective
I felt the lot, especially the stitches afterwards

I had nightmares for years after that experience

DC 2 - a different hospital - a dream - the team were brilliant
I can't fault them

This is interesting. I gave birth earlier this year and was denied an epidural as it was too late, which I didn't question. I then requested diamorphine as an alternative, having had that in a previous labour with success. That was also denied - the midwife asked if I meant pethidine and I said definitely not, I wanted diamorphine and she kind of gave me a blank look like I was giving the name of a non existant drug. Somehow the conversation was never finished (I was in too much pain to argue or get out my birth plan where this was all written down) and I had to just make do with gas and air in the end.

The birth progressed quickly and it was such a positive experience in the end, and with hindsight I'm glad I didn't have the epidural. Nevertheless, it sounds like the midwife wasn't actually following guidelines here and didn't explain anything properly. I thought I was going mental and one of the first things I did when it was over was google 'diamorphine in labour' to make sure it existed!

I gave birth last year in an overseas country and I could choose: no epidural or getting one but had to be induced to fit in the schedule of the anesthesiologist and our insurance didn’t cover it so we had to pay a few thousand £’s for it.

I think it’s absolutely ridiculous to not have an anesthesiologist stand by at all times and having to pay for an epidural because it’s seen as ‘unnecessary’ by insurance. Pure misogyny if you ask me, this wouldn’t happen if men could give birth!

I got an epidural, but the midwife who was in charge of me at the time told me that she was disappointed in me for requesting it. I had been induced starting on the Tuesday, in hospital since Wednesday and it was then Thursday afternoon, so had had over 30 hours of contractions on no sleep, baby back to back (no attempt to turn baby). Was 5cm when moved to birthing suite where I was denied birthing pool due to need to monitor me (which I understand is not always the case elsewhere). Then had waters broken and syntocin drip and a bit of gas and air and got extreme vomiting - I was throwing up blood into the sink and I was shaking uncontrollably so had to be put on an IV line. Midwife (older, who also sneered at my choice of nightie) tried to persuade me not to have any pain relief, but I was still vomiting, uncontrollably shaking and strapped to syntocin drip, IV line and continuous monitor - I thought I might as well have one at this point as my options for less medicalised birth (no birthing pool etc) were pretty limited at this stage anyway. Finally got me epidural (after using the "well I just don't know whether anaesthetist will be available before you give birth") and told me that she was now off to attend to "active labouring mothers" and plan was now to have agency midwife babysit me overnight so I could get sleep to push - fair enough, I understand lack of resource.

Agency midwife was pretty rude to me and my husband overnight and I was uncomfortable in my back despite epidural and still shaking uncontrollably and teeth chattering for much of the night as I think my IV line just wasn't delivering sufficient for my blood sugar needs and I wasn't allowed to eat in case of CS so no sleep was possible anyway. Midwife took pity on me after several hours and gave me a bit of OJ and a blanket so the chattering finally ceased.

I let the epidural wear off to push from the early hours of the morning as was told new shift arrived at 8am and I would be asked to push then. I kept telling the midwives that I was in unbearable pain but that I felt no downward pressure at all. They kept denying this and told me it was the fact that I had an epidural (I hadn't pushed the button for relief for 6 hours by this point). Kept encouraging me to push for 90 mins (which I later understood caused my slight bladder prolapse), but wouldn't listen until I told them to get a doctor. Junior doctor came, read me the riot act about CS risks and told me that if I wanted intervention I should have forceps (I hadn't requested intervention, I just wanted to be examined by a doctor). Finally, after continuous battling from me, consultant agreed to examine me, agreed with me that despite being 10cm dilated I couldn't be feeling downward pressure and there was no way that baby would descend into birth canal, as too big and back to back. EMCS with 9lb 7 baby with 38 cm head (I am tiny).

Basically, in my view it's not just about the epidural. In my experience, you need to get to consultant level to find someone who will look at you as an individual and not just "birthing mother number 5" against what they see as wins for their particular statistical outcomes. Looking back I question why I was even induced - massive waste of resources for tiny woman with back to back larger baby (there was a growth scan on my file due to having measured very large throughout pregnancy showing my baby was predicted to be bigger than average, but at due date not predicted as meeting threshold for being offered a CS - I was 2 weeks overdue though) - if I had been spoken to at any point about my individual situation and advised that intervention was likely anyway, I would have saved everyone lots of time and money and started motherhood a lot fresher with a CS!! But instead you get put on one size fits all pathway where you are just one more birthing mother that they (midwives and junior doctors who manage the majority of births) want to have a natural birth without pain relief. And treat you badly if you and your body don't play ball. I wish I had pushed for a CS but I only really became aware of having a larger than average baby from 30 weeks so I didn't think I would be given one and was sort of persuaded by NCT classes to give it a go.

Sorry, very jaded!! My next will be an ELCS.

Rings true with me.

DD1 Induced with pessary then drip. Hit transition phase and begged for an epidural, for about two hours. Anaesthetist rolled in, by which point I was about to deliver. Shrugged and walked out

Dd2 same, induced with pessary, then they stalled my labour (group B strep which they'd failed to treat me for, and it was only cause I asked what the sticker on my folder was for. I'd been in hospital for 36 hours at this point) and I'd started full labour on the antenatal ward. They strapped Me to monitors and wouldn't let me move. Only gave me pethedine after my MIL demanded they gave me something. Begged for an epidural with DH and MIL fighting my corner, same anaesthetist from DD1 walked in, swabbed my back then said it was too late and fucked off. Delivered half an hour later.

Both times baby was born with cord tied tight around their neck, and with DD2 she'd been in distress throughout, heart rate monitor was showing that Kuch, and when my waters were broken they had loads of meconium in, but still. Nothing.

And with DD1, they put me in a side room after the birth, and I didn't see anyone until my mom and step dad visited at 2pm (so 12hours after delivery) I discharged myself

why did they take the gas and air away? This is the second time I have read it now and I'm curious what the reason was.

We weren't told the reason - DH was in room - I did ask for it back he remembers that but was ignored.

I could have been firmer but was fighting to stay in position I wanted - on all fours or kneeling/crouching and leaning on chair - all good positions for a large baby apparently. MW wanted me flat on my back on the bed. The weren’t expecting a large baby though - over 9lb. She did get me on the bed eventually which made the pain worse but it was near the end just before birth.

This happened during my first labour. I’d battled on through a back to back labour with constant contractions for 12 hours and I was literally writhing around in agony, I couldn’t take it anymore. They even tried to deter me from pethidine first of all but eventually caved, when that didn’t work I demanded an epidural and they delayed it as much as they possibly could. It still doesn’t make much sense to me now a decade later, I felt as though they were torturing me.

Headline of that article is really misleading. It goes on to say that women are denied epidurals at home births or in midwife led units. Well that’s because there isn’t an anaesthetist there! And then says the most common reason is lack of midwives and anaesthetist being unavailable. That’s not a midwife refusing it for their own reasons, that’s the NHS not being fit for purpose.

As a midwife I have never refused anyone an epidural but I have several times had to say the anaesthetist isn’t available. We have 1 to cover labour ward and A&E at weekends, nights and bank holidays. If they are dealing with an emergency or in a Caesarean section there is nothing we can do but wait. Sometimes this means the lady delivers without one. It’s not good enough but it’s not the midwives fault either, there is nothing they can physically do about it.

(group B strep which they'd failed to treat me for, and it was only cause I asked what the sticker on my folder was for. I'd been in hospital for 36 hours at this point)

Yes I never did understand the secrecy.

Due to a complicated pregnancy, and having just had an ECV I was told ( By the midwife or consultant or who've it was who performed the ecv) when I was sent home to call an ambulance if my water broke. They never said why I assumed it was because there was a risk shed turn back to her previous transverse position. So when they went I called the hospital to let them k pa and to check on the ambulance situ. They were quite rude on the phone and said they dont send out ambulances for this. I just explained what I had been told so why they were having a go at me I dont know. So I called my parents fir a lift to the hospital . Then I got a call back saying they had just read my notes and that yes I should get an ambulance. Still without saying why

Anyway I just got I the car as the hospital isnt far and we could he there by time ambulance arrived anyway as my family had already arrived .

Then it just got weirder because when they established my waters had indeed broken and decided to send dp home and me up to the ward someone suddenly said about putting me on an antibiotic drip but wouldn't say why. My waters had just broken I was well within whatever 24 hour or 48 hour guidelines there apparently are for when ABs would be given if I hadnt delivered by . A nurse questioned why I needed them as it hadnt been that long and they wouldn't tell her either. Just vague comments about being on the safe side . Obviously this nurse who was from another hospital wasnt in the know because she was saying I didn't need them and was confused as to why they were talking about them. Anyway I got the impression that they decided to not give me the antibiotics so they didnt have to explain to the nurse or me why I apparently needed them.
9 years later I still have no idea

@KeepYourWigOn
After my DD was born I resolved the same, that there is no way I'd let her be at the mercy of the nhs.
Her induction and birth were not too bad, I received an epidural because I refused the drip otherwise (and the consultant agreed once I had asked for it)
My aftercare was very distressing - basically nine and not believed regarding my injuries and has taken years of private physio, treatment and therapy so if you can protect her from that it's money well spent in my opinion

@Crunchymum A quick Google search confirms links between epidurals and assisted deliveries / EMCS (I don't have the time now to read and ratify the sources) but I thought that was quite common knowledge?

Actually, the weight of scientific evidence - as you can see if you read the Cochrane reviews that I posted and linked to above - is that this is not true. There may be a correlation (for instance, if your baby is huge, you may be in more pain, so more likely to ask for an epidural, and also more likely to have a csec), but that doesn’t mean that the epidural is what caused the need for a csec.

The same goes for assisted delivery.

I agree with @Babdoc in my professional experience of midwives although unfortunately I have seen quite a few of the monster ones. I think to the posters who say they don’t understand why women want epidurals etc - you don’t need to. It needs to be understood that adult women are making informed choices about their bodies. It’s their choice. The way in which maternity care is delivered needs a mindset shift

I'd want to avoid a needle in my spine to be honest

Me too. At the time I had my son there had been a horrible case of a teenage boy with leukamia who had been given the wrong drug into his spine. He had been recovering, but died. It was awful and I said to the midwife I was scared. She told me that there were lots of checks done to make sure it couldn't happen.

I did end up having an epidural and I reject any accusations that women who have them are either wimpy or wasting public funds. I don't cost the NHS anything else other than my smear tests.

I had to have my waters broken for medical reasons. About an hour or so later, I asked for an epidural and was told "it's still early, see how you get on" I said I didn't think I could cope if the pain was going to get worse. Midwife said she would check on me in an hour and see how I was doing. I said "well, can you check me now?" She reluctantly agreed, I got up on the bed and she said "oh wow, you're fully dialated". I asked again for an epidural and she said there wasn't time! Considering she originally thought it was too early, then 2 minutes later told me it was too late I'm not exactly sure when would've been the "right time" to ask for one! She did give me 2 paracetamol though, so thank Heavens for small mercies!

Hoping and praying I don't go in to labour before my planned c section, after the way I was treated in labour first time around.

Had it scheduled in since I was 20 weeks. I can't afford to get ptsd again this time. Managed just about with a baby and ptsd but can't manage with a newborn, a toddler and ptsd. I can't risk the suffering of my family so will have a c section.

@SewingWarriorQueen76 that's disgraceful. Poor you. my dil's midwives did similar with her. A student midwife kept telling the trained midwives that my dil had broken her coccyx as a teenager and that's why baby was stuck.
They wouldn't listen, kept making her push, until my ds went to the desk and demanded that somebody do something.
A consultant arrived and examined dil and whisked her straight off for a cs.

My d's has a huge head and I don't think he would have ever come out vagjnally.

Consequently my dgs is an only child as dil is terrified of going through labour again.

dgs

A quick Google search confirms links between epidurals and assisted deliveries / EMCS - this was exactly my concern when I was being measured up for my epidural at my antenatal check with the anaesthetist in Paris. He soon put me straight - in fact what he said was: "Oh you British like to give birth like Queen Victoria." So glad I listened to him - I had two lovely, deliveries which were both quick and painless. Pain relief and access to an epidural are a priority in France.
How about the NHS is challenged to find these resources by removing the Anaesthetist resourcing to appendectomies for males? I bet that would speed along the funding I'll second that. Who ever said they'd like to have a natural root canal treatment. We don't tolerate unnecessary pain in any other circumstances and we are not expected to. Women should be given the choice - where an epidural is the default option and they can choose to say no.

"Oh you British like to give birth like Queen Victoria."

And even she went for chloroform assisted births once they were available.

@datasgingercatspot

😂😂😂😂😂

It seems like the queen victoria thing is very true!

When I turned down the home birth option (I'm 36, have a low pain tolerance and have what they class as a high risk pregnancy) they still spent three appts asking if I had changed my mind. I wrote in my notes, "no home birth, don't ask again"

I said to stop trying to make home birth happen, it's not going to happen.

If anyone likes the movie mean girls they'll get it

I had an epidural with my oldest - inbetween contractions coming one after the other, mere seconds between them. I was literally rolled onto my side and pinned down by three midwives, trying to stop me from moving in pain with the contractions, whilst the anaesthetist attempted to put the needle (a) in the right place and (b) with one of the midwives heads touching his as she pinned me in place. It took 3 goes. My labour, from start to finish was 4.5 hours long. Because it was my first baby, and I was "just a kid" (to quote one of the midwives on duty... I was 20), they didn't believe me when I said I wanted to push (actually during the attempts to stick a needle into my spine). And I stupidly trusted them, rather than my own body, and resisted the urge to do so until their shift changed, 30 minutes after the epidural, and a lovely midwife called Lisa came in and checked me... and my daughter was born just minutes later. Because of the inept attempts to insert the needle into my spine, and the fact that I went into shock (because of being held down - I hadn't long left my daughter's very abusive "father" - and the speed of delivery), I couldn't hold my daughter on the left side because my arm refused to function. I also had difficulty walking for maybe 3 or 4 weeks after. None of this was checked on, but my consultant (with my second pregnancy) confirmed that the experience was probably due to what happened to me. Now, 24 years later, I have a crippling disability due to nerve damage... in my lower spine: right where the botched epidural took place!

It took another 8 years for me to give birth again - consultant led and in a different hospital. I was induced, due to Group B Strep, and spent a day with an IV drip of antibotics attached to me in 3 or 4 doses, and a TENS machine attached to me. I barely felt my contractions - possibly because of the nerve damage, I don't know - but I seemed to be deciding when they were happening, because I knew, as soon as my waters broke? It was going to be a fast delivery. From the moment they broke to the moment my son was safely placed into my arms and they prised the gas and air mouthpiece from my clenched jaw (I went into shock again because of the speed) was 82 minutes. The midwives - who were fantastic and professional and actually listened to me (as in, they sent my then-partner home because I decided I didn't want him there when I gave birth, due to his buggering off to have a nap because it was "all too much" for him...!) - were astonished at the speed, at how silent I was (like others, when it hurts, I go completely into myself), and how determined I was not to let go of that mouthpiece! I was also horribly sick over my newborn due to the gas and air (so perhaps I ought to have relinquished it after all), and they mopped us both up, coo'd over my baby (who proved himself to be like his father as he also decided to have a nap, mid-delivery - I remember opening my eye just after he'd flown out of me, and the room was completely silent, to see him being held upside down, and his bottom actually being tapped by an anxious midwife. He gave a little mewl of "how dare you interrupt my sleep?!" and all was deemed well by them). I had a hot bath, they rang my partner (at 2am!) to inform him that he'd become a father, and that was that.

I still have flashbacks and nightmares concerning my first delivery, and the way in which I was treated - at the time, I thought/believed that it was probably normal to have midwives decide what pain relief you're having (I didn't have a birth plan with either delivery, figuring that birth never goes exactly to plan...), pin a labouring woman to the bed, mid-contracting, and not listen to her because she's "just a kid". Like every other woman on the face of the planet... I know my own body, but I was so battered mentally by the DV situation, that I simply "put up and shut up" about it. The difference between two maternity units in the same county, though, is vast - the second one was filled with midwives who were kind, professional, compassionate and empathatic to me that day/night. They let me labour at my own pace, and supported me. And yes, I wish that I'd given birth to my oldest in the same place as I did my youngest - but you just don't know until you're in labour, how the situation is going to evolve around you and your baby. I certainly wonder whether the botched epidural efforts led to my disability. How can I not? And given the speed of my labours, there's no way I'll ever risk having a 3rd. If I did, though, it would be at the second maternity unit, even 16 years later.

Who ever said they'd like to have a natural root canal treatment Well there is no such thing as a natural root canal treatment, nature didn't make any provision for it so dentists worked out a way to do it.

My dd is 21 but I still have flashbacks of her birth. My waters broke at home so I was told to go in, got put on the ward and ignored for several hours. Then the midwife refused to believe my waters had broken because I wasn’t in labour, she kept saying I’d just wet myself, despite my insistence there was no way on earth the massive whoosh of fluid was wee. A scan showed my waters were gone, but I was still treated as an inconvenience and ignored.
I also had horrific sciatica from the position she was in, and couldn’t weight bare because of it. Again I was made to feel stupid and as if I was being pathetic because of this, despite my notes clearly saying I had had physio for it in the pregnancy and a long term back condition.
Three days later I eventually gave birth, with gas and air as it was “too late” for the epidural I had been asking (screaming) for for 8 hours. Dd then had to have iv antibiotics for several days as she had an infection, caused by the length of time from my waters breaking to her birth.
I spent my whole 2nd pregnancy anxious about the birth, and had pnd after dd2 was born, despite a much more positive experience, which I put down to the stress from dd1 birth.

Can you think of any other hospital setting where a patient actively has to request pain relief when they are obviously experiencing pain My DD did after oral surgery, in fact it ended up with the 3 other ladies in her side ward all joining in demanding it for her as her pain was disttressing them all.

When my son had a quinsy doctor sent him home saying, "Be careful if it gets any worse, you could die." He didn't get antibiotics or pain killers. We arranged a tonsillectomy privately at a cost of £3,500. I did think he was going to die, he could swallow his own spit let alone eat or drink. He wasn't entitled to an op on NHS as he wasn't having 3 attacks a year. When he had the op the surgeon said the damage ot his throat was terrible.

A month ago my 88 year old aunt broke her hip, she lay on a trolley for 14 hrs before she was seen. No pain relief.

So yes lots of people probably get left in pain unless my family are being victimised..