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...

You havent cared for many women in labour in 9 different countries though have you? (not saying I have either btw before know it all expat and mathan)

you may have a idea of how those countries practice, but its only one or two persons perspectives.

Very different from facts. Its the same when women say they had a 89 hour labour. No labourt would last that long without serious damage or death occuring. Yes women ahve long latent stages but labour per se starts when a cervix becomes around 4cm.

'If continuous monitoring for low risk mothers doesn't reduce neonatal mortality and morbidity and does increase c/s rates than how can it be a good thing?'
-- where are you getting all that from? Would you rather have no monitoring and babies experiencing distress or worse? Monitoring in itself does not cause CSs. Monitoring provides indication to the medical staff that intervention may be necessary. How is that a bad thing? It is the information that monitoring provides that leads to the decisions that are made. Not all those decisions are the wrong ones, surely? CS rates are highest for obese mothers, who may need monitoring because of other conditions such as diabetes or heart problems. Labour is unpredictable even in mothers initially assessed as 'low risk'.

'Have I missed someone saying or implying that epidurals are highly dangerous?'
-- Yes, you did miss someone saying that epidurals are associated with a risk of uterine rupture and maternal and foetal death. It was an outrageous statement.

And yes, there are serious arguments on both sides of the debate on ABs. The serious cons have not been presented here on this thread, however, just a lot of hand wringing about MRSA and shock and horror that giving mothers routine ABs would even be contemplated, despite the fact that post op patients have routine ABs. If infection risk (for GBS for instance) is high and if neonatal fatalities result, then what's to be lost by routine ABS to women whose labour care involved exposure to infection and especially to those whose are at high risk for GBS -- preterm babies? (see link later in my post)

On the subject of GBS -- it can be screened for and treated before labour, during prenatal check ups. This screening is not routinely offered in the UK or in Finland, but it is elsewhere. Routine prenatal screening does not have any significant effect on occurrence between the US and UK though.

GBS does not only occur as a result of VE during labour. It affects certain groups more than others and is associated with diabetes across all groups. It is associated with preterm labour above all.

An excellent paper on GBS here -- 'early onset disease [occurring in days 0 - 7] may only be treatable intrapartum owing to very rapid progression.' So here it seems ABs may actually come in handy?
Here's an excerpt from the link:
'The mortality due to early onset GBS disease [0 - 7 days] has declined over time but remains higher than for late onset disease [7 - 89 days]. A large US multicentre study conducted in 1993?1998 reported a mortality rate of 4.7% for early onset disease (defined as positive culture from blood/cerebrospinal fluid), and 2.8% for late onset disease. The recent UK national surveillance study reported a mortality rate of 10.6% for early onset disease. This may be high relative to the US study because of delayed diagnosis in the absence of screening, or because less severely affected babies with GBS disease were not notified. In the US study, 2% of term babies with early onset GBS disease died, compared with 21% of babies born preterm. Overall, 17% of early onset GBS disease occurred in preterm babies, but they accounted for 68% of the deaths. UK studies have found that 83?100% of deaths due to GBS were in preterm babies.' So maybe it's not just the VE infection risk that gives babies GBS? Maybe there are other factors, and the protocols on VE intervals are not really helpful while more screening and more follow up care might be in preventing fatalities?

(And maybe the poster who argued the GBS and epidurals were linked should have checked their facts first? Especially 'UK studies have found that 83?100% of deaths due to GBS were in preterm babies.' It makes a difference in assessing the risk level of procedures, and drawing conclusions about epidurals, to point out that a very high proportion of deaths from GBS occurred in preterm babies. A huge difference.)

Here's part of the conclusion: 'there is moderate evidence that antibiotic prophylaxis is beneficial for GBS colonized women at high risk of adverse neonatal outcomes. Evidence is lacking on the effectiveness of antibiotic prophylaxis for the vast majority of women identified by GBS screening who have no other risk factors, and any benefits are likely to be small. Screening for GBS would not change management for women with prolonged preterm rupture of the membranes, as all should be treated, but screening may be beneficial for women at moderate risk of adverse outcomes, for example in preterm labour with intact membranes, in whom universal prophylaxis is not justified. The decline in GBS bacteraemia has been associated with a small increase in early onset E. coli bacteraemia in neonates which is associated with a higher mortality. However, it is not known whether changes in E. coli rates are related to antibiotic prophylaxis, or changes in the maternal or hospital acquired flora.'

Emergency caesarean carries over five times the risk of mortality for the mother than planned elective - look on page 13 and use hospital data to get the denominator.(CEMACH)

I know Ushy, I CAN read.....

No I have not cared for women in other countries. However I have perspectives from alot more than 1 or 2 people!

That aside many statistics have been posted by myself and others comparing outcomes, etc in countries other than the UK and that is being used to show that by illustrating these 'facts' there are other ways of doing things in more positive ways without affecting outcomes.

I never said that women should labour on that one way or another is best what I said is that women should be given adequate pain relief, that they should be listened to, that they should be able to labour how THEY want to (not how someone else wants them to).

Regrettably some of the midwives that have posted have made it clear that they way they think women should labour is the 'best' way. There are many ways to labour and to still have a positive outcome. Just because a birth is medicalised does not mean that the mother will have a negative experience. Quite the contrary if they are fully informed, given essential pain relief and properly cared for by their HCP's.

Cleofartra - I find it absolutely astonishing that you are arguing that pain relief for women in childbirth should be limited on the grounds of cost to the NHS.

Over 70 percent of admissions to my local A&E at the weekend are alcohol related. Smokers are treated, for free, when they get chest infections and related illnesses. People who play sports and get injured are treated for free.

But no. It's pain relief for women in childbirth that's where savings should be made.

Ushy, I share your despair. And all of this 'it's what our bodies are designed for' is too glib. A birth can have a good outcome in that a healthy baby is born, but a mother left with 4th degree tears, long term incontinence, PTSD because of intense pain during birth - you name it. From an evolutionary perspective, the baby is alive, the mother still fertile, if she ever lets a man near her again - Nature has done her job. If it's maternal wellbeing we are talking about, and with epidural pain relief, we are - it's a very imperfect design.

'(not saying I have either btw before know it all expat and mathan)'

Neither math nor I ever became personally insulting to you at all, because it's against the talk guidelines here.

But you have done so to us several times and continue to do so whenever you can.

I dont feel they do think that actually, I think people are reading other things that arent there.

I said pages ago, I try and do my best and have not an attitude of 'women should labour the way I think best' I want to be with a woman and do my best for her, whatever her choices. Whether that choice is a ELCS for previous CS, epidural, or her choice of feeding method.

I have seen women with epidurals suffer more intervention - thats a fact. And as long as they are WELL aware of those facts then that is their choice.

Ugh, saying to me here is your rope isnt insulting? Especially when I asked if you could refrain from using terms like that as my close family member has committed suicide recently via hanging.

And still you said basically 'so what? Ive attempted suicide'.

'Ushy - you can despair as much as you like. There are finite resources available for health care in this country, like it or not. The money has to be spent in such a way as to best protect the health of mothers and babies. If there aren't enough midwives to provide safe care for all mothers in labour then HOW can we justify using limited resources for improving women's access to pain relief?'

No, the question is how do you justify the low prioritising of pain relief for women that occurs as a result of limited resources -- at last we come to the bottom of it, thank you.

It really is about women being told to get to the back of the line, and shutting up.

It really is about not enough to go around so women are the ones who have to go without.

Cleo "What, they actually want more perineal damage, c/s, forceps and ventouse without any corresponding improvement in neonatal outcomes?"

Sorry that is just not true.

There is no difference in outcomes -good and bad - between midwifery care which shares sstaff with consultant units.

There is if the staff are different but look at the bold print - this is from NICE
"In trials that had separate staff in an alongside unit from a an obstetric unit there was evidence of a significant reduction in interventions including induction of labour, augmentation of labour, use of opioid and epidural analgesia, rate of episotomy and rate of vaginal/perineal tears and increase in spontaneoous birth but a statistically significant increase in perinatal mortality"

The trade off is more intervention less dead babies. That's why the overwhelming majority of women choose to be looked after by a midwife but IN a consultant unit.

Amen, Gloyw. The idea that a woman should go without an epidural because she has the misfortune to be in labour on a Saturday night and the anesthesiologist is busy attending to drunks with massive head injuries caused by driving impaired makes me spit nails.

The connection between continuous fetal monitoring and emergency sections is well established.

It is thought to be one of the factors leading to the epidural- section relationship.

Not advocating continuous fetal monitoring is not just a evil midwifery cause - obstetricians don't support it either. Its one tool to be used appropriately, like any other tool. NICE don't recommend it.

If you don't continuously monitor it does not mean no monitoring. Fetal and maternal wellbeing are monitored by different tool, appropriate to the situation. If the situation changes, the ways of monitoring will change.

What is it with the term anesthesiologist? In the UK it is always aneathestists. I have never known my colleauges been called anything else.

Apart from back stabbers of course

Oooh silly uneducated me.

[slaps back of hand for having sausage fingers]

right deep breath
Math - once again you are having me sayings things I havent.
Firstly - YOU brought up the cost of tinzaparin.
There are very few women in Tinz antenatally. Various things cause women to require it - such as instrumental deliveries, sections, labour longer than 12 hours - amongst others (age, BMI, parity, PPH, history)
Pregnancy is a MASSIVE leader for potential DVT - not just post-surgery - its the hormonal changes in pregnancy that causes it, therefore if there are things that can be done to aid reduce this than thats for the better surely - or do you think women are happy to inject themselves twice a day for 6 weeks. they need to know ways to reduce this risk - one of them being aware of potential risks of epidural causing the above things. I couldnt give a toss about cost - you mentioned it

You also said I said epidural causes uterine rupture - where???
I said epidurals are know to reduce contractions, thus necessitating syntocinon induction - that is where there is a risk of rupture.

risk - 1:15000, 1:10, 1:1000....whatever - if you are that one - try just laughing it off. All I said was that women need to be informed of this.
Is this a problem.

NOWHERE HAVE I SAID I DONT AGREE WITH EPIDURALS. NOWHERE HAVE I SAID I WITHHOLD EPIDURALS WITH MY HORRIBLE MIDWIFERY POWERS.

GBS - YES - if you want to campaign about something, then let it be routine GBS testing.
As it is the discussion went along the lines of ascending infection - if GBS is present in the vagina and you are having unecessary VEs there is a risk of it affecting the fetus. We dont know of this risk, as the woman is unaware of her infection - the baby goes home asymptomatic - comes back VERY poorly or dead.
We cannot give routine antibiotics to all women just in case. Of course we give abx to women who are infected or symptomatic of infections - we dont withold them.
Yes abx are essential IF you need them.
You cannot give out abx on the assumption that you may have an infection.
If that was the case everyone with a common cold would be given antibiotics just incase the had pneumonia - oh, hang on thats what happened - thats why we have MRSA and the even more scary GRSA

'Ugh, saying to me here is your rope isnt insulting? Especially when I asked if you could refrain from using terms like that as my close family member has committed suicide recently via hanging.'

1. I had no idea a relative of yours hanged him/herself and could not have had such an idea.

2. Such an idiom is commonly used in the vernacular with no stigma attached.

You have continued to be personally insulting over again and again because you disagreed with my opinion.

I stopped addressing you personally long ago because I felt you were being unprofessional.

As you continue to be.

'Especially when I asked if you could refrain from using terms like that as my close family member has committed suicide recently via hanging.'

You asked me after revealing your personal circumstance. I did not use the term again. You continued to be personally insulting.

Expat, Honestly where are you saying I was unprofessional? I have said how I care for women and how I try and get them the best experience. How is that unprofessional? I have said I feel desperatly sad for women here that have bad times. I truly do. I was once in that postion myself and know how it feels so would NEVER undermine a womans feelings about something so personal.

Seriously? How?

And as it goes I did ask you to not use terms such as rope etc, and told you my reasons. You then basically said so what.

This is what I said:

'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.

You said:

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.

'If continuous monitoring for low risk mothers doesn't reduce neonatal mortality and morbidity and does increase c/s rates than how can it be a good thing?'

"-- where are you getting all that from? Would you rather have no monitoring and babies experiencing distress or worse? Monitoring in itself does not cause CSs."

I am not arguing for no monitoring! Intermittent monitoring for low risk mothers (where the midwife listens in every 15 minutes or so in first stage and after every contraction in second stage with a doppler) is quite adequate and is linked to lower rates of c/s.

Continuous monitoring DOES lead to unnecessary c/s, because it has a very high rate of false negatives. Which is why it's no longer recommended in UK hospitals for low risk mums.

"-- Yes, you did miss someone saying that epidurals are associated with a risk of uterine rupture and maternal and foetal death. It was an outrageous statement."

Was it outrageous because no evidence was offered in support of it? Or because you believe the evidence offered in support was inadequate? Were you able to provide alternative evidence to refute the assertion that epidurals can be dangerous to mothers and babies?

"Cleofartra - I find it absolutely astonishing that you are arguing that pain relief for women in childbirth should be limited on the grounds of cost to the NHS."

No - I'm saying it IS rationed on grounds of cost, as are all treatments on the NHS other than emergency care.

I'd be all for reducing the amount of money spent on treating alcoholism and smoking and diverting it to maternity care to improve the health of mothers and babies!

" If it's maternal wellbeing we are talking about, and with epidural pain relief, we are - it's a very imperfect design."

Can we be clear what we're talking about here? Severe birth injuries to mothers and babies are associated generally with substandard care in labour, and with complex health problems such as diabetes. There is no evidence that the use of epidural pain relief has done anything to improve clinical outcomes in childbirth, other than those associated with a reduction of the use of general anaesthetic for c/s. If anything pain relief in labour over all is associated with worse clinical outcomes.

I'm not denying that there will be women who are traumatised by difficult labours and that part of what contributes to that trauma is the experience of unbearable pain.

However it's really not as simple as more pain in labour = more trauma for mothers. If that were the case you'd see worse psychological outcomes for low risk mothers who plan to give birth at home and in birth centres compared to those who give birth on obstetric units who have immediate access to epidural analgesia. In fact psychological outcomes for low risk mothers who have their babies at home and those who book at birth centres are BETTER than for mothers who have immediate access to strong pain relief. By the way - the studies I'm referring to, the outcomes for mothers who transfer into obstetric units from home or from a birth centre are included for analysis in the homebirth and birth centre statistics, and not in the stats for the obstetric units.

Apologies; I've not read the other posts but I had to respond.

I had my DS 4 months ago and a similar situation came my way. I had a fast labour; 5 hours 8 minutes beginning to end, and the contractions were 1.5 minutes apart from the beginning, really painful. I was crying, begging the midwife for an epidural because the gas and air was making me vomit and I was exhausted. She said 'we can do that in a while if you need it, I'll just run you a bath'. I was SOBBING in pain. I've never done this before, I don't know what labour feels like; because of that, I went to the main hospital and not the birthing unit because I didn't know how I'd react to the pain and thought I may need an epi. I did. I bloody well needed it.

NEEDING AN EPIDURAL DOES NOT FUCKING WELL MAKE ME WEAK. That was how the hospital staff made me feel. I was on my knees, literally begging for one. I'm not sure how much more degrading you can possibly get. you'd have thought the midwife was paying for it out of her own pocket. She clearly didn't agree with them; which is fair enough, everyone is entitled to their personal beliefs. I personally believe that a woman an labour shouldn't be left to sob and scream in pain, no better than an animal.

It was only when my DH went to the front desk and had a quiet word with the midwife to intervene that I got my epidural. Because I was calm after that, I pushed my son out in ten minutes, with no injuries at all. Because I wasn't in pain, and I wasn't panicking, I was able to listen to the midwife's instructions and I came out the other side absolutely fine.

OBEM has made me so angry; so many women begging for drugs to control their pain and being told to 'wait' or 'have a bath'. You wouldn't tell an amputee patient to 'wait' and have some gas and air. You'd give them whatever the hell they wanted.

Rant over....

'And as it goes I did ask you to not use terms such as rope etc, and told you my reasons. You then basically said so what.'

I did not use the term again.

You continued to be personally insulting.

I stopped engaging with you because I find you unprofessional in many ways, most particularly because you continue to address posters with personal insults who a) do not agree with your opinion b) stopped engaging with you personally long ago.

So much for your bowing out then .

Please give me an example of how I am being unproffesional?