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...

That is the heart of the thread, MaryMungo. And the fobbing off because of real and highly unlikely risks, both presented as equally likely because what do figures matter on top of the patronising adds insult to injury.

Alimat, for the last time here, it DOES matter how many zeros there are in the risk. A high risk is NOT the same risk as a low risk.

You ask me to believe you are adequately educated and yet you post this 'I mean - in SIMPLE language - it doesnt matter what the % risk is! Whether its 1:10, 1:100, 1:1000 - WHATEVER THE RATIO - its still a risk.' ?????????????????????

All risks are not equal.

MaryMungo - You're so right.

"Include' doesn't mean 'only', Jazzers."

The reason for introducing continuous fetal monitoring was to reduce cerebral palsy, not still birth.

It made no difference.

It is therefore no longer standard practice and not encouraged to be standard practice by obstetricians or NICE or midwives in the UK.

It may be indicated by other circumstances (such as, among others, epidural)where it is one tool among others.

OK Mumsnet is powerful.

What's the wroding on this campaign going to be?

The point of 1 in 15,000 is that you are very, very likely to be that one person, Elbow. It doesn't matter of course if you are that 1` person. But you are very, very unlikely to be that 1 person. OTOH, you are much more likely to be that 1 in 2000 or so that falls in the bath and dies.

math I wasn't trying to be an arse, sorry if it seemed that way.

Ok quiz alert.

Mrs Smith: Hello doc, I would like an epidural.
Doc: ok Mrs Smith, they are in the main very safe but there is a 1 in 15 000 chance that you may suffer paralysis.
Mrs Smith: Oh that's ok, I will take the chance, it seems like a very unlikely probability that I could be the 1 out of 15 000 that that could happen to.
And then Mrs Smith's epidural goes wrong and she is the 1 person it happened to. Do you think Mrs Smith is more likely or less likely to be devastated that she was actually that one person that suffered paralysis?

Mrs Smith is a grown woman who's choice for an epidural has been respected. There are risks in everything. I've never heard of anyone coming off worse from an epidural. I've met plenty more come off worse from a car accident though, and they still get in the car every day and drive to work. Risk doesn't put people off.

bloody hell - I do know the difference that a extra 00000000000000 makes to a ratio.

However - as unlikely as it is to happen - you must be told - it is NEGLIGENT not to tell people

The whole point of my statement pages ago was to say that if you are that one person who is affected - as unlikely as it is - you are not going to say 'oh, well, the risk was 1:15,000, how jolly unlucky of me'

I have had to break news to women who have been affected by things where the ratio is large - that person couldnt give a toss about the stats - they want to know ' why me/ why my baby'

nobody is fobbing off epidurals - we are telling you the facts - if you still want it - then get it.
If we do not tell you of the risks - however small - and that risk happens to you - we lose our job as we were negligent - people sue, it is a litigious society - that is why we cover our backs - not to stop you getting an epidural

Risk is more than percentage or liklihood.

Potential harm and benefit should be factored in.
ie a 1% risk of a headache is not the same as 1% risk of death.

So a risk of being transferred in from a home labour to a main unit for slow progress may be higher tha na risk of uterine rupture at home (eg VBAC), but the consequences of a rupture at home are very different from the consequences of a transfer for slow progress.

Women have different perceptions and different views of these risks in their own circumstances.

Which is why midwives, obstetricians, anaesthetists
discuss risks in details. The risk of death from epidural is tiny but is legally required to be disclosed.its not scremongering. its a legal requirement.

Woman have fought for centuries to be treated as autonomous, so it is vital that all risks and benefits are explained or else we are just returning to a state where women were assumed not to be able to take responsibility for their own decisions.

So even if we don't like it we have to hear it !

I started to read this thread and got a bit anxious. My first child was born 7 years ago, 56 hours after the contractions started. I got an epidural but only after 3 shift changes, an anxiety attack on pethidine, an attempt to break my waters when there was nothing there (had seeped over the previous 24 hrs), baby in distress etc.

The 4 midwives I saw were all really 'nice' but they did not use their experience to guide me appropriately in what medication I should or shouldnt have. They delayed my epidural until the point where I was ready to collapse with exhaustion. Yes, it delayedhe birth a little bit more. Yes, I needed venteuse. Yes, it meant I needed a bit of extra care.

Had I had an earlier eipidural I may not have developed post birth trauma. I couldnt think about the birth without crying for a year.

A risk is still a risk. To not tell anyone of that risk is negligence. Yes a high risk is different from a low risk but it is still a risk. Some risks we are willing to take, others we aren't, only once we are in possesion of all the facts can we make that decision.

Oh the thread has moved on somewhat since I finished reading. Anyway my above post still stands.

SatinShoes, you had a right to adequate pain relief. It's not about whether people are nice, it's about getting what you want safely and in a safe environment. Were you ever given any explaination why you couldn't have an epidural earlier?

I am so sorry for your trauma Satinshoes.

But that is partly what I was saying earlier about an extreme event making it very hard to see other experiences as valid as yours.

Just as an example - someone else might have been traumatised by a ventouse, whihc they may not have needed if they had not had the epidural.

For some women, the trauma of instrumental delivery is worse than the labor pain. Noonene really knows until they are there in their own experience.

That is not in any way intended to diminish your experience, Just to say that it might have been different for another woman.

I don't think we will move forward on this thread unless we are willing to step outside ourselves. Its very hard.

Thankyou for sharing.

"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."

Well I felt obstructed in the request for an epidural, and nobody ran me a sodding bath either. I had to run my own bath, both when I first went into labour (on my own), and as soon as I had given birth. My labour wasn't one to one. And there certainly weren't any massages on offer either.

Damn right something was missing.

elbowgrease - when i went in the hospital i had told them i had a preference for a natural birth (naive). The midwives used that as a reason for the first shift. The follwing few shifts they kept saying it wouldnt be much longer and i should keep going, that other women delivered naturally all the time and I'd be fine.

It was a back to back birth which I understand is more painful.

My 2nd birth went better. I told them at the outset I would want an epidural by the time I got to about 5 cm. They gave me the epidural at 5cm and panicked when I said I needed to push. Another back to back and my body was telling me to push even though I wasnt dilated enough. Last stage was quick though and the epidural kicked in about 10 minutes after I delivered.

Jazzers - I understand your point and it is valid. I would have been horrified at the thought of ventouse before that delivery but I was so grateful for it to be over tbh. DD was however rushed to SCBU and we didnt see her for nearly an hour after she was born. They left us alone in that time without updates, so the medical treatment wasnt the only issue I had with the birth.

This is just bringing back so many memories for me

I had #1 with just G&A, #2 with G&A then pethidine which I swore never to do again. #3 was back to back. I never knew this was why I was 'ready to push' then when MW examined me I was told I was only 3cms. He also came out with his arm cupping his ear so the little toad grazed me all the way down the birth canal. Which hurt more than the episiotomies with #2&3!

I asked for an epidural and was told for nearly 3hrs that it was just coming. Then the consultant & MW came back and I knew from the looks on their faces it was too late so the conversation went something like this:
Me: If you tell me it's too late I'm going to scream...
Consultant: Now, buttonmoon, sometimes these things just...
Me:

Now pg with #4 and if I want an epidural this time I will get one. I don't care how 'rude and unreasonable' that makes me. And I will have one at 1cm if I discover that it's back to back again.

MWs do have a habit of telling you how much pain you're in IME. Whether or not they've had a baby before is irrelevant. All 3 of my labours have been different so there's every reason to believe that every woman's will be even more so!

I don't see that anyone could have an objection to being given accurate risk stats before agreeing to a procedure.

What many people are objecting to the fact that they often don't even get as far as being told the risks.

What MaryMungo said "But I have yet to read that story here. What I am reading is "No, you can't have it yet dear, just a bit longer, when you're Xcm, you can bear it, no can't have it yet you're doing fine, whoops the anesthetist is busy now, just have to do it the old fashioned way, it's okay it's natural pain, aren't you proud of yourself!"

rings very true I'm afraid.

And it may of course be true about the anaesthetist being busy, but that's really not the point, is it?

Ladies,I have said earlier on in the post, get involved in your local MSLC. MSLC is the maternity services liason committee. You can do this by contacting your local maternity unit and asking to speak to a supervisor of midwives, or ask to speak to the service manager. Tell them that you would like to help to improve the service by becoming a user representative. Then you can represent yourself as well as the hundreds or thousands of women who deliver in your local maternity unit.

Couple of things:

1. Expat, could you explain how, exactly midwives are 'lazy arsed?' Just finished a run of nights where I had 30 minutes break in an 11 and a half hour shift, and I'd like it clarified for myself and my colleagues who ran an 18 bed unit and 5 bed labour ward with 5 staff.
2. Not using a CTG for monitoring does not equate to not monitoring. In the absence of risk factors, NICE recommend monitoring for a full minute every 15 minutes in labour, and after each contraction in the second stage. There is no evidence to suggest universal CTG monitoring improves outcomes, and a lot to suggest that it has been a big factor in raising LSCS rates.
3. Midwives do NOT deny pain relief- I would never, ever stop a woman from having whatever analgesia she needs. To promote the image of midwives as some sort of coven that takes pleasure in women suffering is such an offensive generalisation that I cant believe it can even be countenanced on a forum like this.
4. Likewise the idea that midwives are bungling fools who watch births turn to disasters until doctors leap in and save the day to the relief of all.
5. There are times when epidurals cant be given straight away- for example the anaesthetist might be in theatre, or called to ITU. It may be that labour is progressing rapidly, and the baby may be born before the epidural can be sited. There may be clinical reasons too- for example the baby may not be coping well with labour, and the physiological effect of an epidural may increase the stress. In that case we try to discuss it, but it's not always possible at the time.
6. If you use offensive language and sweeping statements to malign a profession, please dont get offended when members of that profession respond in a less than positive way- perhaps they may be upset by what you say. it is easy to justify rudeness by calling it 'blunt speech' or to rubbish other peoples' opinions and hide it under the blanket of 'devil's advocate.

Not to mention that the hypothetical anaesthetist wasn't busy two hours ago when our hypothetically labouring mother initially asked for the hypothetical epidural in the first place....

Elbowgrease - yes, hopefully many people who have valid feedback will feel encouraged to join such a group in their area.

But forums such as these are also valid and reach a wide audience. I'm never going to join a group to become a 'user representative', for several reasons.

Firstly, I don't even live in the area any more. Straight after the birth I was just grateful to have a baby at all, I wasn't interested in complaining about how she got here. Thirdly, I knew remarkably little about the politics and procedures of childbirth, and thought my experience, though horrendous in parts, was pretty normal (which, sadly, it probably is).

Sorry, but we (that is to say those of us in my unit) do NOT lie about the anaesthetist being busy. It is, in my experience, a myth. I cant say anything about other places, but if any midwife did that, and it came to light, there would be hell to pay. But then again, it seems that we are all pathological liars who want to encourage pain and suffering among women....

MistyValley - you dont need to live in the area.
you dont need to even talk about your experience if you dont want to.

These forums need general public to inform trusts what is wrong and what is right about their practice in order to make changes.

We as employees can tell the trust there is a massive shortage of midwives until we are blue in the face, but until the public complain and discuss it, the trust will ignore it and the department is deemed to be coping