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...

Just because you are not offered an epidural when you come in does not mean you have been 'tricked', imo. Did you ask for one?

You've coped well at home, are 8cm when you come in so it is probably too late to have an epidural as by the time it is effective the baby would be born anyway.

No trickery there.

Well done and I hope you are not traumatised by your labours.

Poppyella - I was interested in your response to Lucykate saying:

"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."

How do you know she had coped well at home? She might have been in utter agony and not coping well at all.

But you are commending her ('well done') for not turning up and bothering anyone till she was 8cm, and managing without pain relief.

This is what I mean by what 'good' women are 'expected' to do.

(Sorry Lucykate to use your example here, as I know nothing about you and your birth either - hope all DID go well and easily for you).

i think i was very lucky, both were untraumatic births, fairly quick and pretty much on gas & air alone.

i was born with a slight heart defect so i was very aware of staying calm for fear of my heart being more of a problem than the birth.

oh how did i know someone would come and comment about what i said. In that way. So utterly predictable!

well done lucykate. you have had two babies. You are no more 'good' or 'bad' than someone who didn't have an epidural!

if she wasn't coping well at home, surely she would have come to hospital earlier.

some of you lot sure get the wrong end of the stick!!

Surely if Lucykate hadn't coped well at home she'd have come into hospital earlier?

Sorry if I misunderstood your post Poppyella.

There are plenty of scenarios where someone wouldn't turn up till they were 8cm though - just because you can't see them doesn't mean they are calmly and happily starting off their labour at home, as I'm sure you're aware.

One scenario might have been that she went to hospital when she was 1cm dilated, and got sent home again. She might have spent a traumatic few hours at home without support, then set off and got stuck in a traffic jam on the way to hospital. Just one possibility amongst many.

Just to address that though MistyValley, (you are right that may have been the scenario) it is at present completely unrealistic for everyone who comes into hospital in the latent phase to be kept in and supported by midwifery staff. Awful but true.

I'm aware of that DrMcDreamy. And you're right, it is awful, and very sad that so many women start off their labours in an extremely scared and unsupported state.

And it probably doesn't help things later on either, when they finally DO get admitted.

I had one birth with epidural (my first) and one without (my second). Labour was exactly the same length each time, about 6 hours. First time round I thought it might be 24 hours plus, hence the early request for epidural. Second time round I knew it was likely to be no longer than last time, also I had done lots of yoga so breathing and gas and air got me through most of it - though I did shout for pethidine at one point and MW told me I was too far on, but actually I'm glad I didn't have it in case of side effects, even though there were a couple more hours to go in the end. Very lucky that both births were straightforward - did have some second degree tearing first time round, but much less tearing with second and recovered more quickly from the birth.

I do think women should get pain relief if they want it unless there is a medical reason for them not having it.

By the way even when I had an epidural the first time round I had to let it wear off for the pushing out stage. I was rather mortified to find that out at the time but it wasn't too bad as by then I knew it was nearly over.

DrMcDreamy "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."

It isn't only staffing though, is it? It's attitudes and training as well.

Wasn't it the Royal College of Midwives that wanted to charge for epidurals a few years back because they considered them 'unnecessary'?

This thread is massive and there are a lot of very angry women posting terrible personal experiences.

Most midwives I am sure do a fantastic job but there is already a campaign to increase their numbers which I think everyone supports.

This is a completely different issue.

"I'm aware of that DrMcDreamy. And you're right, it is awful, and very sad that so many women start off their labours in an extremely scared and unsupported state.

And it probably doesn't help things later on either, when they finally DO get admitted."

Indeed, however I am a little torn as to whether or not admitting people in the latent stage would be beneficial even if we could staff it appropriately. On one hand it would help build up that relationship between mother and midwife that can be so important for those later stages (you're far more likely to listen to someone that you know and have built up a relationship with) on the other hand there is not much a midwife can actually DO for a woman in that latent stage - aside from the fact that it can last for days and therefore a woman is likely to see several changes of staff in that time, negating the benefits of building up a relationship with one person. Also it is unlikely you will be able to relax in hospital the way you can at home.

"DrMcDreamy "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."

It isn't only staffing though, is it? It's attitudes and training as well.

Wasn't it the Royal College of Midwives that wanted to charge for epidurals a few years back because they considered them 'unnecessary'?

This thread is massive and there are a lot of very angry women posting terrible personal experiences.

Most midwives I am sure do a fantastic job but there is already a campaign to increase their numbers which I think everyone supports.

This is a completely different issue."

I think the issues are a lot more similar than you give them credit. Many many of the problems discussed on this thread (which has been interesting and certainly given me stuff to think about) could be alleviated if not completely solved by having more staff on the front line. It is proven that one to one care by a known care giver is more effective at reducing requests for pain relief - by no means all requests - but many women on here who have told their stories admit they were frightened and didn't want to be left alone in pain and that is why they requested an epidural. That is disgusting, not that they did not get an epidural but that they were frightened of being left alone and in pain, intimating that one might be manageable if it were not for the other.

DrMcDreamy - I don't think not being left alone is good enough. Ideally we should be attended by someone we have had some chance to get to know - not someone we met five minutes before.

Oops sorry, I see that you refer to a known caregiver.

Popping onto what is quite an established thread but just wondering why 8cm is considered too late? I was a failed homebirth, coped til fully dilated with no pain relief in the pool but after 4 hours of pushing and no baby transferred in. Baby was presenting the widest part of his head and sort of stuck sideways? When I arrived was obviously 10cm but put on a drip to speed up contractions, put on monitor and told not to push or move (had to lie on back). At this point I asked for an epidural and got one after about half an hour. They then did the ventouse delivery - why should I have been allowed one and not anybody else at 8cm? Or is this juts hospital policy in different areas? Or maybe because they thought could need an EMCS? Just interested in what midwife views are.

I was surprised that the epidural didn't actually take the pain away in any case - they kept telling me it was only pressure but felt like pain to me!

My hospital midwives were excellent by the way. The community ones at home less so but that is another story.

Yes, care by a known carer does reduce pain relief requests but does it reduce pain? Or is it what Misty Valley talked about? The pressure from other women to be a good girl and manage without pain relief?

The internet is changing things. There are women posting "It wasn't lovely and empowering" it was agony and humiliating and degrading - I never want to experience it again.

It is not all to do with care - nature is a bit of a bitch and women are not all well designed for childbirth.

Everyone used to say childbirth would be different if men had babies. Sites like Mumsnet have given women the power to demand that they should get the exactly the same treatment as men would have.

Not everyone will want pain relief but some will. Childbirth is difficult enough - all women's choices should be respected whether it is homebirth, elective caesarean or epidural on request.

lucykate You were tricked!!! One of the NICE guidelines says that you should get one at any stage of labour and it should not be tailed off at the delivery stage.

I just think it is shocking the extent to which this is going on.

Ushy I find it incredibly difficult to engage with you.

"Yes, care by a known carer does reduce pain relief requests but does it reduce pain? Or is it what Misty Valley talked about? The pressure from other women to be a good girl and manage without pain relief?"

What exactly do you want?? I for one would have thought that less requests for pain relief is a good thing, it means women are able to cope without pain relief using other strategies so that pain relief is not necessary. If women still require pain relief then fine!! Have it! I really can't understand how you manage to twist around the fact that less pain relief requests due to one to one care is a bad thing because it is obviously down to peer pressure? Really?

Cleofartra - you mention that there is a "limited spend" in the NHS. Fine. I totally accept that. Who decided that the cuts would be pain relief for women in labour?

I am still traumatised by my experience. I have not had any more children as I am too scared to be in that helpless situation again, totally at the mercy (or lack of) of a medical professional.

Who decides on how the money is spent? Well, not the midwives that is for sure, yet they are the ones (mostly) getting the flak.

DrMCDreamy What exactly do you want?? I for one would have thought that less requests for pain relief is a good thing.

Yes, you'd think so but it is not necessarily the case.

Oh, Lordy - don't want to get too techy on the research side with this (sorry - the day job!) Less requests may or may not be a good thing. You'd need a subanalysis of other issues such as whether women considered they had adequate pain relief with a really targeted question. Satisfaction in general is not the right measure. They may be incredibly satisfied overall albeit that satisfaction was diminished by lack of pain relief.

I won't drone on otherwise I'll bore everyone to death

LadygoneGaga - I wouldn't say that 8cm is too late for an epidural if you're a primip. If you're a multip who is whizzing on quickly and I expect you to deliver in the next hour I'd say that I think you're probably going to deliver by the time its working. Its going to take a minimum of 10 minutes to get the equipment, Dr there. Then about 20 mins to site it and another 15-20 minutes to get it working effectively. That's best case scenario of the Dr being available.

Saying that if a woman still wanted one I'd ring the Dr and get them there. If they think the woman is calm enough to site it then they'll do it. If she's in transition though this may be tricky. I have seen an epidural be sited and as it was finished being sited we rolled the lady over onto her back and the head was half out.

Anyway at work today every room on delivery suite was full and midwives were caring for 3 women each. Nobody was getting epidurals. Another day in an NHS hospital. That wasn't down to a lack of anaethetist (we have a dedicated delievry suite anaethetist) or down to midwives attitudes but purely down to staffing. Where I work if someone doesn't get an epidural who wants one (in established labour) I would say it was down to lack of staffing 70% of the time, anaethtist in theatre 25% of the time and yes I'd say that there probably are a small number of midwives who would say that 8cm is too late, etc and refuse to budge who would probably account for the other 5%.

Ah

So um can we perhaps agree to disagree on that? It might be a good thing and most would perceive it as being so but if you get techy about it then it might reveal um something else?

"Cleofartra - you mention that there is a "limited spend" in the NHS. Fine. I totally accept that. Who decided that the cuts would be pain relief for women in labour?

"

Where I work the hospital has to save £60million over the next 3 years. Its had its funding from the government/PCT cut by £20million a year for the next 3 years. So partly its whoever decides how much money each hospital get.

Then the chief executive and his other high up colleagues have to decide how much money is given to each department.

So a combination of those 2 groups.