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...

Maybe I missed it in all her posts but has mathanxiety any experience of the UK system?
She talks about the L & D nurses for two of her births, so can't be talking about the UK there, so her generalisations may not apply to UK midwifery.

It seems that lack of anaesthetists is one of the big problems. Perhaps midwives should stop covering for the management and tell it like it is - i.e. the trust will only fund 1 anaesthetist for xxxx people. What then though?

Ozziegirlie, it is great to hearv that you had great care. I think that the differences are PRIVATE care in Australia. You have paid for it, that seems to be the case here too, although, some people have said that when it goes wrong you are thrown back to the NHS hospital.
I too gave birth abroad with my first, in a private hospital.The care was not much different to here in the UK.

MA, I hope you wrote in a letter of complaint about this ?nurse?. I take it this was abroad as here in the UK we have midwives "with woman" who work alongside obstetricians who "stand before" the woman. The only nurses I gynae nurses, which would be a completely different field altogether, kind of like comparing a blacksmith to a farrier IYKWIM. Complain does not mean sue by the way. Not everything can be solved with money and taking away from an already overstretched budget is just doing yourself over or rather more, taking away from other women who's care could be greatly improved with said monies. "So sue then" We learnt that very trick from our American cousins who have a completely different health system to us. One that will see a person dying on the street because of lack of health insurance.

Hyperstimulation of the uterus can cause rupture. Even in non VBAC women. Hyperstimulation is assosciated with syntocinon use. Which in turn is assosciated with epidural use.

For the record I have never ever seen anyone lie about the availability of an aneasthetist.

RUSerias, some of your points are coming across as slightly odd, if you don't mind me saying. 'Princesses' is a questionable term to be using in this context. Are you applying it to all posters here who aren't somehow 'appreciative' enough of the treatment they have received?

Are you a midwife yourself?

And I'm not saying hyperstimulation is a huge risk but it is a valid risk.

"The population-based incidence of uterine rupture in the Netherlands is comparable with other Western countries. Although much attention is paid to scar rupture associated with uterotonic agents, 13% of ruptures occurred in unscarred uteri"

From the study Zwart et al (2009)which is an interesting read.

Hmm..we seem to be considering an awful lot of the risks of epidurals and none of the results of the failure to give pain reiief when it is requested; post traumatic stress disorder, relationship breakdown as a result of phobia of future pregnancy, bonding difficulties, depression and anxiety.

The Royal College of Psychiatrists have a motto: "No health without mental health".
It is disturbing to hear some midwives say their first priority is the health and safety of the mother and baby with apparently no understanding of the psychological dimension of health.

Ushy you make a reasonable point, no midwife worth their salt intentionally sets out to destroy a womans mental health. We all need to work together. Women need to understand that the NHS is not a finite resource and sometimes certain pain relief is not appropriate and as midwives we need to listen to women and take on board their concerns and requests. It really shouldn't be this difficult.

I was fobbed off from an epidural during my induction, with ever more ridiculous excuses and promises of being able to have one "soon". When I asked to know an exact time frame (i.e. within 2 hours, within 4 hours etc) so I could try and mentally cope I was told I was being demanding and they couldn't ever tell how long it would be or if I'd get one at all. I then said that I wasn't prepared to continue with the induction drip and pulled it out of my hand. In an amazingly fortuitous coincidence the anaesthetist was suddenly available and I got one.

The epidural only worked on one side of my body, so was pretty ineffective, so the consultant called the anaesthetist back. The pompous anaesthetist marched into my room and told me it was the end of her shift and I would have to wait until another became available, telling me that I was very lucky that she had given me an epidural as she was very busy and "having a baby doesn't entitle you to pain relief".

It is attitudes like this that make me so cross. Yes, people have babies without pain relief, but that doesn't mean they have to. You can amputate someone's leg without anaesthetic but I would never expect a hospital to try that.

On the subject of midwives, I had polar experiences. One was hopelessly ineffectual as she sat at the end of my bed blowing her nose (with my tissues) constantly telling me she felt too ill to be at work really and her nightshift replacement who was like an angel to me, helping me through it and treating me with dignity and respect. You can guess which one's name I gave to my DD as a middle name. I think in all professions you get good and bad, but maybe in hospitals they should have more supervision to weed out the ones who have no interest in the job.

I also think that it is a disgrace to think it is an acceptable response to a person in pain to say that there is no pain relief available. I can't see that happening in A&E. Why is the labour ward any different?

biscuitnibbler what an awful experience - so it is not only some midwives it seems to be endemic in maternity services.

You asked why the labour ward is so different. I think it is because it is women and women don't push their corner. It is actually an example of huge sexual discrimination.

The labour ward is considered to be different because labour pain is considered to be 'physiological pain' ie the product of a natural and healthy process. That's the ideology behind it, anyway.

It doesn't seem to take into account the fact that induction, for example, isn't natural, and often makes contractions a lot more intense, painful and closer together than they would 'normally' be. Oh and stuff like episiotomy, and forceps / ventouse - I'm not sure where that's supposed to fit into the model of natural physiological pain.

But the fact that there's a very good statistical probability that they will feature when you give birth, with or without epidural.

Sorry, last sentence should say:

But the fact IS that there's a very good statistical probability that they will feature when you give birth, with or without epidural.

Ushy, you make an important point, but it raises the question of whether it is pain that causes the (currently rising) PTSD in postnatal women or treatment to these women by medical professionals that may involve the refusal of pain relief.

Personally, my mental health issues in my pregnancies and post-births had little to due with pain. They were flared and grown by my mis-treatment at the hands of people in a percieved authority over me that were also percieved to be supposed to be caring for me. I still have nightmares and panic attacks over the midwife who told me, with my first, that if I didn't push hard enough for her, she would cut me while pulling the tray of scissors towards her. I still have a sick feeling in my stomach and tears in my eyes about the third stage of my third birth - being told I needed to have the injection for my placenta (regardless that it had come out fine in my previous birth just fine after ten minutes), having a reaction that almost killed me, having gas and air pushed in my face while I was trying to push it away (gas and air makes me vomit and dizzy, I hate it) being treated by most of the medical staff that my reaction was my fault, hearing them talk about in the high dependency ward "the hippie who'd been taught a lesson" while looking at me over their shoulder...

I remember the pain of labour, but it doesn't haunt me. I imagine it haunts women more who feel that it was part of manipulation by those who are controlling it and them while they are suppose to be caring for them. It's only part of a larger whole of problems in some (sadly many it seems) hospitals. Women should be given all of the information about all the things that are available and could happen way before the delivery ward and given more confidence that they could it naturally if they so want to, but this will only work if medical staff are better training on treating women has intellegent human being who can understand risks and benefits when given to them rather than emotional manipulation that is far too common.

mistyvalley wrote

The labour ward is considered to be different because labour pain is considered to be 'physiological pain' ie the product of a natural and healthy process

am

i am not articulate enough to express my horror.

In what way?

well, ok

say you go running, fall and break your leg.

the pain resulting from this is as 'natural' as the pain from childbirth.

it stops the person who has injured themselves from doing more damage etc etc etc.

yet, for some reason we feel no need to form an ideology to treat this pain.

we dont weigh up how 'natural' this pain is and administer pain relief accordingly. or decide that as the pain is natural that it must then follow that it is HEALTHY to be in agony.

It's because bleating on about "natural pain" is how medical professionals inure themselves to the sounds of our screaming.

Teething is a natural, physiological pain. The ache of bones knitting themselves together is a natural, physiological pain. Losing your hymen is a natural, physiological pain.

Childbirth is a cruel paradox of evolution whereby the advantages of bipedalism and larger brain sizes outweighed the inevitable consequences of smaller pelvises and increased cranial circumference.

Our bodies didn't evolve to cope with labour half so much as our minds did. That's why from earliest pre-history you have birthing partners and oil massage and chanting and special breathing.

Well now it's the modern age and we have birthing pools and tens machines and- miracle of miracles- walking epidurals! And by heaven, if a woman wants to avail herself of one of these options she should be so allowed. Any other way is barbaric.

Absolutely. So long as you know the risks to yourself and your baby. Once you've weighed up those risks and whether you are prepared to accept them then you can make your decision. The other thing that is slightly different on the labour ward is that you don't just have your pain to think about, that pain is your baby making it's way into the world, any pain relief may then have a knock on effect on your baby. It is also a transient pain, once the baby is born mostly that pain is over. Its about working out what is best for you in conjunction with your caregiver so the optimal outcome is had.

With a broken leg for example the optimum outcome is a fixed leg. To do that you may need to keep your leg immobile, to do so you need pain relief so you are able to keep that leg still (massively simplifying things here I know), in childbirth the optimum outcome is safe delivery of the child, that is the point of childbirth. I am deliberately reducing things to their most simplified form. By that I mean the whole point of childbirth is to birth a child.

Oh gawd. m tying myself up in knots here, I know what I want to say but think I will have to come back and articulate it correctly.

im sorry drmcdreamy but that still doesnt address the underlying idea that because its childbirth you should just put up with the pain.

taking painkillers for a broken leg may have consequences and side effects, but no one advocates NOT taking the pain killers. and tells you that you coud cope with it as its not for a long time etc etc.

its the weighing up of womens pain against everything else and saying, well, womens pain isnt worth that much in the first place, so everything else is more important.

im also not expressing that quite right!

"The Royal College of Psychiatrists have a motto: "No health without mental health".
It is disturbing to hear some midwives say their first priority is the health and safety of the mother and baby with apparently no understanding of the psychological dimension of health".

First off - it was me that said that the safety of mothers and babies must be the first priority of midwives. And I'm NOT a midwife.

We have a situation at present where women and babies are being damaged physically and emotionally by short staffing on the wards.

I believe completely that women need to be listened to and to receive pain relief if they request it. But we HAVE to acknowledge that there is a limited spend and at the moment the very basic things that ought to be in place to provide SAFE care - namely appropriate staffing, are not there, and that this needs to be a priority.

I do think Ushy it's fair for me to make this point and not be interpreted as saying 'it doesn't matter if women don't have access to pain relief in labour'. I'm really not saying that. It does matter. But it matters more that babies are ending up in SCBU and women may be coming home from hospital with severe and avoidable birth injuries and infections because of short staffing on the wards.

"the underlying idea that because its childbirth you should just put up with the pain"

But NOBODY is saying that women should have to tolerate pain they find unendurable or that pain relief shouldn't be available. There are so many straw man arguments being set up here!

All DrMcDreamy is doing is pointing out the discussions surrounding managing pain in labour are different from the discussions surrounding managing the pain which arises from injury and illness because they are of different natures. That's not to say that labour pain is less important or less worthy of attention or less severe. However, many women CAN and DO cope with very severe pain in labour without pain relief and are happy to do so, mainly because the pain is a) transient b) episodic and c)associated with an overwhelmingly positive experience (meeting your baby) rather than an overwhelmingly negative one (injury and sickness). That means people are likely to experience it in a different way - as a means to a wonderful end!

Would like to add - I've seen some really poor care being handed out by midwives, but I've seen far more examples (and been lucky enough to experience it myself) of really good practice. I take my hat off to you midwives on this thread - I don't know how you cope with what you have to do day in, day out. Your jobs are very, very hard. Far harder than most people realise.

The only thing I 'get' about what DrMcDreamy said is that the baby's health also has to be taken into account as well as the mother's.

So that makes pain relief more complicated, and some mothers may prefer to minimise any risks, however small, by avoiding pain relief altogether.

But just because it's more complicated shouldn't be used to justify pressurising all women into NOT having pain relief as a 'default position'.

"I imagine it haunts women more who feel that it was part of manipulation by those who are controlling it and them while they are suppose to be caring for them. It's only part of a larger whole of problems in some (sadly many it seems) hospitals."

NotjustKhangastan - you have hit the nail on the head with this comment. I couldn't agree with you more!

"to justify pressurising all women into NOT having pain relief "

But who pressuring 'all' women into not having pain relief?

Nobody!

"But just because it's more complicated shouldn't be used to justify pressurising all women into NOT having pain relief as a 'default position'"

Agreed. But please don't apply the experiences of a minority to all women. 'Default position' if that is the way you wish to refer to it IS no pain relief - because that is how everybody starts in labour and how many end their experience, once the decision has been made to use pain relief then it is down to the woman and the midwife to work in conjunction to get the appropriate level of pain relief, that means offering all options and discussing pros and cons of each. Not epidurals on demand for everyone no matter the circumstance.

I've said it before and I'll say it again, antenatal education and continuity of carer could make such a difference in the majority of these circumstances. For these to be bettered then more staff need to be available. If mumsnet want to get behind a campaign I'd say this is where the most good could be done.

not sure if i was tricked out of an epidural but i wasn't even offered one with either of my births.

with dd, i was 8cm dilated when we got to the hospital so was told i was too far along to have one, and with ds i didn't ask for one although i did ask for pethadine, which i didn't get as after they broke my waters, it all happened so fast and ds was out.