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 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.'

But still not acknowledging that women don't walk away saying they had a great experience if their experiences of pain are not listened to by their healthcare professional.

That is what this thread is about!

'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.

Please do then, I've tried to commit suicide myself in the past.

If there are better terms I could use, well, they didn't come to mind.

So sue me.

Funny, all the midwives' comments on here just to go to illustrate so many of the points made on here by women on here.

So caring, so constructive about other peoples' pain and the relief for it they felt they needed.

Ok Ok.

I was one of those women who walked away feeling demoralised, I know not ALL women do walk away feeling euphoric about birth. I havent erked away from that have I? I am merely trying to say this is the care I give, and how I hope the majority of MW give.

This may have been asked but:

If the Aneas is tied up in theatre, or cant come pronto - who's fault is that?

Why dont some of you channel all of this negativity into campaigning towards making things better in the future? genuine question. Only this week there was news of Midwifery places being cut. This will just add to the already over stretched staffing levels and these problems multiplying.

Too many questions that if i answer i will be deemed wrong and judgmental and inconsiderate and uncaring.

However - your last post you say we HAVE to do a VE when the woman thinks she feels the urge to push.

No we dont. Sometimes we do, sometimes we dont - there are far more other signs to look out for other than feeling pushy.

As for just giving women antibiotics for infection - are you for real? you really think its ok to give women antibiotics in labour and to their baby, just so we can VE more often.

There is no average length for labour - once labour is established - strong, long contractions 3-4:10, shortening of the cervix, cervix being around 3-4cm dilated, then in primips we are happy with half a cm an hour. multips 1cm an hour.
But as there is still a waiting list for the Mystic Midwives Crystal Ball, everyone is different -it can be much longer or much much shorter.

It is not the gloves!! It is the risk of ascending infection, infection present in the vagina getting to the baby, especially if the waters have gone. Sterile gloves or not!!

And yes, the risk is small, but it is still there!

Oh, but don't worry about that, lets just give antibiotics out like smarties to cover that little problem.

'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.'

And this horrible example of mismanagement simply would not happen if men were the patients or if there were more men represented in the midwifery profession. Shortstaffing happens when the medical needs, never mind the pain relief or breastfeeding needs of a whole class of patients are dismissed -- because childbirth is a physiological process maybe? Or maybe because women are invisible and their healthcare needs associated with childbirth are not considered a priority compared to the trials of motorcycle crash victims for instance? Or because the work of their mainly female midwives is taken for granted and not seen as a professional service because it is rendered by women in the main, for women?

The horrible mismanagement is equally visible when the reason given for not giving a labouring woman an epidural is that the very scarce on the ground anesthesiologists are elsewhere; why are there not enough anesthesiologists? And what the heck happens when there are two prolapsed cords at the same time? Who gets the anesthesiologist then? Gross mismanagement = not having enough qualified personnel available. More people should sue.

The gloves remark was tongue in cheek: yes I know it's not the flipping gloves -- But yes, let's give out antibiotics when women get an infection. What a novel idea! They don't have to be handed out like Smarties, just in the appropriate dose, for the appropriate infection. They kill infections in women as well as in men. They have been proved effective for decades. Is it preferable to avoid the very small risk of infection or have a woman endure agonising pain? What is your priority here? Avoid a small risk or prevent a huge pain?

The average epidural takes effect in 20 minutes, Poppyella.

Just read whole thread

So why are there not more anaesthetists on maternity wards? Is this a silly question?

And if I am clear from the very start that I want an epidural and my DH is there with me fighting my corner, how're my chances?

so what infection would you treat?
How do you know the woman has an infection - on postnatal ward when she is pyrexic, at home when the baby dies of GBS?
Infections dont always show up straight away - they incubate, possibly showing up well after delivery.
Overuse of abx is real - MRSA proves that.
Its not such an easy option as just giving woman antibiotics.

If you have 2 emergencies at the same time you shit yourself! Really - its happens and its horrendous. I lose a few years of my life when it does happen.
Its not just anaesthetists, its doctors, scrub teams, ODPs, midwives that you need for each emergency.

I love my job, but at times i despair of how short staffed we are.Its not easy, its not safe and its not fair on women to have one midwife running between two or three rooms trying to offer her best to each family.
Unfortunately, midwives are the messengers and regularly get shot

I'm just wondering if any of you on here who have written of your experiences of dreadful treatment at the hands of midwives have contacted the maternity units and made your grievances known?

The thing is that nothing can prepare you for the pain of childbirth. And it's often shocking and overwhelming, even when the birth itself goes smoothly. Which of course, it often doesn't. Which makes the pain and shock all the worse, and sometimes truly physically and psychologically damaging.

And 'the system' will continue to be railed against for as long as it is perceived to be shrugging its shoulders and going 'yeh, duh... childbirth hurts, innit. What do you expect.'.

'The system' falls down badly when women first go into labour, and are left alone and ignored until 'the system' deems that they are far enough along be 'processed'. Then, it seems to be pot luck as to whether you are looked after well or not. During my pregnancy and while giving birth, I came into contact with perhaps 15 or 20 midwives, and one registrar. Some were great, some not.

I'm not interested in midwife bashing. The midwife who attended my labour was great, except for a bit of gentle fobbing off with regard to epidural. Which as it turned out, it seems I would have been better off having, as the registrar complained about me having insufficient anasthesia whilst she tried to stitch my fanjo back together after ventouse (I was unhelpfully leaping and yowling every time she stuck the needle in).

Oh and btw I encountered at least two midwives who used the grimace technique. The one who told me I wasn't in labour when I was (not enough cms grimaced, obviously), and even one at a pre-natal appt who claimed to be able to diagnose labour over the phone by the sound of a woman's voice . So they are around.

This is such an interesting thread - expat and mathanzxiety I pretty much agree with your every word. The midwives are not painting themselves in a good light at all, all patronising 'there, there, you don't know what you are talking about, I am the expert and I am right'.

Unrelated by also colouring my opinion is having a gynae operation last week and being refused pain relief post op, snarled and sneered at whislt i was crying in pain at 5am. I was ttc but tbh, after that, I am seriously thinking of stopping. The feeling of being disregarded and disbelieved about my own pain is so raw in my head at the moment. Normally I can stand up for myself - however, after 3 nights with no sleep, in pain from the op and feeling all at sea - I was NOT in a position to stand up for myself and I felt hugely let down by the HCPs I saw - a similar vulnerability you feel in labour.

I am tired of HCPs trotting out the same old 'the body is beautifully designed for childbirth'. No it is not. It is a series of compromises to ensure the continuation of the species with, historically, a fairly high attrition rate. In the 21st century we have modern methods of pain control, yet we are seeming to harken back to some halcyon day of natural childbirth which didn't, imo, exist.

"Which as it turned out, it seems I would have been better off having, as the registrar complained about me having insufficient anasthesia whilst she tried to stitch my fanjo back together after ventouse (I was unhelpfully leaping and yowling every time she stuck the needle in)."

So the registrar didn't stop and offer you effective anaesthesia? She just carried on with her assault?
Err not the midwife to blame then its the doctor, she's carrying out the ventouse and subsequent suturing.

I had had local anaesthetic, it just wasn't doing much. She stopped to apply more (I think, it was pretty hazy by that point) but seemed to be in a bit of a rush to be elsewhere.

When the midwife came back in after the stitching, she looked in horror at my fanjo, and said 'god, she's left you in a right mess' - whether that was because the registrar had to dash off elsewhere I can only guess. Probably, as I do recall that she had been quite hard to get hold of when DD went into distress.

I have been a midwife for almost fifteen years and many, many epidurals take longer than 20 mins to be effective. My own included. I have seen it with my own eyes!!

How many women have you looked after in labour math? How many labouring women have you actually seen? Often the pain is reduced during that 20 mins but the woman may also need a top up of bupivicaine for it to be fully effective (particularly to get rid of the 'pressure' pain felt in the later part of labour). Which needs to be given by an anaesthetist who is probably off in another room by then administering an epidural to someone else! So the woman has to wait.

And by this time, in some circumstances the baby would be born before the epidural works. Again, seen it happen - frequently!

During this thread math, you say that lots of things in obstetrics have a 'very small risk' - DVT, uterine rupture, infection (and what on earth have men got to do with that??) - oh, but as long as epidurals are in place, that's fine, we'll just treat with fragmin, antibiotics, crash sections, it's not a problem. So long as she has an epidural.

Two prolapsed cords - the one who prolapsed first would get the CS first. Unless of course someone has a magic wand and can suddenly make an anaesthetist appear.

So post-op patients, men and women alike, shouldn't be given routine ABs? Because MRSA exists? They are also routinely discharged before any infection might show up. If someone has a real bacterial infection that presents a real risk, then ABS are the way to treat it. You can't just fold your arms and say they're overused globally and therefore we're not going to use them any more. They do what they're supposed to do the vast majority of times they are appropriately prescribed and properly used. They have saved countless millions of lives.

Presumably women return to their doctor when they have symptoms of infection and get antibiotics at that point? If on the postnatal ward, then nurses and doctors can identify the infection and administer ABs -- no worse place to be sick than in the maternity wing of the hospital with all those staff members busy elsewhere though, so maybe the maternity wing is not the place to have an infection.

How many babies died last year from GBS?
How many women used to die from puerperal fever before ABs and sterile latex gloves?

To seriously say that risk of vaginal infection is a good reason to refuse a VE and an epidural for labour pain is really ridiculous.

mathanxiety I think you'll find the incidence of pueperal infection increased when childbearing moved from home to hospital. Mainly because doctors walked from post mortem to attending labouring woman without washing their hands.
Simplest way to reduce cross infection hand hygiene, prevention is better than cure always

By the way when I say 'the system' I don't mean midwives, I mean all the HCP's you encounter along the way, and the way the system itself is set up and funded.

Oh and GOML - I too get very annoyed when people bang on about women being perfectly designed for childbirth. It's a load of old cock. If we were, there would be no need to go near a hospital, doctor or midwife in the first place.

www.rcoa.ac.uk/docs/epiduralanalgesia2010.pdf
I particularly like section 1.3

again math - youre confusing and putting words in peoples mouths -

MRSA occurred BECAUSE of overuse of abx, yet you are saying its ok to offer routine use of abx to treat infection that may or may not be there.

You are also saying:

To seriously say that risk of vaginal infection is a good reason to refuse a VE and an epidural for labour pain is really ridiculous

who said that? - you said earlier that infection would not happen during VEs. We said it did. Noone said dont give an epiudural because of it.

re;GBS - a quick scan - in the USA 12,000 infants each year are affected by GBS. Of that 2000 will die.
In the UK 2000 babies will be affected, of these 1 in 10 of them will die
Still ok to offer more VEs?

Nobody said that. A VE is not an 'operation' so you are not 'post op' after a VE. Nobody said ab's don't have their place, of course they do. Nobody said that women shouldn't have ab's when they have symptoms of infection.

And ffs I didn't say that the risk of 'vaginal infection' should be a reason to refuse a VE or an epidural. The infection I was referring to was that to the BABY - ascending infection up the birth canal, such as GBS which I know you know can have horrendous consequences for the baby.

Of course VE's should be done, and not only at a rigid 4 hourly interval, but as and when the midwife sees the need. But oh no, don't worry about the baby or getting a puerperal infection that could hinder you actually caring for your baby - as long as you get a flipping epidural!!

You are totally missing the point. But I really can't be bothered to try and explain it to you any more, you obviously won't understand.

It takes 10 to 30 minutes, on average. It's not a big medical secret.

So a patient might need a top up? So therefore don't give one?

No, you can't predict how quickly a baby will make his appearance -- but again, that is no good reason not to give one surely? You don't know if it's going to take two hours more or six. Epidurals are still given in hospitals where pain management for women in labour is a priority despite the unpredictability of childbirth. It's a question of where your priority lies.

If you are going to insist that every woman in labour gives 'natural' birth a trial and to resist pain medication, then you will find all sorts of silly reasons not to co-operate with a patient's request for an epidural, many here on this thread. If that's what your hospital is about, then patients should be informed before it's too late to take their business elsewhere.

Epidurals were developed with labouring women in mind. The anesthesiology profession and the pharmaceutical industry are well aware of the circumstances of labour and how fast or slowly it can go. Yet they persisted in developing the epidural and in developing techniques associated with it, both for initial administration and in topping up, in monitoring of patients while it's in effect, and in researching the best window for the needle to be inserted -- they need to know how much a woman is dilated; yet another group of professionals is on here questioning the work of the anesthesiologists, making epidurals sound far more risky than they are, and putting up all sorts of really nonsensical objections to the process of administering them at the right time. It makes absolutely no sense unless there's an agenda of making women try birth without pain relief, a political agenda that actually disempowers individual women in the name of empowering them.

The risks I mentioned are small. And you are there to treat/ deal with the prolapsed cords and the crash sections etc., whether they happen after or without epidurals. You are a medical professional and that's your job. And so is pain relief when that relief comes with very, very small risks and great benefits.

"And this horrible example of mismanagement simply would not happen if men were the patients...."

My OH has been waiting for an op for 5 months. The op has been postponed twice. Once because the ward was needed due to the swine flu outbreak.People are always complaining about the dire care they or their loved ones have received in hospital. This is an issue within the whole of the NHS, not just the maternity service. Underfunded and understaffed and it is set to get worse before it gets better.

Oh another thing, the overprescribing of antibiotics causes Clostridium difficile.

I suppose the only way women can get what they need is to join your local MSLC as a user representative and have these discussions with the people who are in charge of your service. Bring all of the arguments that you have laid out here to the table and maybe they will realise that these issues need to be addressed before any other women are let down by the system.

www.oaa-anaes.ac.uk/assets/_managed/editor/File/Info%20for%20Mothers/EIC/2008_eic_english.pdf

20 minutes to set up and 20 minutes to work = 40 minutes when I went to school