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...

"A doctor who specializes in pregnancy, labor and delivery".

In the UK obstetricians would not be involved in a normal labour or birth in any capacity.

So they are only called in to deal with disease or dysfunction.

They have more or less no involvement in normal birth.

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

How luvverly. At the moment the evidence suggests that low risk mothers cared for by obstetricians in pregnancy and birth have much higher rates of intervention in labour, without any improvement in maternal or neonatal outcomes compared to midwife led care. But I'm sure your friend is very good

Arsebiskits - your point about women not realising what happens during an epidural is interesting, and I can see your point.

But it does beg the question of WHY the realities of epidural comes as such a shock to many? There is no earthly reason why they can't be given a leaflet and diagram beforehand which explains the pros and cons.

ushy you said "Many of the women demand epidurals for their second or late babies because of the memory of the experience of the first"

But equally, many women actively avoid a second epidural for subsequent births, such is their dissatisfaction with epiduralised childbirth. That door swings both ways. At this point, I've been with hundreds of labouring women, and there are many more who are disillusioned with epiduralised birth than there are those who would be utterly traumatised if they didn't get one. Not saying that we should dismiss those who are traumatised, mind. Just that the perspective is being skewed.

mistyvalley because we don't actually have a proper birth discussion with them at 32 weeks, as we are supposed to do. I think antenatal information is lacking. Reasons I've heard for wanting an epidural include,"My sister/cousin/friend said I had to have one," - in the absence of factual, objective information, women rely on other people's subjective experiences.

And, re the question of why so many women aren't aware of the mechanics of epidurals, it's probably for the same reason that so many are utterly shocked by having to have an emergency CS.

It's because of the culture of letting women go into childbirth with blinkers on, believing that their bodies are perfectly designed for childbirth and that things are SO unlikely to go wrong that it's not even worth worrying your little head about.

"in the absence of factual, objective information, women rely on other people's subjective experiences."

Yes, I'd agree with that.

arsebis "I've been with hundreds of labouring women, and there are many more who are disillusioned with epiduralised birth than there are those who would be utterly traumatised if they didn't get one"

That's interesting because the latest stats say 91% of women who have epidural would have one again. The main cause of epidural dissatisfaction is it not working. Inexperienced anaesthetists, leaving the epidural late inlabour are two factors that could reduce failure but there is a lack of will to do anything about it.

Women's pain in childbirth is a low priority - so much for equality.

Ushy - would agree that women need accurate information about epidurals.

However, for many women I know it's not the possible risks of epidurals that are the issue. Certainly not for me personally either. It was the indignity of labouring with a catheter in situ, the unpleasantness of having a venflon stuck into the back of my hand, and not wanting to deliver in in stirrups (as many, many women do with an epidural, even though it's not usually necessary), plus feeling disabled and immobile throughout an event I see as an essentially physical and active, that was profoundly off-putting.

I also had the increased motivation for not having an epidural of having enormous babies - it's no fun trying to shove out a 10 pounder sitting upright on a bed partially paralysed and unable to feel much from the waist down - epidural or no epidural. And I'm amazed the doctors don't warm those of us who make huge babies of the increased risk of s/d that come with having an epidural (which is likely to become more and more of a problem because of the increasing incidence of g/d among pregnant women).

"That's interesting because the latest stats say 91% of women who have epidural would have one again"

Women are pretty loyal to their birth choices generally - if their choices are realised.

Women who've opted for homebirths being a case in point.

"Women's pain in childbirth is a low priority"

Well - it'll always be a lower priority than theirs and their baby's physical safety won't it?

"It's because of the culture of letting women go into childbirth with blinkers on, believing that their bodies are perfectly designed for childbirth and that things are SO unlikely to go wrong that it's not even worth worrying your little head about".

Aren't MOST women aware of the fact that nearly 1 in 3 births in the UK is done by c/s now? The majority emergency c/s?

You kind of have to wonder how any woman can get through 9 months of pregnancy with no knowledge of the fact that most first time mums giving birth in hospital will have some sort of intervention in labour.

"You kind of have to wonder how any woman can get through 9 months of pregnancy with no knowledge of the fact that most first time mums giving birth in hospital will have some sort of intervention in labour."

Which makes it all the more surprising that the subject is swiftly swept under the carpet when you bring it up in antenatal appointments. At least that was my experience.

"Which makes it all the more surprising that the subject is swiftly swept under the carpet when you bring it up in antenatal appointments. At least that was my experience"

The community midwives in my area are working flat out just PROCESSING mothers through their routine antenatal care. It's absolutely shite. They really have no time or energy to have any sort of meaningful conversations about anything other than medical issues. It's very bad.

Well I could not agree more that one to one care and encouragement would lead to less women feeling like they need an epidural.
Its not happening though is it?

However, to see these women begging for an epidural on OBEM is highly distressing.

For what its worth, had a a home birth with my first, it was ok, very lovely indie midwives, all the trimmings

I had the 2nd at the hopital with an epidural i was not traumatised by natural childbirth but I did not want to be stitched again on gas on air
Twas much better

ushy you said, "That's interesting because the latest stats say 91% of women who have epidural would have one again. The main cause of epidural dissatisfaction is it not working. Inexperienced anaesthetists, leaving the epidural late inlabour are two factors that could reduce failure but there is a lack of will to do anything about it."
That's interesting - can you post a reference to those statistics?

mistyvalley I'm not sure I get the link between lack of birth preparation - emergency c/s - womens' bodies being poorly equipped for childbirth. The c/s rate isn't a reflection of womens' inability to give birth vaginally, it's a reflection of the medicalisation of childbirth.

arsebis That's interesting - can you post a reference to those statistics?

Sure I can't actually find the original one I referred to but I found another similar one which gave even higher recommendation figures (95-98%):

Retrospective assessment of epidural analgesia

Ginekol Pol. 2005 Apr;76(4):277-83

"Women's pain in childbirth is a low priority - so much for equality."

I don't think equality has anything to do with it. Actually, most medical professionals will try to get people to deal with their pain with as little medication as possible regardless of the cause. I know people, of both sexes, who've been in exrteme chronic pain for years who are prescribed exercise, physiotherapy, and/or 'relaxing a bit more'.

Most do it as it's safer and has far less side effects (and as someone who had one of those unlikely horrible, life threatening side effect to something I was told was "completely safe", it was extremely distressing to find out that they knew this could happen and didn't bother to tell me and my husband) and pain medications tend to be tolerated after time and the more powerful ones have worse side effects.

There are some medical prats who think people should just get on with it, especially if they think the person did it to themselves (my husband, who has been in extreme chronic pain since 19, has been told to his face by multiple medical professionals that he originally wasn't going to get XYZ because they thought his injuries were due to motorcycle accident and/or sporting injuries).

It has nothing to do with equality, it has to do with some medical professionals being rightfully cautious and some being prats. We need to boot the latter and find better ways of communicating with the former to get both parties to a place where they feel their concerns are being heard.

Labour pain is one of the severest pains measured.

Where in medicine are people left in that level of acute pain for such a long time and not being offered pain relief without any hestitation.

Could you be specific and tell me exactly what other specialism does this?

"I'm not sure I get the link between lack of birth preparation - emergency c/s - womens' bodies being poorly equipped for childbirth. The c/s rate isn't a reflection of womens' inability to give birth vaginally, it's a reflection of the medicalisation of childbirth."

I wasn't relating lack of birth preparation to emergency CS rates. It was more a comment on the lack of information on what will happen if you have to have an emergency CS. It's barely even acknowledged that it's likely to happen in the first place.

This means that when it does, it often comes as even more of a shock to women (and their partners) than it otherwise would have done. This must contribute to stress and difficulties with coming to terms with it both during and after the procedure.

I realise my last point is a bit off topic, it was a continuation of my point that women are led blinkered into childbirth by this idea that nothing will go wrong because their bodies are designed to cope.

Mistyvalley You are so right. People are just not given full information.

Arsebis The c/s rate isn't a reflection of womens' inability to give birth vaginally, it's a reflection of the medicalisation of childbirth."

That's interesting. Is there a study comparing morbidity and mortality outocomes of a group of women who are not allowed caesareans versus a group of women who are not? Could you let me have a reference?

OOps! I meant who are allowed and who are not

But womens' bodies are designed to cope! Although having said that, there is an argument that it got a lot harder for homo sapiens when we started walking upright. And this whole thread has meandered in and out of many topics!

usha thanks for the link. Firstly, it's a very small, localised study. It's not very recent. The fact that 87% of the participants were primigravidae seems to support my original observation that many multiparous women aren't that fussed about getting an epidural. Do you have any sturdier evidence than this? A systematic review would be more reliable.

Jellybellies: "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!!"

I think it would be a good idea to keep communication channels open. From what I have been reading here over the last couple of days, it seems that the main concern that women have is that they weren't listened to.Communication is the key as people are aware of what you want for you. Maternity services are women's services. It is only right that you should have your needs addressed. If you talk to your consultant and a SoM,they will be able to discuss all options and the pros and cons of each choice. Then you can take the info away and have a good think about what you want. When you have made your decision, share it with them. They can help you to come up with an individual birth plan that's suits you. Anything that is discussed should be written in your notes, so that everyone is aware that the discussion has taken place and everyone is aware of your choice.Hope that helps ; )

The NICE guidelines are very clear about the risks associated with elective caesarean section.
However, when you say women who are 'allowed' c/s versus those who are not 'allowed' them, do you mean those who request elective c/s without clinical indication?

Women's bodies aren't designed to "cope". From a strictly physiological and historical standpoint, it's the infants' bodies who are designed to be as fully developed as possible, with the largest head size that can possibly pass through a female pelvis whilst killing off no more than a third of us.

And if effective pain relief is available to mitigate this practical joke evolution has pulled, I damn well want it.