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...

Arsebiskits - that's a huge part of the problem in the UK though, isn't it? Being midwife-led, the culture is one of avoiding anything 'medical' as far as possible.

But there aren't the resources to support this, in terms of midwife numbers and space and facilities for women at every stage of labour.

So many labouring women are falling painfully between the two stools of 'supported midwife care and natural birth as far as possible' and 'medicalised birth with freely available pain relief'. (Maybe those two terms aren't strictly accurate but I hope you will get what I mean.) It's actually very cruel.

But I do think that women should be free to make their own choices about pain relief without having to fight for it, or be made to feel that they are failing in some way if they want it.

arsebis I can't help feeling the voices of ordinary posters like me are being drowned out by a chorus of professionals.

No-one is saying childbirth without epidural is ridiculous. No-one

We are saying wehn we ask for an epidural we should get one.

Arsebis how could you say this: "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"

What are you talking about?* You're saying we all have our silly little girly minds operated by men? GRRRRRR

Oh come on!

Thanks elbow grease!
I have met my consultant after my scan do discuss if unwanted a c section. I didn't and she was happy with that. But I did say thAt I was worried about tearing again and she wrote in my notes that there was to be a very low threshold for giving me an epsiotomy(sp).

So should I book an appt with her and say that i would like an epidural this time to avoid issues? I just want to make sure that I get one if I need it as another tear would really mess up my pelvi floor!!

"So many labouring women are falling painfully between the two stools of 'supported midwife care and natural birth as far as possible' and 'medicalised birth with freely available pain relief'.

I agree with you Ushy!

We are setting women up for horrible experiences if we prime them to want a natural birth and then subject them to a system of care that in every way militates against this happening.

(Which, on a personal note, is why I remortgaged my house to pay for an IM for my second and third births, and stayed the fuck AWAY from hospital until it became a medical necessity for me to go in!).

whoops - sorry, that comment was directed to MistyValley.

"Being midwife-led, the culture is one of avoiding anything 'medical' as far as possible".

Not sure about this - as far as I can see being admitted to hospital in labour, labouring and giving birth on an obstetric bed, and having people stick their hands into your body at regular intervals to see how far your cervix has dilated are all part of a medical model of childbirth! And that's about 90% of all births in the UK at present at the moment

ushy I'm saying that the medical professionals have historically viewed women as being weak and incapable in every aspect. There is plenty of evidence to support this. Midwives were also, historically, denigrated by the medical professions because of the threat that they posed to a very lucrative business, the 'business of being born'. This threat came in the form of recognising and promoting the fact that women can, by and large, give birth quite successfully without intervention. One central tenet of midwifery philosophy is the faith in womens' intelligence and innate ability to be women.
There's no point in trying to put words in my mouth or twist my words into other meanings. It is self evident from this thread that pain free childbirth is viewed by some as more than desirable, it is viewed as their right as a woman. I'm not denying that right, I'm merely commenting on the social circumstances that have brought that thinking about.
But don't forget, the epidural might buy a a pain free experience (although this is not guaranteed either), and it might have prevented some of the distressing experiences reported on this thread, but it doesn't eliminate the chance of a woman feeling traumatised by her experience.

It's a shame that there is such a lot of politics and ideology involved - 'medical model' vs 'non-medical' for example.

And this concept that physiological pain is fine and just something that you have to suffer if you're a woman. Period pains are normal and physiological, so is it ideologically wrong to take a paracetamol?

fwiw I bought into the whole 'natural' thing when pregnant, and I am squeamish about needles so wasn't at ALL keen on the idea of epidural. So I'm not coming from some sort of 'medical model' background.

I just don't think you can blame women for being a bit bitter and cynical about having been sold some sort of hippy dream about water births and breathing your way through pain (while the midwife mops your brow) when the reality turns out to be very different for so many.

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

No - I'm talking about doctors being instrumental in creating systems of maternity care which make labour unbearable for women. For me it's the elephant in the room in any discussion about pain relief in labour, whatever it is. You can't talk sensibly about epidurals without acknowledging the social context in which women are giving birth and how it impacts on their ability to cope with labour pain.

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

I assumed we were all in agreement that if women request an epidural, it's available, and it's safe to site it, then she ought to have it!

Anyone NOT agree with this?

"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".

Had my three births and have done with all that now (thankfully). Would have to say though, my experience is that most women who want epidurals get one. On the other hand, the women like myself who want to give birth without pain relief and want one to one care, freedom of movement, the chance to use water in labour, or the chance to have their baby at home, face huge obstacles when it comes to realising their birth choices. I had to pay out my own pocket because my choices (to be looked after by a midwife I knew and to have my baby at home) were simply not available to me on the NHS, despite the fact that both these things were clinically and emotionally instrumental in me having a safe and satisfying birth.

On the other hand, had I wanted an epidural (and even in my case a planned c/s given my g/d and enormous baby)I assume I would have been given one without too much of a struggle.

"I just don't think you can blame women for being a bit bitter and cynical about having been sold some sort of hippy dream about water births and breathing your way through pain (while the midwife mops your brow) when the reality turns out to be very different for so many"

Problem is when your choices for labour are completely at odds with the care that you're actually given, and the environment in which you give birth. It's like trying to run a Weight Watchers club in a fish and chip shop. S'not going to work for most people!

I broke my leg, had surgery to insert metal plates etc.

Needed mothing more than a paracetamol, I have no idea why it just did not hurt.

Offered morphine, tramadol and all sorts of pain relief every 2 hours which I did not need.

I was even offered gas and air for stitch removal!

Why should childbirth be some sort of endurance test? If there is money for that there should be money for adequate pain relief in labour!

The conflicting ideologies are, unfortunately, central to the provision of maternity care. It's a battle that's been raging since time immemorial. They used to burn midwives as witches you know. Thankfully all that has changed(oh yeah, I am being sarcastic).

And you're right, it does detract from the ideal of placing the individual at the centre of care.

But when you say that women are sold a hippy dream about birth, don't you think they're sold a dream about childbirth and parenthood in so many other ways? Couldn't you equally say that parenthood is going to involve shitty nappies, vomit, smells, grazed knees, lack of sleep? Parenthood isn't a sanitised process, why are we trying to sanitise childbirth to such an extent? I'm honestly not promoting one above another, I'm really not, but I'm wondering what reality is acceptable and what reality isn't?

"Why should childbirth be some sort of endurance test?"

It's not an endurance test and nobody has suggested it is or it should be.

But you need to acknowledge that many women don't want pain relief because they weigh up the pros and cons and feel both them and their babies will be better off without it.

Those women have just as much right to have their wishes catered for as women who want to be drugged up to the eyeballs.

At the moment you are vastly more likely to get pain relief in labour than you are to get one to one care, the one thing which makes NEEDING pain relief less likely.

Which is why I think that all the breast-beating about the availability (or otherwise) of epidurals is a bit annoying. Most women don't want epidurals. They just want optimal care in labour and the chance of a normal birth. And at the moment many of them not getting either!

arsebis

Many of the women demand epidurals for their second or late babies because of the memory of the experience of the first. Some even want caesarens. They are not 'talked' into it.

Childbirth can be horrific even if you have a nice midwife and nice surroundings. Nature is actually a bit of a mysogynist - babies are getting bigger, women are having them in their mid/ late thirties and birth is getting more painful. It is no use saying birth is natural when western lifestyle isn't natural.

There seems to be a midwifery belief that birth is a wonderful thing and as long as no one interferes women will be 'empowered' by the experience. Some of us do not buy into that belief.

Those of us that don't - based not on male mind bending but on our own experiences or those of friends - have a right to get pain relief when we as for it.

I say a right because there is no other area of medicine where people are routinely left in a sound proof room - the delivery room where their screaming will not upset other women, experiencing one of the severest measurable levels of pain and are not provided with effective pain relief when they are for it.

Would men tolerate this? No then why hsould we?

The point is that women ARE sold the hippy dream at antenatal appointments, and via the whole 'natural childbirth' culture.

If they were given a more truthful appreciation of what their birth experience might entail - and why - then maybe there wouldn't be so much shock and anger when things don't go smoothly?

"Childbirth can be horrific even if you have a nice midwife and nice surroundings."

Speaking as someone who had one forceps delivery following 24 hours in active labour, one shoulder dystocia with an 11 lbs baby and a third labour where I took 20 hours to go from 8cm to fully dilated, I would agree that childbirth is very, very hard, it hurts A LOT and it's not something you'd ever consider doing if there wasn't a baby at the end of it.

But I know that with the right sort of care, birth actually CAN be 'empowering' and 'wonderful' - even when it involves excruciating pain and exhaustion. Not saying it always will be or that it should be, but it CAN be. And I know plenty of other women who have had similar experiences to mine.

"I say a right because there is no other area of medicine where people are routinely left in a sound proof room"

No - because in no other area of medicine are health professionals involved in the care of people who are generally completely well. Pain in itself is not pathological in childbirth. And many women are accepting of fairly extreme levels of pain - they're happy to go without pain relief because they want to work with it to get their baby out as quickly and as efficiently as possible.

Can't think that's true of many ill people - that they see pain as having any sort of purpose at all, and in fact is a sign of the healthy functioning of their body.

"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." - What a load of twaddle, I am sure that my old uni chum back home that is an ob/gyn specialist who trained for 14 years - yes 14 years of training not a measley 3 years would have something to say about that!!! Doctors in North American at least have to do 2 years pre-med, 4 years med, and 4-8 years of specialistion. Sure makes a midwives 3 years look....

I agree the midwives commenting on this thread (on the whole) have certainly given backbone to the arguments given.

If women are so well informed about the risks and benefits of epidurals, how come I've had the following conversation on many many occasions:

Woman in labour: "I've had enough, I'd like an epidural now,"

Arsebiscuit RM: "No problem, I'll ring the anaesthetist, he/she will come straight away if they're not in theatre/in another room. They will also run through the risks of the epidural with you. (it goes without saying that this is not the ideal time for a woman to be hearing about this for the first time, but it's the way it seems to be)
The epidural is effective for most women, but not all. It is associated with a slow second stage, and to an increased risk of instrumental delivery (vacuum or forceps). Having an epidural doesn't mean you will have a complicated or instrumental birth, not having an epidural doesn't guarantee that you won't, it just alters the risks.

You will need to sit in one position for about 20 minutes while the epidural is sited, and remain completely still for a few of those minutes. You will be on the CTG for the rest of the labour. I will have to put a needle in your hand to give you fluids because your blood pressure might go very low, and you will have a tube inserted into your bladder because you won't be able to pass urine. (woman's eyes widen - this is news to her). You will be able to move around the bed to some extent, but you will not be able to get out of bed. You will remain immobile for 4 hours, your urinary catheter will remain in situ for this time.

For all those women who wanted an epidural and not got one, yes I am saddened.Genuinely. I've also seen how women can have excellent birth experiences with epidurals. But I've also seen how many womens' experience of epiduralised birth constituted a massive reality rebate. Some were very upset to be catheterised, some hadn't realised how helpless they would become, some were distraught at their inability to push effectively and, when the fetal heart rate indicated problems, were completely terrified at their powerlessness to do anything. I've never seen anything so vulnerable - and women in childbirth are already a vulnerable group. It wasn't the empowering experience that they were expecting, and that clash between expectations and reality breaks my heart.

Cleo "Most women don't want epidurals. They just want optimal care in labour and the chance of a normal birth. And at the moment many of them not getting either!"

Cleo - that's the belief and I know what you mean but it is NOT always true. I had had one child with a nice midwife and it was a horrific experience. I've got two friends who have had similar experiences and say exactly the same.

I WANTED an epidural. If I had a choice between a midwife and an epidural I'd have picked the epidural!

What really griped me was after the perfect epidural birth number two, postnatal midwife said did I have any regrets about 'needing' pain relief because there was a 'Birth Reflections' service!!! I said no, I could probably cope with the terrible guilt and feeling of failure ...teehee

The difference is BecauseItolYouSo, that doctors spend almost all their time focused on DISEASE and INJURY.

Most babies birth themselves. Why would doctors waste their time on developing expertise in an area in which they simply have no useful purpose?

no wonder i didn't get one if you cant even get one if you beg.

i had ptsd from my first birth and kept telling myself well you are the one who wanted a natural labour.

I wondered why my shit midwife (who i made a formal complaint about) didn't suggest one, or suggest ANYTHING to help me.

she was a total bitch, but i can also see that from reading here she couldn't prob be arsed.

2nd degree tear,pushed for 2 hours but baby flew out, no guidance from her on panting or anything. 27 hr labour, grazes, cuts and all that on top of spd.

She wouldn't even let me get off the bed as she had a 'bad back'.

fucking fucking bitch.

No Ushy - I did make a point of saying that it's not always true that women don't want epidurals.

But I'd suggest it's MOSTLY true, and that the figures would bear me out.

becauseitoldyouso
your name says it all.

A junior reg will have studied 5 years as an undergraduate and may have had only a few weeks of postgraduate medical obstetrics and gynaecology experience.
My neighbour's daughter has had 8 weeks obs AND gynae experience and is now walking round the wards with a prescription pad.

The difference is BecauseItolYouSo, that doctors spend almost all their time focused on DISEASE and INJURY. - I am afraid that you are INCORRECT it depends on what area you specialise in.

Perhaps you should be clear on the definition of an Obstetrician - A doctor who specializes in pregnancy, labor and delivery.

My old uni chum focuses on women and babies and ensuring they have the best pregnancy and birth experience possible.

arsebiskits - Mine name says it all?? I can see that the name calling shows you up as a mature and intelligent woman!

Cleo Yes, but are women told the real truth about epidurals or the scaremongering version? (See Mathanxiety posts]

They are often told they increase caesareans, you'll need an instrumental delivery. My friend told me her midwife talked of 'paralysis' risk!!!! No quantification about just how infinitessimally small this risk was.

Nor are they told that epidurals work best if administered before 7cm. They are told to 'hang on' to see if they can 'manage'. They are not told that actually this will reduce the chance of the epi working if they do need it and increase the risks because they won't be able to keep as still.