Anyone else 'tricked' out of epidural?

[liznay]

I went over my birth notes today at the 'Birth Reflections' service at my local hospital. (In order to get closure and prepare for No 2!)
To cut a long story short, My previous labour was 27 hours from start to finish although I was only admitted for the last 7 hours.

I asked for an epidural no less than 6 times during this period and was given the excuse that I needed to be 4 cm before I could get one.
Suprise, Suprise, no one would examine me to check how dilated I was and so then it became 'too late' to give me once I had reached 10 cm.
Despite Nice guidelines saying that no woman should be refused an epidural (even in the latent first stage!) apparently the hospital have their own policy.
I am SO ANGRY about this and feel that I was ignored and treated like a small child. Incidentally, the hospital are unapologetic about this and refused to say sorry about the care I received. The most that they would conceed was that they had 'somehow failed me'.
Why is this still happening to us in the 21st century? Anyone else had a similar experience? What can we do about it, and how can we prevent it happening for subsequent births? It's time that midwives stopped deciding for us how much pain relief we need and consult with us regarding how to make our births more comfortable. Not saying that all midwives are like this, but mine was a particular dragon....
I don't want this to turn into a debate on the pro's/cons of epidurals as this has been done to death elsewhere...

I'm glad I never gave birth in the US, tbh, though I was born American.

My husband and all my children are Scottish, I am a British national/dual national and have lived here for 10 years.

Although, often enough, I am treated as if I should have no opinion on British life, don't understand any of it (that is true about England and Wales, as I have never lived in either) and I should, with my family, 'go home', though my children and husband are every bit as Scottish as any other Scot born.

(I often wonder if my friends who are Pakistani or Indian/Scottish would get the same treatment, but that's another story).

I think if you pay taxes somewhere your opinion should count there, and I think if you are a taxpaying woman the health service should deliver whatever it promises to you, because you have paid for it.

If I had not been given an epidural I know that I would never have another vaginal delivery. I'm in no way "traumatised" (don't want to belittle the experience of those who have had really bad births) but the pain of the 30 mins waiting for the anaesthetist after my waters broke (I was at 6cm by then and had laboured at home for 15 hrs doing ok before coming to hospital) will always be with me in "Top 10 worst experiences of my life". I had a great, supportive midwife helping me with the gas and air and supporting me to remain mobile but I was not coping in any way whatsoever. I was a sobbing wreck.

I live overseas so had an obstetrician led delivery. We talked about all the options beforehand and she said

"It's up to you, but what I'd say is that whilst I agree that a pain relief free birth is a completely natural thing, 35 year old women having their first child is not a natural thing. Older women having their first child tend to have longer and more painful labours than younger women. Don't ever feel that you're losing face by saying that you need an epidural."

I am so glad I asked when I did and SO grateful that I only had to wait 30 mins.

I was actually offered an epidural repeatedly during my first birth, and was told I was getting one for a manual placental removal regardless that my notes specifically say I should not get one due to my history of low blood pressure (actually had a anethesiologist tell them off for the latter, she was absolutely marvelous after dealing with midwives and nurses who acted like my almost-dying reaction to the injection was my fault).

I had a horrible, life threatening reaction to the "completely safe" injection to speed up the placenta. I was put in the high dependency ward with women who'd had horrible complications to epidurals and spinal blocks. None of us expected to be there, but it happens. All medicine has some likelihood of causing problems. I think women should be given a full discussion of pros, cons, and risks of the different things that can be done during labour, birth, and third stage. If there is time for a home assessment for women who want home births, there should be time for a run down of the medicinal interventions - other than just handing out pamplets.

I mean, my husband had to go in before his knee surgery, discussed his previous reactions to medicine - particularly anesthetics - and given a list of every littlev thing that could go wrong against why it was worth the risks. I don't see why a similar thing couldn't be part of standard NHS antenatal care. As someone who had an unlikely reactions, it would have led to a lot less 'what could I have done differently' feelings to know that, although unlikely, X% of women do have a bad reaction regardless of anything else' and this would hopefully allow women to get whatever care wanted during such a difficult time if there was a signed paper saying 'yes, she knows the risks and thinks it is worth it'.

ok I feel I want to respond to some of the things said in this thread
firstly - why has noone swore and cursed either a: the system
or b: the anaesthatists.
It appears to be 'bash the midfwife'. ther midwife does not put in the epidural - the anaesthatist does. The midwife phones the anaesthatist to organise it - if they are too busy saving someones life/ baby's life having a PPH or emergency section, then that is not the fault of the midwife.

Also - epidurals do affect the mode of delivery. There is copious amonuts of research stating that yes, they can lead to higher instrumental deliveries/sections. It can lead in later life to pelvic floor problems caused through pushing too long - it is much harder for women to push effectively when they have no urge to push.

When women are in labour, they need to mobile to facilitate the birth mechanism - an epidural does not allow this. Being on CTG does allow for this - if women are told to stay on the bed and that they cannot go to the toilet, then that is wrong. If you have drips attatched, you can wheel them to the toilet. Likewist the CTg can be tempoarily disconnected to allow this.

I am pleased to be able to work in a place that does not have the problems that most of you are discussing - if women require an epidural then they can generally get it - as long as the anaesthatist is free - if not, they are told and given an approx time scale for when they will get it.

Epidurals do not lead to caesareans. Have a look on the obstetric anaesthetists site.
There is a possible link to increased instrumental but this is disputed with some studies showing a link and others not. The difficulty is that women who request epidurals are those may have obstetric problems to start with so does the epidural cause the problem or is it the result?

Ther definitely was a difference with the old style epidurals but the evidence for the newer lighter epidurals is mixed.

The obstetric anaesthetists association consider you increase your chance of having an instrumental delivery by 7% if you have an epidural but that may be much less if you give birth in an upright position - there is a big uk trial going on at the moment.

There needs to be much more effort to improve pain relief for women - labour pain is one of the severest pains known yet it is the only one that people are expected to 'cope' with rather than have relieved.
In fact, research into obstetric analgesia is way down the priority list - women's pain doesn't matter - we're second class citizens where the health service is concerned.

This is the one area that we do not have equality - totally appalling - some of the posts on this site where women are talking about their experiences would not be out of palce in the Amnesty International Mag...

I am also shocked at the blame being directed at midwives. If there is not anaesthetist or he/she is dealing with an emergency it is hardly the midwife's fault.

"There is a possible link to increased instrumental but this is disputed with some studies showing a link and others not".

Would LOVE to see a study where one arm compared outcomes for low risk mothers having elective epidurals, the control arm being low risk mothers who are given one to one care all the way through labour by a midwife they've met before, who have access to a birth pool and are encouraged to mobilise.

Reckon the outcomes would be very different!

And would also like to know if any studies comparing outcomes for epidural vs non-epidurals control for the impact of continuous care in labour. We know continuous care is linked to lower rates of c/s and instrumental birth, and we know that in the UK at present many women spend a good deal of their labour alone (unless they've had an epidural, in which case they'll have a midwife with them all the time).

Ushy - I think the thing that's worth remembering with pain in labour is that experiencing severe pain in labour is not necessarily linked to women reporting lower satisfaction with the birth or to poorer psychological outcomes, hence perhaps the lack of motivation in addressing it.

What Ushy said- if men had babies there'd be more anaesthetists. It's barbaric to expect a woman in severe labour pain to wait 3 hours or just to be fobbed off. It's another example of the infantalisation of women. "There, there dear, you did it, it wasn't so bad was it? and you've got your lovely baby now, and didn't jeopardise his health by that fraction of a percent by asking for an epidural."

My local hospital generally achieves one to one care in labour whether an epidural is in place or not.

But surely it underlines the higher risk aspect of them if other units, who are unable to achieve 100% one to one, give one to one with epidural.

I had one to one continuous midwife support and had been mobile for the previous 12 hours of my labour. Still had an epidural. No disrespect to midwives but no amount of breathing was going to get me through the referred pain in my hip that made me feel as though I was being racked.

BaggedandTagged - there is good evidence though that overall if women have one to one support from a known midwife they're much less likely to need pain relief in labour.

Wanted to add, that I wouldn't want to see the wider availability of epidurals without a corresponding rise in the number of midwives.

Cleofartra, there are loads of studies that show that severe pain leads to worse outcome for women - PTSD, depression etc.

Look what women are posting on this thread as well. These are real women talking about real experiences and how their lives and mental health have been affected by the barbaric attitudes to pain relief within maternity services.

I agree that one to one care is good but labour pain is real pain - it is not in poople's head! Women want good 'one to one' care and the pain relief they ask for.

The post delivery pain and trauma (physical, emotional/ mental) from a section or an instrumental comes into the PTSD / depression studies too.

"Look what women are posting on this thread as well. These are real women talking about real experiences and how their lives and mental health have been affected by the barbaric attitudes to pain relief within maternity services. "

But the stories here are fundamentally about unsympathetic and unresponsive 'care', women not being listened to and women feeling disempowered - all of which are linked to poorer psychological outcomes (and physical outcomes!).

It's not as simple as more pain = worse psychological outcomes.

"I agree that one to one care is good but labour pain is real pain - it is not in poople's head! Women want good 'one to one' care and the pain relief they ask for".

But not all women are primarily concerned with having the least pain possible in labour.

Different women want different things. Some will want the maximum amount of pain relief. Some are more preoccupied with having a birth which isn't interfered with.

What all women want is to be listened to, and to be given the best opportunity to have the birth they want - with pain relief or without.

I totally agree that MW provision needs to be better and that it is a critical factor in positive birth experiences. Women need to be able to have one person to support them throughout labour and we cant all afford to rush out and hire a doula.

It just concerns me that women are saying "I am in agony. I can't bear it. Please get me an epidural" and are not being taken seriously.or made to wait 3 hrs. I mean, it's almost as though they know you cant actually "die of pain" so there's no downside to refusing.

It may be a factor in the rise in elective c-sections possibly? I'm not sure I'd have a natural in the NHS.

"It just concerns me that women are saying "I am in agony. I can't bear it. Please get me an epidural" and are not being taken seriously"

Think it's a very good idea for women (or their birth partners) to insist that a request for an epidural be written in their notes at the time it's made.

"It may be a factor in the rise in elective c-sections possibly? I'm not sure I'd have a natural in the NHS."

Yes - can see the logic here. At least if you're having an elective you can pretty much guarantee you won't spend most of the birth alone or being looked after by one very stressed and busy person!

I agree with you Cleo, about women wanting very different things.

Some women will complain if they were offered pain relief !

I made them put it on my notes that I only consent to receiving oxytocin if I get an epidural first. So that is exactly what happened. Although I reminded them of it every hour just in case.

Cleofartra - "But not all women are primarily concerned with having the least pain possible in labour."

No problem. But the posters on this thread clearly think pain WAS an issue.

Absolutely agree women need to be listened to.

"I want an epidural" means "I want and epidural"

Not getting an epidural for someone who says this IS unresponsive and unsymapthetic.

There seems to be a bit of a golf between midwives and some groups of women over this.

Quote MA:"AFAIK from the experience of friends, monitoring in the UK was constant at least a few years ago (maybe ten years ago?) when they had their epidurals, with the baby's heartbeat and their blood pressure monitored (which is what I had for mine)." Yes they probably would have been monitored throughout "because they opted for an epidural, which puts you in a higher risk category". As well as all the above mentioned risks, you are also at risk of DVT from being immoble for such a long time with excess fluid on board due to the pregnancy.DVT was shown to be one of the leading causes of maternal death in the last CEMACH report.

As for being pakistani, polish american, everyone should have the same treatment, regardless of whether you have paid in to the system or not. If you are not a UK taxpayer, you should expect to get billed for your treatment and pay up. The NHS does not have a bottomless pot of funding. In comparison, a friend of mine was treated for a sprained ankle in the US last year, he was sent an enormous bill for the treatment he had received.
The rise in c-sections could be put down to defensive practice and is probably more due to the NHS not wanting to be sued.

In response to Ushy re: research on the Obstetric anaethetists site.....

What about other research - cochrane reviews etc.

you cannot take seriously research undertaken by 'interested parties'

Its like believing research undertaken by say...Nescafe coffee saying Nescafe is the best to drink - we have research to prove it!

I

from the Cochrane review 2011...

Epidurals are widely used for pain relief in labour. There are various types, but all involve an injection into the lower back. The review of trials showed that epidurals relieve pain better than other types of pain medication, but they can lead to more use of instruments to assist with the birth. There was no difference in caesarean delivery rates, long-term backache, or effects on the baby soon after birth. However, women who used epidurals were more likely to have a longer second stage of labour, need their labour contractions stimulated, experience very low blood pressure, be unable to move for a period of time after the birth, have problems passing urine, and suffer fever. Further research on reducing the adverse outcomes with epidurals would be helpful.

Sorry - have been lurking on this threat and not posting but Alimati's quote above is interesting (and surprising):
"There was no difference in caesarean delivery rates"

I would have though C-section rates would be higher after epidurals simply because they'd be happier to agree to an epidural if they thought someone was having a complicated labour or one more likely to end up in c-section anyway.