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...

The OP was not given a reason for not getting an epidural other than she was not 4cm dilated.

She asked six times yet no one would examine her again until it was too late for one.

'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.'

She felt she was not listened to and her needs were ignored.

No mention of anaesthetists being busy in the OP.

But plenty of people on here who were also not listened to and whose needs were ignored.

I think (and this is just a guess tbh) with regards to the OP, a vaginal examination is an invasive procedure, it can increase the risk of infection if the waters have gone by introducing foreign bodies to the vagina. We try and limit vaginal examinations wherever possible, normal protocol tends to state that we offer vaginal examinations four hourly, less if we have clinical indication to do so. It may be that the OP had a midwife who stuck rigidly to the guidelines and labour moved relatively quickly thus rendering the clinical need for another examination unecessary.

Maternal request can be an indication for a VE but it does have to be balanced against other factors.

Maybe the question is why 'clinical indication' does not seem to include horrible pain that a patient does not feel she can endure?

And don't you use gloves? Surely infection can be treated with ABs? Doesn't the doctor's gloved hands have contact with the uterus if there's a CS? If another factor is simply that not enough time has elapsed since the last VE, and the result of waiting is that labour will progress beyond the point where an epidural can be administered or that a woman will have to endure much more horrible pain than she would if an exam right there on the spot indicated she had reached the magic number or would by the time the anesthesiologist arrived, why not balance the infection risk against the much greater risk of horrible pain? Horrible pain is very important. It is a factor that should be taken into account surely?

There is an attitude that the pain is not all that relevant here while a multitude of other factors is; to the labouring woman it feels as if she is being treated as a mere vessel, slab of meat, etc.

You have correctly identified the issue of MWs sticking rigidly to their protocols though. How different would the situation be if the MWs actually felt they could make decisions and be more responsive to their patients? Again, it's only in the area of childbirth where the (100% female) patients are treated primarily (and for the purposes of saving money imo) by professionals who do not have the same education as doctors or the same decision-making powers, or the same status in the medical hierarchy.

And surely the risk of introducing infection into the vagina is the same no matter whether the VE is performed two hours or four hours apart? How does the interval affect the risk of introducing infection?

So poor OP got refused an epidural because she wasn't 4cm, but as she's not 'supposed' to be examined nobody can tell if she's dilated any more? Sounds like a lose-lose situation for her.

'Tis "Catch 22 -- The Maternity Ward".

to clear a few things up (as the OP )
I was admitted to hospital at 12 midnight and examined found to be 2cm - asked for epidura; - ignored.
1am - asked for epidural, told that I had to be 4cm
2am - begged to be examined, so that I could have my epidural, told that I had to be 4cm vbut they couldn't examine me until 4am due to protocol saying VE's no more than every 4 hours
3am, begged for epidural, told the same
4AM, begged for epidural, examined, found to be 10cm, was told that I was lucky that I had done it all by myself and ready to push now (despite no urges to push)
Baby not delivered till 7am, IMO in most part due to the fact that I was terrified of having to do it all on just G&A

mathanxiety, if you are VEing every two hours as opposed to every four hours surely it stands to reason that he risk of infection is greater the more examinations performed?

I take great offence at this remark:

"Again, it's only in the area of childbirth where the (100% female) patients are treated primarily (and for the purposes of saving money imo) by professionals who do not have the same education as doctors or the same decision-making powers, or the same status in the medical hierarchy."

Midwives spend 3 years studying, pregnancy, childbirth and the postnatal period in its entirety. 3 years on one subject. No doctor in the world gets that.

I'm so sad at how midwives are perceived.

DrMcDreamy we can only go by our own experiences. Some women feel really let down by midwives, and getting defensive is not going to address that.
FWIW I spent nearly 2 weeks in the maternity ward with placenta previa, and met a lot of midwives as a result. Some of them were lovely. Some were not. The lady who attended my own caesarean was fantastic. There are some who, if I ever go back and see them again, I will order out of the door. We are not denigrating a whole profession, but some of them are leaving a lot to be desired, and it needs to be addressed somehow.

They say whatever they want to suit them IMO.

When I was in labour with DC2 I had indie midwife but hospital birth (only in because was a VBAC). Had same experience as a lot of people on here - for 12 hours I was apparently "4 cm". I had 3 exams during this time. At the end of 12 hours I started screaming for an epidural because it got so painful and then 30 mins later the baby's head started moving down.

They basically lied because they didn't have a free delivery suite and I was meant to be on continuous monitoring for the whole labour because it was a VBAC. Never saw a continuous monitor or a delivery suite.

Sorry only just read the last page. Of course if you are the only one on the ward that day you will probably get the MW with you for the whole labour (except unless you are in the hospital where one born is recorded in which case she will be having a cup of tea and biscuits).

Sorry only just read the last page. Of course if you are the only one on the ward that day you will probably get the MW with you for the whole labour (except unless you are in the hospital where one born is recorded in which case she will be having a cup of tea and biscuits).

Yeah that programme is doing nothing for the midwifery profession.

Aaaah I have just sat and read all 12 pages after being pointed to this thread by a regular MN'er who thought I may (as a Midwife) find it interesting.

It has made me feel a whole load of emotions from sadness that some of you have had crap times, to Exasperation of some know it all posters who seem hell bent on blaming the MW for everything. My BP is a little high too

Anyhow I just want to say for now, as someone else said - Midwives are the experts on normal childbirth. If a woman is under shared care then of course she has her care led by a Obstetrician alongside of a MW. The MW will try and keep everything as normal as possible within sometimes some really difficult circumstances. Hmmm I am rambling now but it seems some of you look at Drs like God like figures. Aneasthesists are usually available in our unit, yet sometimes women do have to wait. They may be with another woman, or in main theatres with car crash victims etc. It happens sometimes, and my tummy sinks when I tell women, as its a shoot the messenger worry.

Also someone said right at the beginning about breaking a leg or having a appendicectomy - you get LOADS of pain relief. Uh yeh, course it isnt natural to break your leg or have abdo surgery is it? Childbirth is a normal physiological process and hurts. It is meant to, and of course you can have relief from that pain - but if it isnt there asap for whatever reason then you have to go with other coping strategies/options until it does. I'd like to think a MW could help pacify a woman with other techniques until she can get her requested pain releif.

Whoever said that "Again, it's only in the area of childbirth where the (100% female) patients are treated primarily (and for the purposes of saving money imo) by professionals who do not have the same education as doctors or the same decision-making powers, or the same status in the medical hierarchy"

Utter shit.

I would like to see any other profession where you stay on all the time after your shift so as not to leave a ward of women needing breastfeeding help/woman needing post op care/woman turns up in labour and there are no other staff to cover. Or a woman asks you to stay on after your shift and look after her, I have done this lots. Midwifery is more than a job.

I have nurse friends who once there shift ends they go. Simple as. Short staff? Call the site manager who will call in agency/bank staff. We would never have that luxury in Midwifery, we have on call systems to cover our shortstaff issues.

My nurse friends laugh at this. Last week a colleague did a late shift and was on call from 10pm - 6am, and had to stay on. A lot of the time you forget you have a bladder as you dont get time to pee, let alone grab drink/snack.

Ok I have just moaned about how crap it is and totally gone off the point, so I would liek to say I LOVE my job and would never do anything else. I am exasperated at the system, and when you come on sites like this and see the MW bashing it hurts. It makes me feel sad.

I also would like to say I really do think some of you sound like you would really benefit from Birth Discussion - that probably sounds patronising. It isnt meant to be. Just picking up on vibe.

Runs for cover

'I have nurse friends who once there shift ends they go. Simple as. Short staff? Call the site manager who will call in agency/bank staff. We would never have that luxury in Midwifery, we have on call systems to cover our shortstaff issues.'

I have plenty of nurse friends who stay on after their shift to do paperwork.

Getting wisdom teeth is a natural physiological process, too, but you're given pain relief when those come out and cause problems.

Dying is a natural physiological process, and it can really hurt, but no one expects dying people to just cope because it's a natural thing or wait hours and hours for pain relief (or maybe they do, considering how many posters on the assisted suicide posted about their experiences watching their loved ones die in agony).

Only in childbirth are you expected to just cope and patronised, bullied, made to feel weak or guilty and belittled if you don't 'cope' according to someone else's (a total stranger's) standards.

Maybe if some of these women had got the pain relief that they wanted when they wanted it they wouldn't need to be thought of as would 'benefit from Birth Discussion'.

Dying in agony? Well if they are in agony then surely they are in some kind of pain that has caused that agony no? So it becomes not physiological.

As for Wisdom teeth, I still have mine, does everyone always have them out? No of course not! It all depends on how they are coming through and if there is space etc. I wont go on about wisdom teeth though as its off the subject and I have left my old job as a hygienist behind a long time ago

Of course expat you seem to have a answer for everything, especially when a MW has tried to explain how life can be sometimes.

Yeh nurses do stay on and do paperwork. I didnt say all nurses did I?

I would say if a woman is in your words "patronised, bullied, made to feel weak or guilty and belittled if you don't 'cope' according to someone else's (a total stranger's) standards" and youa re implying of course its those pesky lazy arse good for nothing bitter midwives doing the aforementioned things, then I say they are probably needing to give up the job. I have met some dinosaur Midwives in the past, and can see how some of these things may occur. I think it is less common than good care given. Obviously talking about how good your MW is doesnt get the headlines does it?

The alst poster who mentioned birth discussion - well no of course! But sometimes shit happens and in childbirth things can go wrong quickly, I have witnessed it myself as a Mum as well as in my job. And can honestly say I highly recommend it. It can bury a lot of bitteness, and negative emotions that some women carry with them. Regardless of how it has arisen.

'Dying in agony? Well if they are in agony then surely they are in some kind of pain that has caused that agony no? So it becomes not physiological.'

Ah, okay, so cancer pain is not physiological then.

Dying is just as natural a process as childbirth and for many, it hurts very much.

But most people would find it barbaric to expect someone who is undergoing the natural physiological process of dying to just cope, wait for hours, that's how it is.

You seem to have a very defensive answer for everything as well, seem to miss the point of the OP entirely, and again, basically illustrate the point the OP was trying to make, which is that it's not uncommon for women to not be listened to and their needs ignored by midwives.

Many of the 292 posts on here are from such women. But again, it's midwife-bashing when they share their experiences.

So here, have some more rope. You're doing fine.

"The alst poster who mentioned birth discussion - well no of course! But sometimes shit happens and in childbirth things can go wrong quickly, I have witnessed it myself as a Mum as well as in my job. And can honestly say I highly recommend it. It can bury a lot of bitteness, and negative emotions that some women carry with them. Regardless of how it has arisen."

For most women on this thread 'it' has arisen because they were denied the epidural they requested which if they had of received it would have meant that for them 'shit' happening would have been a lot more pleasant and bearable.

Cancer ISNT physiological.. Thats why the sufferers have syringe drivers/adequate pain relief in situ.

I am not defensive, I was trying to illustrate how it can be from the other side. The same as if there was a thread by Midwives moaning about women in labour. Would you not try and put your point across?

I try and do MY best as a MW, I want women to walk away saying they had a great experience of childbirth, regardless of mode of birth etc. I want them to say hey DHTPHTG was really suppoertive and listened didnt she. I want the best for the women whatever they want, I really do. I feel demoralised reading this, and sad as I said before that some women have had a shit time.

Yeh I will bow out, as you some people do not like having their opinions challenged. I really dislike the term about being given rope too, there are better terms you can use and very insensitive too, especially to someone who has just lost a family member via this form of suicide.

"The last poster who mentioned birth discussion - well no of course! But sometimes shit happens and in childbirth things can go wrong quickly, I have witnessed it myself as a Mum as well as in my job. And can honestly say I highly recommend it. It can bury a lot of bitteness, and negative emotions that some women carry with them. Regardless of how it has arisen."

For most women on this thread 'it' has arisen because they were denied the epidural they requested which if they had of received it would have meant that for them 'shit' happening would have been a lot more pleasant and bearable.

So having birth discussion, saying how they felt, getting an apology isnt going to help? it may help towards closure. I personally found BD very very useful, and it closed some doors and answered a lot of questions.

Thats all.

Taking out wisdom teeth is not a 'natural physiological process'. But growing them is! Do you expect pain relief for the whole growing period then???

And just because you've had 5 children does not make you an expert in childbirth. How many labouring women have you seen?? And cared for??

As I've said before, way up this thread, sometimes putting an epidural in and it becoming effective would take a much longer time than actually having the baby. Particularly for a multip.

So I guess you could say that yes, I have fobbed women off when they are screaming for an epidural at 9cm. As a labouring woman, having a venflon put in, trying to sit extremely still, curled in a ball, whilst someone has a rather long needle in your spine is bloody difficult in the later stages of labour. And even if it goes in easily, the drugs need to take effect. And by the time this has all happened, the baby's head is usually almost out anyway!

Don't get me wrong, the above scenario would be totally wrong for a lady in the earlier stages of labour, particularly a primip, who is finding the pain hard to manage. In this case, an epidural should, if requested, be given asap.

As long as there is an anaesthetist free!!

I have been looking after one woman where her long awaited epidural was just about to be given. The anaesthetist had gowned up and then came the knock on the door. "cord prolapse, room 3, crash section'. He was out of that room in an instant. The lady I had to look after had to wait. Was not coping, in agony, and quite possibly has the problems of PTSD some of you have experienced. And that is horrible, awful for the woman and I know from watching her have to cope with more pain, extremely distressing for her and her partner.

But the other baby would have died if the anaesthetist did not go.

It's shit but it happens.

I know this next comment won't go down too well, but as a midwife and a mother of four (and yes I have laboured with and without an epidural) -

Childbirth hurts!! Did nobody ever tell you??

"Childbirth hurts!! Did nobody ever tell you??"

Missing the whole point of the thread - IT DOESN'T HAVE TO!!!

If you are VEing every two hours with the same pair of gloves you used on the last patient, then yes the risk of infection is higher. But with the usual hygiene measures in place, what is the real risk of VEing every two hours or two hours after the last one? You're going to have to do a VE right when the woman thinks she feels the urge to push even if it's been less than 4 hours since the last one anyway. If there was any really unacceptably high risk associated with VEs then they wouldn't be done at all.

For a lot of labours you might only get to do 2 VEs anyway so you're not going to exponentially increase the risk of infection by doing them two or three hours apart. What's the average length of labour and how long is the average woman in the hospital before giving birth? Long enough to do two VE's fours apart?

Again, you don't seem to be prioritising the suffering of the labouring woman and the issue of pain relief.

Well, it does have to to a certain degree doesn't it, unless you have an epidural before labour even starts.

Or just have one in place at conception. Problem solved