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...

"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.
"

I have to say that sometimes as a midwife I'd agree with that statement that pain relief isn't a priority. That doesn't mean that I think its right - I don't.

But like I said earlier about the times when I'm physically caring for 2 or 3 women in labour. If any or all of them wanted an epidural they wouldn't be able to have one. Becasue ensuring their safety would be my priority, not pain relief.

However as a midwife I think its disgusting that there aren't the staff available so that both safety and pain relief/requirements could be met without safety being comprimised. My managers would probably agree with me as well but they have a limited budget and can't employ more staff.

Maybe there ought to me a Mumsnet campaign that maternity services get more funding. Not that I'd hold my breath that it would do any good as there have been countless campaigns by various organisations over the years. I bet Samantha Cameron would have got/did have an epidural if she'd wanted one. Maybe if she'd been in the situation that so many women on this thread have been in Cameron might not have gone back on his promise for more funding/better staffing.

"Then you can represent yourself as well as the hundreds or thousands of women who deliver in your local maternity unit"

Agree. As long as you are prepared to represent people who may have a different view from you and whose chosen cause may have an equal call on resources.

So that the representative who thinks that to promote natural birth is to infantilise women is give the SAME prominence as the representative who thinks that to promote pharmacology in labour is to infantilise women.

Resources need to be increased but evenly spread to encompass all. Shutting down birth centres to fund epidurals is as bad as restricting anaesthetist availablity in hospital.

If one extreme view grabs the voice it does not serve women any better than if it was the other extreme which grabbed the voice.

Elbow -- the point of telling someone a risk is 1 in 15,000 is to give her the chance to make up her own mind about whether she will chance it or not. Epidural is optional, and available at the request of the woman. Hence the need to tell the magnitude of the risk.

How devastated a woman is if she ends up being the 1 in 15,000 is a separate question entirely from the question of whether she has the right to make up her mind and what figures or facts she is given when the time comes to make up her mind.

Obviously, in a 1 in 15,000 case, 14,999 women took that chance and things turned out fine from the pov of whatever procedure related to the chance. In the remaining one case it did not. That one person was devastated. But she made up her own mind, based on he information she was given. Her devastation does not change the fact that the other 14,999 were ok or that the likelihood of what happened in her case was very, very slim. (Agree with JazzieJeff)

The possibility of trauma as a result of intervention exists, but so also does the possibility of trauma after being denied pain relief. What side you come down on depends on how seriously you take the question of pain relief during labour imo. You can't predict who will be traumatised or by what.

Alimat, one poster here was denied a VE on the basis that the hospital only did them every four hours; it was suggested by another poster that this may have been the case because increased frequency meant more risk of infection, and someone else said that was bad because GBS killed 200 babies in the UK. It turned out that the GBS fatality figures related overwhelmingly to preterm babies; in term births, the risk was far lower -- there are nuances behind the figures. In the case of the 1 in 15,000, which related to uterine rupture, I think it should be pointed out when relating the risk involved, that it is far more likely to happen to some women, specifically VBAC candidates, than to others, so in the case of this particular calamitous complication the risk is even smaller for most women. Same goes for the GBS infection/death risk, which applies far more to preterm babies than term infants.

I have absolutely no objection to being told the risks, but I want the exact figures and I want to know who constitutes the highest risk group and if I am not in it, how that changes the risk for me, because since I have a right to make up my mind about my medical care I would feel cheated if I conscientiously tried to make a decision and found out later that risks I had been told about applied to another sort of patient entirely.

math...

yet more waffle, waffle, waffle

don't you have kids to look after??

yawn

mmidwifeandy

great post btw

couldn't agree more

....I have absolutely no objection to being told the risks, but I want the exact figures and I want to know who constitutes the highest risk group and if I am not in it, how that changes the risk for me, because since I have a right to make up my mind about my medical care I would feel cheated if I conscientiously tried to make a decision and found out later that risks I had been told about applied to another sort of patient entirely......

hallelujah - math actually gets it.
What we have been trying to say for ages.
What we actually tell women and why we tell them.
We tell women ALL the info and what it means specifucally to them - they decide if they want it. simple

Midwifeandy, you're taking the criticism of various MWs on this thread as if they were directed at you personally. You shouldn't, because they were not, as far as anyone can know anyway. Plenty of women had bad experiences dealing with midwives who were not you, who didn't work hard to help them, and who treated them like nuisances when they wanted pain relief. Responding in an offended manner to criticisms of the work of others when you yourself did not see those MWs at work is more defensive than helpful. If improved patient care in maternity units is going to happen, the MWs and other staff there are going to have to ditch the defensiveness and listen without getting the hackles up.

"We tell women ALL the info and what it means specifucally to them - they decide if they want it. simple"

Except it's not, is it? That's why this thread was started.

Well stop talking to us as second rate lumps of dog shit on the ground then.
And patronising us

Then we can discuss issues like adults

sorry misty - not at you, replyed to math

Do you tell women the risk of uterine rupture applies more to VBAC candidates than to other women?

Do you refuse to do a VE on a full term patient who wants an epidural, because of GBS, whose most serious risk involves preterm babies?

Never did I say I had any objection to being told the risks, Alimat. What I object to is scaremongering and misstatement of risk.

What MistyValley said.

And do stop taking every criticism of MWs in general as if they was directed at you personally. That is the key to adult discussion.

You dismissed statistics not too far back ('whatever') and were not apparently aware of the facts behind many of the figures that people dug up and linked to, otherwise you would never have tried to pass off uterine rupture as a realistic risk associate with epidural.

'as if it was..'

yes - any VBAC lady will have been councelled with the risks.
If they are not VBAC they will be told that having an epidural can slow you labour down and may require the need for syntocinon. If we need to start syntocinon, then once again we will discuss the risks in order to fully inform them so as to make their decision

You seem very het up on the uterine rupture - do you not believe it exists or something?
And dont come back with your famous risk factor ratio as we all know what it is by now, youve repeated it often enough. I have explained where the risk comes from - the use of syntocinon(in my post)

I would refuse to VE any lady if i didnt think it was appropriate. As is my job. If it is appropriate, i will offer a VE

I have seen several full term babies suffer from GBS. They ended up in SCBU. One died. The mother did not know she was carrying GBS.

In our small unit, we have an information card that lists risks associated with epidurals, as well as the advantages and disadvantages. The risks are given as numerical values, but also given in words, so for example 'poor analgesia' has a risk of about 1 in 10, and this is quoted as 'quite common.' more serious risks, with values of, say 1:50,000 are given as 'very unlikely'. We find this helps the women have more perspective in weighing up pros and cons. There will still be issues with understanding probabilities, because interpreting these things isn't easy for some. For example, a 1:10000 chance may seem significant, but our unit has 1000 births a year, which means this event could be expected once in 10 year, which shows it's not that likely.

On the topic of anaesthetists, it also needs to be borne in mind that the doctor isn't sat in a chair waiting for you to ask for your epidural. He or she might be attending an operation (the other night we had a big road accident and the victim's leg took 3 hours to fix). Anaesthetists are hte lead professionals in ITU, and a sick patient might be a higher priority. These things do happen, and in a smaller unit there will be a delay, especially at night. it's a bit like seeing your GP. Everyone moans when they have to wait a long time, but when it's their turn, they expect to be seen for as long as it takes. It never occurs that other people want that too, which is why we have to wait.

what is it with uterine rupture - can you please go back to my post and you will see CLEARLY that i have said epidurals can slow labour, requiring the use of syntocinon to speed it up - this carries the risk of uterine rupture - its the cascade of intervention we all talk about

AND you seem unable to understand what has been written - you are like a dog with a bone - WHATEVER - was written - as Im sure you stubbornly know - as in whatever the ratio - not 'whatever' as in a stroppy teenager.

But Im sure you know that - your very intelligent and can work out ratios and we cant

I'm sorry, Math, but you (and others have spent 23 pages making blanket statements about our profession, and maligning us in many ways. You can't do that, and expect a dignified silence. Yes, we don't all give care to the same standard, much as we would like. There are a lot of 'old school' attitudes that don't necessarily reflect or respect the needs and opinions of women. An awful lot of us are working very hard to improve women's birth experiences, and it is my goal that the women i look after don't go through the same things as we have read about here. But we are human, and that doesn't happen. However, as a group, we are working very hard to change things, and if you make these sweeping statements, then, yes, I do get offended on behalf of my colleagues.

Alimat, uterine rupture in a non-VBAC case is an infitessimally small risk.

You yourself brought up uterine rupture initially, and you stated it was a risk associated with epidural. You restated that opinion in your recent post: 'You seem very het up on the uterine rupture - do you not believe it exists or something?
And dont come back with your famous risk factor ratio as we all know what it is by now, youve repeated it often enough. I have explained where the risk comes from - the use of syntocinon'

Here is what the risk ratio has to do with uterine rupture: it shows how very, very small the risk is unless you are a VBAC candidate. That is why I keep on repeating it and I don't know why you keep on dismissing the figures and what the figures mean. Because they are central to what women here on this thread are saying about MWs that they are high handed and tell women lies when they ask for pain relief, lies about the doctor being on her way, and lies about risk, and refusal to perform procedures based on their own incomplete understanding of the risks the GBS thing for example. The idea that an incomplete knowledge of who is primarily affected by GBS death means you might refuse to do a VE on a term patient is very shocking to me.

And at the risk (hardehar) of boring you even further by stating a fact, the risk of uterine rupture absolutely does not come from the use of syntocinon except in VBAC patients. It applies primarily therefore to VBAC patients. That's why I asked you if you pointed out this nuance to all of your patients or just gave them figures that may have led them to believe they were at some risk of uterine rupture despite not being VBAC candidates. Little details are important. Statistics apply more to some groups than to others.

One in a million other women will experience rupture. I know one such woman. She lost her baby but she herself survived. She didn't fit any of the normal risk categories. That is why I am so familiar with uterine rupture.

And no, you absolutely did use the term 'whatever', in bold, like a stroppy teenager and not in the manner you now claim. I will find the post when I have time and c&p it if you like.

Midwifeandy, I have had lots of evidence on this thread that all is not fine and dandy in the profession, some of it posted by MWs themselves. The point of the thread was to contribute experiences that should not have happened and 23 pages later it is possible to form conclusions and make generalisations. And again, don't assume anyone is criticising you personally, but don't rush to the defence of MWs who are giving your profession a bad name either. That is not the way to fix anything.

It's here MA:
Quote Alimat
"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 really do not take the whatever as being meaning to be stroppy. Read the whole sentence.

She also says
"NOWHERE HAVE I SAID I DONT AGREE WITH EPIDURALS. NOWHERE HAVE I SAID I WITHHOLD EPIDURALS WITH MY HORRIBLE MIDWIFERY POWERS."

and
"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."
Think it is pretty clear that Ali means that the use of epidural slows down labour THUS leading to the use of augmentation via syntocinon, which may cause uterine rupture.

mathanxiety to recap, you said, "That statement is one of the most arrogant and contempt-filled I have seen about any group of patients and about any medical professional's mission. Everyone involved in L&D is out of step except you apparently. The integrity of midwives is called into question when they fudge facts and present risk as likelihood, and omit pertinent information like actual figures -- 1 in 15,000 for instance."

OK, first things first: that statement was mostly an explanation of the role of the midwife. I have fudged no facts, I'd love to know exactly where I did that, nor have I omited any pertinent information. Although you have diverted the argument so many times that contributors might be forgiven for missing something.
Finally, I don't understand where I was arrogant - I have entered into an interesting debate with a few other contributors, none of whom seem to have been moved to your level of vitriol and venom. And this from someone whose contribution to this debate kicked off with a description of a 'stupid bitch nurse' and a 'lazy bitch nurse'.
You're quite the charmer yourself, aren't you?

It was in a post far up the thread that Alimat lumped in uterine rupture and (maternal and foetal death) with other risks associated with epidural, without giving any indication that any of the risks she mentioned were either equal or likely.

It is very clear to me that when someone says '1:10, 1:1,000 ... whatever...' she is stating that figures mean nothing to her. Alimat has made clear her disregard for and lack of understanding of figures throughout the thread. Here's her previous post, (again with that WHATEVER) '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.'

(And the more I look at that alleged 1% typo post, the less the explanation makes sense to me. How do you mis-type the number 1? Why would you mean to type a percentage point instead of spelling out 'percent' '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.' 'That % category' doesn't make sense. You may accuse me of being patronising, but I sincerely think you mixed up 1 and 1%.)

"Don't you have kids to look after?'
Yes, Poppyella, shut that articulate woman up and put her well and truly in her place. How very arrogant. And contemptible. A disgraceful comment of which I hope you are ashamed. I hope you don't bring your attitude to work with you.

And yes, stand shoulder to shoulder with your fellow MWs. Circle the wagons. (I don't know if you have to be Irish to understand that one, but it works both ways) Ignore, ignore, ignore, and insult.

Your contributions to this thread have greatly added to the generally poor impression of MWs that is being formed.

Arsebiskits, she was a lazy and stupid bitch, and I had the misfortune to encounter her twice, once with DS and once with DD2.

She pretended not to be able to speak English both times (she was Taiwanese) but miraculously managed to understand what the doctor said and reply to him in perfectly intelligible English when he came around briefly. She tried this trick both times with me, two years apart.

With DS, she initially refused to numb my hand with novocaine before inserting the IV needle (for my induction) a practice that had been warned about by the nurse I had done prenatal classes with. This nurse warned the group to have the back of the hand numbed first (this was done for my first labour without complaint by the nurse I had that time) and that some of the L & D nurses (she was an L&D nurse herself and had seen her colleagues in action) couldn't be bothered numbing first because it meant they had to spend extra time performing the procedure, or for other reasons known only to them.

She argued with me, just as the Lamaze nurse had warned "You want two needle? Why you want two needle?" On being told I wanted one small needle and then I wouldn't feel the second and much bigger one in the sensitive back of my hand, she whined, "But I have to walk all the way back to the dispensary, all that way, to get novocaine for you?" I offered to go and fetch the novocaine myself if it was going to be too much effort for her. So off she went, shaking her head at me. Then she inserted the needle, set the drip and sat buffing her nails, finally leaving for lunch after another adjustment of the drip. Another nurse came in after half and hour and immediately changed the interval for the drip. I had been having contractions a minute apart, all alone, and had thrown up, because the stupid, lazy bitch had adjusted the drip wrong. The monitor told the story.

Are you trying to tell me I don't know a stupid, lazy (lying) bitch when I am dealing with one? I have never encountered anyone with the sheer neck of that cow.

Your statement was mostly a description of the MW as god. It was about your way of doing things regardless of what the individual patient wanted.

I am so shocked by the stories on this thread. In comparison I gave birth in Australia, in a private hospital.

I was induced due to gestational diabetes. I was offered an epidural to be put in place (without the drugs) when induction commenced. The midwife then put the drugs in when I asked, a couple of hours later. I had one midwife sitting at my bedside continually monitoring mine and tha baby's heart rate/contractions throughout labour. I was given a "mobile" epidural by the midwife so I could walk to the loo.

When my contractions led to heart decelerations in the baby I was taken through for an EMCS within the hour, calmly. My same midwife stayed at my head throughout the EMCS. She then came back onto the ward with me and acted as "go between" between bed bound me and my baby, who was in the nursery for blood tests.

I can't fault a single point of my care and it is so shocking and terrible that mothers have to go through labour begging for pain relief.

I can see why MidwifeAndy is upset. There are some shocking stories here, and I do think that often lack of resources is at fault rather than the midwife's attitude.

I do think however that the fundamental problem is not one of the risks not being explained properly prior to a procedure. The main issue is that an awful lot of women are not given the option of an epidural when they need/want one.

Please all stop name-calling. It really isnt very productive andf weakens any argument you may have.

I've come back to the thread as the issue has brought back many memories. An friend of mine told me that my labour would have been so different in her country. They would have gone straight for an emergency caesarian to save the trauma. My point being that actually government and/or PCT policy makes a difference to the decisions in your labour, possibly as much as the individual midwife you happen to have.

mathanxiety, you talk the talk (with a few lazy bitches thrown in) however, can you walk the walk. Why not prove it and become the midwife you so desire? Then you can take insults from women when you're trying to deliver care to the best of your ability with the resources and guidelines you have to hand?
When a woman is upset by her experience and you try to answer her questions, I'm sure you'll have all the answers.
You're seem to see yourself as some kind of C list celebrity on Mumsnet with all you're groupies, but are you this brazen and rude in real life? Perhaps you're one of those women who smiles sweetly and when asked if happy with everything regarding their care at the time says, 'Yes, thank you, fine,' then goes straight home moaning about how awful everybody was and how awful you're experience was.
The midwives have tried to answer questions here, but you are determined to disagree, purely because they're midwives.

Anyhow, the spoilt princesses on this thread are BOOORING me now so is Mumsnet. BYEEE