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 am late to this thread, but just wanted to jump on and defend midwives / labour/ drugs etc!

my first baby was back to back and in an aukward position - after about 26 hours of labour I was put on a drip and offered an epidural there and then even though my notes said I didn't want one... they did this in my best interests - they knew I was shattered (strong contractions for that whole time) and they knew they were turning the drip up high... they listened to my concerns, got the anaesthetist to talk to me and then WE agreed together to do it. It didn't work fully so I was given top ups and then a stonger dose of it - which was heaven. I ended up with a c-section and after checking babys position told me I had done the right thing and she was never coming out naturally.

My second birth I had been practicing natal hypnotherapy. I was much more relaxed about the whole experience. My early labour lasted about 3 days (plus longer stop starting)... but I coped far better because of how relaxed I was. When I was eventually admitted I had an AMAZING midwife, who really advocated what I was doing. I was up and about lots, as every time I laid on the bed I found it far more painful.
eventually she told me she thought I needed 'something' as I was clearly a bit frazzled (4th night, no sleep) - she suggested pethadine to help me rest, which I took.

eventually I was pushing without any control over it - and it turned out baby was again in a difficult position and it was putting pressure somewhere - even though his head was really high. They suggested an epidural to help stop the urge to push which I accepted. Unfortunately that didn't work, and when they saw me pushing uncontrollably with an epidural and gas & air and trying to breath through it they knew something was going on!

Both ended up with c-sections, it turns out I have odd shaped hips or something which prevented babies descending

but anyway - I digress... because of the length of my labours I have had experience of quite a number of midwives and have found all of them to be supportive and encouraging of my preferences, whilst still looking out for the best for me and my baby

so to the midwives here feeling they need to defend themselves- you do an ace job! :)

I'd say that it means we respect each others professional knowledge. An aneasthetist knows anaesthetics, if they are using that particular mix to create a dense block then it'll be for a good reason. It might be that they are unfamiliar with 'how' to create a lighter still effective block. It may be that the research from an anaestetic point of view shows that the denser type block is more effective. It could be for any number of reasons. It might be something such as their policies state that is the type of epidural they use. It can take years for policies to be rewritten. By all means we can have a chat with the anaesthetic staff but it is highly unlikely that it is us that will make the change.

Ushy - any thoughts on the fact that almost ALL these trials of epidurals compare regional analgesia with opioids? Cause we all know that women who've had opioids often spend much of their labour in a supine position.

mummynoseynora - you're absolutely right - most midwifes do a fantastic job.

I think what might seem like midwife bashing isn't actually that at all. People are asking whether midwives are giving the right information to women and respecting their requests.

What's being hightlighted seems to be that midwives are TRYING to do their best for women based on the information they have but they are being given in their training is way out of date. It is the other posters like mathanxiety who are ahead of the game.

It just makes me think the internet and mumsnet are amazing.

PS Cleo - impact studies include all women in a given hospital or location. Some will have opioids and some not.

Dr McDreamy "It may be that the research from an anaestetic point of view shows that the denser type block is more effective."

This was in NICE guidance years ago !!

"PS Cleo - impact studies include all women in a given hospital or location. Some will have opioids and some not".

According to this Cochrane review - Epidural versus non-epidural or no analgesia in labour,

"Twenty-one studies involving 6664 women were included, all but one study compared epidural analgesia with opiates".

Can you link me to the impact studies you refer to?

Thanks!

A couple of the posters here seem very angry with midwives inparticular, very angry indeed. Maybe those individuals should train as midwives and go on to deliver care in a way they see as appropriate.I am serias.

Not frustrated midwives are you?

"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?"

Er - because then we wouldn't feel so patronised and left in the dark? It would make us more able to make informed choices? I don't see anything wrong with a pre-natal briefing including the following information:

'You are strongly encouraged to go for a vaginal delivery unless there are good medical reasons not to.

The chances of you having a normal vaginal delivery without the need for interventions are x%. If there are problems, this stuff might happen to you (info on ventouse, foreceps and emergency CS).

A vaginal delivery means x% risk of 1st degree tear, x% risk of 2nd, x% of 3rd, x% of 4th. Elective C-sections have risks x, y and z. The benefits of each are x, y, and z.

Your options for pain relief at stages a, b and c are x, y and z. Here is a list of their benefits and risks.'

Yes it might be a lot to take on board, but at least it will be honest and informative.

The Cochrane review is out of date - it is still being referred to but it included studies from the 1980s which is no good because those epidurals are completely different to the ones used today.

Segal did the study below looking primarily at c/s but also instrumental.

Google : Segal and Gilbert The effect of a rapid change in availability of epidural analgesia
Segal S, Su M, Gilbert P.

Have we got a bit off the tack of the OP?

I reckon we should have a Mumsnet campaing on this one.

"All women should have the right to update info about epidurals and be provided with one if they ask"

Can you imagine any male MP trying to oppose that one?

OOps!! I meant campaign

Oh hang on a minute, why don't we go back to the "good old days". Let's follow the American way and go and have a chat with the lovely gas doctor and tell him that we don't want pain thank you very much.

Taken from www.midwiferytoday.com/articles/timeline.asp

1914: Twilight sleep was introduced into the United States. Upper-class women formed "Twilight Sleep Societies." Obstetric anesthesia became a symbol of the progress possible through medicine.

1920: Dr. Joseph DeLee, author of the most frequently used obstetric textbook of the time, argued that childbirth is a pathologic process from which few escape "damage." He proposed a program of active control over labor and delivery, attempting to prevent problems through a routine of interventions. DeLee proposed a sequence of medical interventions designed to save women from the "evils" that are "natural to labor." Specialist obstetricians should sedate women at the onset of labor, allow the cervix to dilate, give ether during the second stage of labor, cut an episiotomy, deliver the baby with forceps, extract the placenta, give medications for the uterus to contract and repair the episiotomy. His article was published in the first issue of the American Journal of Obstetrics and Gynecology. All of the interventions that DeLee prescribed did become routine.

1938: By this time, doctors used "twilight sleep" in all deliveries

Women fought long and hard against "Twilight deliveries" and the right NOT to be treated like a slab of meat. Having said that, I know that childbirth is painful. It is the right of every woman to have evidence based information to choose what form of pain relief she wants. It is sad to hear that women are not listened to, but you can't downplay risks just because they don't fit into your plan of risk free, pain free birth.

And the 200 babies that died of GBS, please don't downplay that for the sake of trying to get your point across.

Why should we have to choose between 2011 and 1914 ?! Also, this thread is NOT a debate for or against epidurals.

I was shocked to see, on one born every minute, that the woman who wanted an epidural was told : "Not unless you win the lottery honey" or something similar.

That is the root of the problem: Money.

I had my babies abroad in a private hospital, and the cost of the epidural was around 800 pounds. Clearly, as it is not essential really, the NHS have a policy to do it as little as possible. It's about money.

"that the woman who wanted an epidural was told : "Not unless you win the lottery honey" or something similar"

No - she was asking about the cost of a private c/s.

I don't believe for one minute that midwives working at the coal face have any interest in denying women epidurals in order to save the NHS as a whole money.

Why would they?

Chandon - absolutely, the thread is about honest information and choice. And where choice doesn't exist, trying to establish exactly why.

We don't Chandon. But I was trying to point out that we have gone full circle. We live in a society that has the right to choose what we want. Sometimes we don't get what we want and then we look to blame someone for that. It seems that midwives who don't actually administer epidurals are being blamed for women not getting one, not the anaesthetist who actually sites it, or the hospital trust who buys them in.

And my post was also about how we have let ouselves be tricked into thinking that child birth is not normal by a man who is not capable of giving birth. He basically said childbirth should be taken out of our hands and placed in the hands of the doctor who delivers us from all evil, Amen.

Ushy - am I right in thinking that most of the studies referred to in the analysis you mention are done in US hospitals?

Given that many labours in the US are augmented and continuously monitored, that most women give birth in supine positions and there is widespread use of sedation, is there anything useful these studies can tell us about the impact of epidural analgesia on NORMAL PHYSIOLOGICAL LABOUR?

" We have a duty to provide optimal analgesia during labour. This is clearly achieved with epidural analgesia"

This comment from the conclusion of the study you mention says a lot to me. That hospitals have a duty to provide pain relief and sedation to women in labour, but not to provide optimal conditions for labour which might enable many women to cope without epidurals or opioids. In my view the way intrapartum care is often delivered in hospitals creates a necessity for widespread epidural use. But hey ho - medics like to feel needed!

I wasnt given an epidural with my first though I "d repeatedly as he was back to back. I ended up pushing too hard as that was the only thing that stopped the pain and had a third degree tear.

Would really like to avoid that this time! My question is how do I get the consultant to see me when I am in labour? Do I ask the midwives? What if they say no or say that he/she is busy?

Ushy says;
What's being hightlighted seems to be that midwives are TRYING to do their best for women based on the information they have but they are being given in their training is way out of date. It is the other posters like mathanxiety who are ahead of the game.

• what we are being taught is not out-dated. At uni we MUST use the most up to date research for any essay/dissertation otherwise you will fail. Likewise, all of our policies are updated every two year to account for new information. Cochrane reviews are the 'gold standard' of research whereby they look at SEVERAL randomised control trials and collate ALL of the evidence available and the most upto date evidence on that subject - the epidural cochrane review has research from 2008- and was updated in 2010. By looking at SEVERAL reviews it eschews bias from one author - its no good stating one piece of research - anyone can find one giving them the answer that they want to hear. This is from the cochrane website: "The reviews are updated regularly, ensuring that treatment decisions can be based on the most up-to-date and reliable evidence" "Without Cochrane Reviews, people making decisions are unlikely to be able to access and make full use of existing healthcare research"

This is the UK, not the USA - there is a different ethos in this country, Math seems to think several very odd things - such as its ok its only a 1:1000 risk, we dont need to know about it, the other 999 will be fine. And that antibiotics are the way forward.

I'm fascinated with the view that the lack of universal availability of epidural analgesia might be a feminist empowerment issue.
One of the social aspects of childbirth that interested me as a childbearing woman and a midwife is that the promotion of epidural analgesia is a feminist issue - that women are being oppressed and coerced by a male dominated medical profession into believing that they cannot carry and birth their own babies without help. The concept of women as weak and ineffectual, ill-equipped to undergo pregnancy and childbirth without medical assistance, is not a new one. And it seems to have become so entrenched that anyone who defends womens' ability to give birth without medical intervention is accused of being somehow anti feminist.
I have always supported womens' informed decision making, whether that is to have an unassisted birth or to have a c/s for breech. My 4 year degree gave me the opportunity to study the science and the facts: this is something that most of my clients don't have the opportunity to do. It is the midwife's responsibility to provide the evidence, where it is available, as to the risks and benefits of any intervention. But if that same client group is going to call midwives' integrity into question, or simply refuse to believe what they're saying, then there's no point in us even practicing. Being 'with woman' goes deeper than just saying, "yes, you must have that intervention because you want it, and of course you must have it right now because you stamped your foot, no of course it won't cause you any harm." Being 'with woman' involves telling the truth about interventions then supporting their informed choice.

JellyBellies, I would ask to see a supervisor
of midwives, go through my notes with her, then make an appointment with a consultant and discuss my plan of care for the delivery.
NICE does state that all women who request an epidural should be able to have one, even in the early stage of labour. Discuss with the SoM and consultant when would be the best time to go in during labour. You can quote the NICE guidelines for your epidural to be administered in early labour. They should point out the pros and cons of having an epidural too soon.
It's all about having all the facts and then making an informed choice. This is what should happen.

Cleo - we are not talking about doctors forcing women to have epidurals they don't want.

We are talking about women who request it (like the OP and many others) who have it denied.

You obviously have strong feelings about natural birth and that's fine - when you have a baby go for it. Other women, however, who don't share your ideas, have a right to have their views respected.

"women are being oppressed and coerced by a male dominated medical profession into believing that they cannot carry and birth their own babies without help."

But they aren't 'helped' are they? Women are pretty much left to their own devices without medical or emotional support till they have reached the magic 5cm dilated.

Then they are often left to labour alone for prolonged periods of time due to understaffing.

Then in post-natal wards, they are often left alone while they try to establish breastfeeding and look after newborns. Not much help going on there, medical or otherwise.

And absolutely nobody at any stage tried to persuade me that I COULDN'T manage without pain relief, in fact quite the opposite.

Ushy this whole thread is riddled with examples of how the thought of childbirth without epidural is viewed as a ridiculous idea by medical professionals and women alike! Nobody needs to force anyone, the product has been sold very successfully already.
MistyValley yes, this is true. I have experience of maternity services in the UK and abroad, and I am considering returning to the UK to practice. My biggest misgiving about this is the fact that I will most likely be unable to provide one to one care for women in labour.
And I'm pleased that you were encouraged to manage without pain relief - with the caveat that I'm sorry if this represented an unsatisfactory experience for you. But my assertion that the Medical Model of childbirth promotes intervention and only views it as safe in retrospect stands.
It boils down to your concept of what constitutes 'normality', and I believe that this has been skewed by an omnipotent medical profession. I have huge respect for obstetricians, by the way, when their expertise is being used appropriately. Just in case anyone thinks I'm dissing the docs.

Almat The Cochrane review has noted the new studies but not update the conclsuions yet. It says so itself.

"The 31 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed."