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...

*Professional before anyone jumps on me for having sausage fingers

I just did!

I stopped engaging with your personally because I find your posts on here unprofessional, you continue to personally insulting and frankly IMO you are not doing much for your profession.

It is the opinion of an internet sprite that you just can't seem to let go. It leads a person to wonder what you are like professionally.

Now, once and for all, being personally insulting is against guidelines here and because you continue to do so and there is no ignore function on this board I'm going to pretend you don't exist because tbh I hope I never have the misfortune of meeting a healthcare professional like this IRL.

Jazzers, what sort of monitoring are we talking about here? Foetal scalp monitoring or foetal heartbeat monitoring that involves a sensor on the stomach of the mother?

Foetal monitoring of both kinds is often put in place because of some indications of foetal distress like mec present in the waters, or the patient's history or because labour has been very long, in order to check the foetus at regular intervals. The conditions that lead to the monitoring are what lead to the CS, not the monitoring itself.

US article on foetal heart monitoring, including tables showing risk factors that indicate monitoring, all of which makes me ask what exactly you mean by 'The connection between continuous fetal monitoring and emergency sections is well established.' Because monitoring does not cause CSs.

And it can also provide information that can lead to a decision to go ahead without a CS.

Jazzie Just read your post. "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"

How on earth can we let this go on? It is barbaric.

Can someone not start a Mumsnet campaign about htis. That is what the original OP wanted - some action?

"Sorry that is just not true.

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

No - I was talking about low risk mothers where the lead professional is an obstetrician. This only really happens with private care in the UK.

Low risk women birthing in consultant led units in the UK still primarily receive all their care from a midwife, unless there are complications in the birth.

RE: increased rate of perinatal mortality in birth centres - this is an issue which is widely debated and there is a lot of conflicting evidence.

Certainly the information available through the MIDIRS Informed Choice Initiative, which is produced in conjunction with the NHS and the RCOG, is that there is no significant difference in neonatal mortality associated with either homebirth or with birth centres.

I havent been personally insulting to ANYONE here.

And I hope I never get to meet a know it all, bitter woman like you, in whatever capacity.

Take that whatever way you want.

Bye.

Calling someone a know-it-all because they disagree. Calling someone bitter because they disagree . . .

I agree that a campaign ought to start.

Has anyone seen the 'Save Midwiery campaign?

'Save Midwifery' is a campaign designed to improve our failing maternity services
Description The maternity services in the UK are under a very real threat and we are here to campaign for change.

Do you know anybody directly affected by a preventable still birth or where complications were made worse by lack of midwives? We need to hear from you. Email us in confidence on [email protected]

Get the government to expedite the recruitment of the 3000 midwives they promised in their pre-election pledges.
Get the government to increase the number of midwifery training places

Referring to 'Americanising' simply by referring to North American data is quite insulting by default to anyone who is North American.

Obviously shows ones true colours. Rather than respecting data from some of the UK's closest neighbours that have tonnes of research and stats on many of the topics covered.

math - I did my dissertation on this but cannot find my references.I will keep on searching.

Basically you are wrong - it is proven by several research papers that unnecessary CTG - by whatever means of assesing the fetal (not foetal) heart rate can give a false positve. I mentioned this pages ago.
Intermittant auscultation is far safer for low risk women.
When women have gone to section or had instrumental deliveries because of pathological CTG - cord gasses from baby following delivery have more often than not been found to be all within normal limits - ie - NO fetal distress
In high risk women there is more chance of baby becoming distressed therefore this necesitates continous monitoring, again though amongst this group there is a large amount of uneccesary insrumental deliveries, where th CTG notes a problem.
Where i worked the policy was for performing x3 fetal blood sampling maximum - after that it went to section. Obviously if problems are 'noted' on CTg when you are only 5cm, there is a big change of going to section before you get to fully.
Having an epidural makes you high risk, this necessitating CTG.

There was so much money spent on developing CTG initially and bringing it into the workplace that when the audits proved they didnt save any more baby's lives, it was brushed into a corner by the powers that be

Am I the only one to be [shocked] at the yawning gap between the views of the general public and midwives?

I really cannot believe what I am reading!

There are women saying they were screaming and begging for pain relief and midwives saying 'pain relief isn't a priority'

I think it is frightening! An we should definitely have a mumsnet campaign to have pain relief given more priority.

Agree that the answer is more midwives.

And the some of the ones we already have showing more kindness and sensitivity!

I don't know where I should start with your last post, Alimat.

You did in fact bring up the cost of heparin. You said it was £995 for 6 weeks. I will go back up the thread if you want to prove this to you. You brought up the cost; this particular information is not something I would even have access to.

I will also quote for you the post where you set forth the risk of uterine rupture as one associated with epidurals.

'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.'

"WHATEVER' ???????
Do you not understand
(a) what all those zeros mean
(b) that claiming to give women the 'facts' they need but brushing off actual facts with a 'whatever' shows ignorance (and I don't use that term lightly) of what statistics, and therefore facts are, and suggests that you have no business advising anyone on any medical matter, ever, or at least until you learn something about risk. And what zeros mean.
(c) don't know where to start on the question 'Is this a problem?'

As for laughing, I would if there wasn't so much at stake here.

NOWHERE HAVE I SAID I DONT AGREE WITH EPIDURALS. NOWHERE HAVE I SAID I WITHHOLD EPIDURALS WITH MY HORRIBLE MIDWIFERY POWERS. Throughout the thread you have stated the so-called risks associated with epidurals and told us women need to be informed of the facts before getting an epidural. Those risks were grossly inaccurate (and that telling 'whatever' reveals why) -- if that is what you are telling your patients you need to hit the books and start learning something about risk and the difference between high and low.

Routine ABs for women delivering preterm, because it is preterm babies who die 83 - 100% of the time from GBS, would surely be better than a wait and see approach, given the serious side effects of GBS illness even if babies do not die? Yes I know there's MRSA, etc.

'pain relief isn't a priority'

No - it's not a priority. A healthy mother and a live baby is the most important outcome when it comes to childbirth. Anything which might threaten that (as a huge increase in the number of epidurals used without a corresponding increase in the number of midwives working on labour wards would do) needs to be treated with caution.

Jazzie, so sorry to hear your story and hope that you are ok. Congratulations on your little one.

BITYS:Referring to 'Americanising' simply by referring to North American data is quite insulting by default to anyone who is North American.

I think it was a referral to the way child birth is perceived and handled, rather than against North Americans as per se....or that is how I read it any way.

May the gods of labour keep DontHatethePlayer and her ilk away from me when I have my next baby. How not to advertise midwifery as a caring profession, no?

mathanxiety - when anaesthetists seek consent from mothers having epidurals they do mention that there is a small risk of death and permanent paralysis associated with it. They give the stats. That's all that's required isn't it?

The personal accounts here are very valid and its good to hear them.

I think that when anyone has a truly negative or positive extreme experience of anything (anything - birth, A&E, non medical things too, maybe teaching methods ? Lots of others)it is very very difficult to step outside that. And that is not a criticism or lack of empathy with anyone's personal experience - just how it is!

SO ....

The person who truly felt obstructed in a request for an epidural will understandably have difficulty believing that many other women are very pleased to have had the bath run for them, to have had massage, the one to one midwifery which meant they did not need the epidural.

AND ....

The person who booked home birth to avoid pharmacology may have difficulty understanding why another person starts with a mind set that they will need an epidural.

BUT ...

Both are valid - they are just different.

For every feminist who believes that epidural is a right, another believes that support for non interventionist birth is a right.

AND ....

Both philosophies require RESOURCES. Surely at the end of the day this is what this thread is about.

If women divide, we won't win. Both extremes should support the other in campaigning for MORE RESOURCES, whether its more community midwives and birth centres, or more anaesthetists and midwives to give one to one in hospital.

Its the same fight. Why fight each other or claim the other is wrong?

Its not a question of "if men had babies there would be more epidurals" OR "if men had babies, birth pools would be free to hire at home" ..... its IF MEN HAD BABIES THERE WOULD BE MORE RESOURCES.

Mathanxiety either you or I are not reading the posts properly.....

'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.'

I take this to mean, it doesn't matter what % the risk is, if you are that 1% category who is affected then it is not so easy to laugh off IYYIM.

I also find it a bit strange how some people can post, what I find to be rather insulting comments and then pull the "you are not being professional" card, when they don't like what has been said.

please do not patronise me Math

Amazingly I do know what the 00000000000 mean !!

My example was - whatever the ratio - it could be 1:10, 1:100, 1:1000, 1:100000 - you must be told of it. As said above - if you go for an operation you sign the disclaimer/ consent form after they have told you could die. Whats the ratio for that - but they still tell you!

I think I said that pages ago too

Several people have said the risk of utrerine rupture was not caused by the epidural but the epidural necessitating the use of syntocinon. How many more times are you going to quote your ratios about that?

can you also point out where my risks were grossly inaccurate?

Thankyou unshy and elbowgrease Unsurprisingly, I was totally fine once I had an epidural.

Yes, there is a risk of epidurals going wrong, but this was explained to me twice; once when I was discussing my birth plan with my community midwife when I was 35 weeks pregnant, and once when I was signing for the epidural. I was completely aware of the risks, and was happy to take them on.

I made a choice to have my DS at the main hospital instead of the local birthing unit because I wanted the option of an epidural to be made available to me.

I think that these days, childbirth (in the right circumstance) can be empowering to women. I mean; you've created a whole new life, nurtured it for nine months and you're getting it out all by yourself. Amazing. Unfortunately, I think it can turn into a degrading and frightening experience if the woman's wishes with regards to pain relief are not respected. If you want minimal intervention, then that's great. People respect that. Why don't as many people respect women who WANT intervention?

Well put Jazzers. If I could insert a clap smiley I would. :D

I also find it a bit strange how some people can post, what I find to be rather insulting comments and then pull the "you are not being professional" card, when they don't like what has been said

Thank you. I agree.

[scuttles off to read AIBU threads]

Over-reliance on CTG and misinterpretation of feedback contribute to its lack of usefulness. The older use of just two categories of interpretation also contributed to more CSs.

The real life complications it sought to prevent initially include foetal death however, so clearly there are complications worth monitoring for, and clearly the field represents a work in progress. The American College of Obstetricians and Gynecologists published new guidelines for interpretations of results in 2009, so clearly the technology is here to stay, has not been thrown out altogether, and will probably undergo refinement and improvement as time goes on. Meanwhile all the data that CTG has produced in hundreds of countries has left researchers with a huge amount of material to work on.

If you did your dissertation before 2009, you may have been working on the older, two category basis for decision-making. There are now three, in the US anyway. The distinction between 'clearly abnormal' and 'indeterminate' and needing further observation has been made in order to cut down the higher rate of CSs associated with the older, two-category system.

no, I did it in 2009
I live in the UK
I follow the UK guidance - of which in 2009 there were also three catagories -
normal
suspicious
pathological

We also undertake CPD - where we retrain in CTG - and are re-told not to rely on the and not to use them in low rsik women for a reason!