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...

'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'

And in the US approximately 3890000 babies are born every year. In the UK, 708708.

Bit of a difference in population there.

My last epi took 26 minutes in total from teh time he got going till when I was painfree. I timed it to focus on something.

Are those stats for GBS for all babies or just term babies?

math - i give up - once again you are putting non-sensicle words into our mouths

A fair few of us have tried to explain what we have to discuss with women, and why epidurals are perhaps not without side-effects - information that women are entitled to - to go into labour with the full facts, yet you still say all midwives have an agenda of putting you through the worst possible pain and laugh at you.
FFS - you pick and choose selectivley what you want to spout about - now its the fact that men are entitled to pain relief and women arent and that VEs arent done often enough and antibiotics are fine given out like Smarties.

night night, sleep tight

Maybe it wasn't much of a pain then expat if the test dose alone took care of it.

Routine use of ABs to treat infection that may or may not be there is done in post op wards. I did not advocate using ABs this way, however -- what I said was treat infection once diagnosed. Infection comes with symptoms and can be diagnosed and treated. A former SIL went home with a surgical sponge inside her after delivery, and she lived to tell the tale. An infection is not the worst thing that can happen to you.

Refusing to give a woman a VE on the basis that it might lead to an infection and might lead to getting a Rx for that infection is not going to make MRSA magically vanish. It is just one more silly reason to refuse pain relief to women, because apparently childbirth is a test of character and toughness and ability to endure pain unnecessarily, and not a temporary but very painful circumstance that can be made far more bearable by a simple and low-risk proceedure.

I did not say infection would not happen during a VE. What I said was that the risk is small and using that small risk as a reason not to give a VE that might be used to determine dilation so that an epidural could be given is ridiculous and shows a gross misplacement of priorities. Yes, increased risk of infection was indeed suggested as a reason a MW wouldn't do a VE within a four hour interval.

Why not give the raw number of births in the UK for 2008 and 2009 to show how few babies were affected by GBS?
2008 -- 794,400 live births
2009 -- 790,200 live births

Of this number a mere 2000 were affected by GBS, with 200 fatalities according to your figures. The risk is small.

Thank you for telling me my job. You are so very clever. I really didn't know I had to treat/deal with those things as a midwife.

I didn't say it was a 'big medical secret' at all, just stating facts as they happen in real life. I didn't say top up's wouldn't be given. They are of course given, unless the baby had been born, because that would be pointless wouldn't it.

I have never 'insisted that every woman in labour give natural birth a trial and resist pain relief'. I actually think epidurals are brilliant inventions. And I wouldn't in a million years question the work of anaesthesiologists.

And I am not putting up all sorts of nonsensical objections to the process of administering them AT THE RIGHT TIME. I am however, stating that it is fairly obviously (to an experienced midwife) that if a multip comes in in advanced labour, if she's had normal births last time/s, it is OFTEN the case that the baby would be born before an epidural has a chance to become effective. I have seen it happen - have you?

You are putting words in peoples mouths. Your belief that midwives might have 'an agenda of making women try birth without pain relief' defies belief actually. It is pure nonsense.

Anyway, it can't have been that bad for you otherwise you wouldn't have gone back 5 times so why get quite so het up about it all.

'Maybe it wasn't much of a pain then expat if the test dose alone took care of it.'

Of course, it was all in my mind, I'm sure.

It was 2AM and he said he wanted to go to bed.

It was far more effective than my last one in 2003 in that I felt nada until about 9AM, despite a 2nd degree tear and stitches.

But I'm sure you know exactly what went on, though.

Such superior knowledge as is present on this board.

Another thing, the reason why men get what they want is because they stick together. It's called power in numbers. They also beleive that they are superior, as do many women. Which is why they are paid more, have better career prospects and let's face it, don't stay at home to bring up the kids. For the most time, women do that. But sometimes we women have a lightbulb moment and this lead to women and midwives demonstrating side by side to make child birth better.

I find quite interesting the notion that if a risk is small it's unimportant. Not so if you are the one in however many thousand if affects. A risk may be small but if I we don't tell you about it and you're the unfortunate soul if happens to I'm pretty sure you wouldn't shrug your shoulders and say "ach it was only a tiny risk so I can understand why no one bothered to mention it". I mean hysterectomy is a very small risk at a caesarean section however you can guarantee the surgeon will make sure you're aware that there is the slightest possibility it could happen.

I know nothing for certain expat but at least I'm willing to admit it.
My throw away comment was just that, I thought throw away comment without foundation was the mainstay of this thread and so was just joining in.

Dr McDreamy you say if a risk is small it's not unimportant when you talk about epidurals.

Can I ask you how many women you inform of the risk of 4th degree tear and lifelong faecal incontinence from normal vaginal birth? That is far more common than any of the serious epidrual risks but I have never had a midwife mention it to me.

When you promote VBAC, do you tell women they are eleven times more likely to suffer uterine rupture and more likely that their baby will be brain damaged?

I think a lot of people feel that the risks of 'normal' birth (YUK what a term) are played down but any intervention like epidurals which might cost a bit more money and actually make life a bit better for women has to have every teeny tiny risk spelled out.

Actually I have no problem with spelling out all the risks - as long s you do it for everything and do not just cherry pick :)

The difference between a 'normal' delivery and something like an epidural is one is going to happen anyway regardless of the risks. By that I mean giving birth is not something we are 'doing' to you. If I give you an epidural I have to tell you the risks of my doing so. You are going to give birth whether I'm there or not, it is a normal physiological response to getting pregnant in the first place.

With regards to VBAC, yes it is discussed that your risk of uterine rupture is indeed raised, which is why at my unit you are given the choice of VBAC or ELCS, once in position of all the facts.

And also with regards to 4th degree tears and lifelong faecal incontinence. This is far more likely to be associated with instrumental deliveries. Which as we all know are further assosciated with epidural use.

Position of all the facts? Brain working faster than fingers there. I of course meant "possession".

Ushy that's true, the risks of vaginal birth are not just downplayed, they are not mentioned AT ALL.

Why - because 'the system' is set up for women to have a vaginal birth by default, and probably judges that it will make a lot of women press harder for electives.

But yes, all risks should be clearly spelt out beforehand.

Agree MistyValley, and as for epidurals causing fourth degree tears and more instrumentals, can I repeat myself?
Old epidurals did, the new ones don't seem to.
Effect on instrumental vaginal delivery (forceps and vacuum deliveries)
The use of epidural analgesia does appear to have an effect on the instrumental delivery rate. If you are saying your anaesthetist uses the old type - why don't you have a chat with him her and suggest they change over.

"A meta-analysis of RCTs comparing epidural with non-epidural analgesia during labour found that instrumental vaginal deliveries were more common in those receiving epidural analgesia, with an odds ratio of 2.19 (95% CI 1.32?7.78). This included 10 studies and 2369 patients of mixed parity. On the other hand, a more recent meta-analysis of 9 impact studies, including over 37 000 patients, found no increase in instrumental vaginal deliveries when the epidural rate increased by more than 25%. The type of epidural analgesia might influence spontaneous vaginal delivery rates (see COMET study)."

mathanxiety - the other very sound reason for not doing VE's is the fact that in many women find them extremely distressing and intrusive, and because of this they may disrupt the normal hormonal cascade of labour and result in a more difficult, prolonged and painful birth.

MistyValley - what would be the point in telling women all the things that can go wrong with a vaginal birth if you aren't offering them any alternative to trying for a normal delivery?

In any case, labour is a normal physiological process. Nobody sits us down and tells us about everything that can go wrong when we eat (choking, indigestion, food poisoning), or empty our bowels (anal fissure, constipation) do they? So we can consider choose whether to be tube fed and have a colostomy instead?

Jeez, what's the world coming to?

Ushy - can't see the problem with the use of the word 'normal' to describe a birth which happens spontaneously.

'Normal' walking is walking without the aid of a stick or zimmer frame.

'Normal' defecation is going to the toilet without needing manual evacuation of your stools, or laxatives.

'Normal' labour is labour which starts and is completed without drugs or instruments.

So no judgement there. Just an acknowledgement of the physiological norm.

Math - ages ago you asked how often we give out tinzaparin as you didnt believe it was a big problem for postnatal women dying of DVT.
In my unit I would think that 1:4 women go home on 7 days of tinz and around 1:15 go home with 6 weeks supply.

And lets just hope that all of these 'small risks' dont happen to yourself or anyone you know. Its not such a small risk when it happens to you

Can i just add - as midwives, a woman having an epidural is a dream to care for.
We get to actually look after only one patient, rather than runnning between three rooms.
We actually get to be 'with woman'.
We have a lovley, calm, sleeping woman, who we wake up when its time to push.

Lovley shift!

....so why then, when its such an easy shift, are we still defending 'normal birth' and suggesting that epidurals arent perhaps the greatest thing since sliced bread.
Hmmmmmmm - I wonder?
It couldnt be that we have the mum and baby's best interest at heart - how foolish of us

Agree MistyValley, and as for epidurals causing fourth degree tears and more instrumentals, can I repeat myself?
Old epidurals did, the new ones don't seem to.
Effect on instrumental vaginal delivery (forceps and vacuum deliveries)
The use of epidural analgesia does appear to have an effect on the instrumental delivery rate. If you are saying your anaesthetist uses the old type - why don't you have a chat with him her and suggest they change over.

Oh I do wish there was a laughing hysterically emoticon. It's not quite as simple as just having a wee chat with the nice gas man and asking him to use the nice epidurals that don't do any harm.

sorry Ushy - just picked myself off the floor from laughing -

just have a chat with the aneasthetist to change their practice - hahahahahaa - yeh right!

I have heard of these lighter epidurals, but in the 4 hospitals i have worked at, have never seen one - thats a fair few anaesthetists to change their practice. There is obviously some reason why they dont want to change their practice - if its so good they would have changed

It's the case, isn't it that almost all this research uses women taking opioid pain relief as the control group?

DrMcDreamy - "Old epidurals did, the new ones don't seem to".

Is this true for primips?

Cleofarta I was quoting Ushy with that sentence, sorry if that was unclear.

"sorry Ushy - just picked myself off the floor from laughing -

just have a chat with the aneasthetist to change their practice - hahahahahaa - yeh right!"

Doesn't this say something a bit sad about professional relationships? That's a bit scarey