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...

women who choose to go to hospitals who tend to be more safety focused

I get so fed up of this 'hospital is safest' argument:

The best equipped hospital in the world is only as good as the staff attending.
One message coming out strongly from this thread is how poor staffing ratios are and how this compromises the quality of care.

Having had one of each, there is no doubt in my mind that the one where I was given 1:1 attention by a known midwife (i.e. home) was much safer than the one where no one had the foggiest who I was and were more interested in their high risk cases.

Margles you said that you were fed up with the hospital is safest argument.

But on the evidence we have at the moment, consultant unit hospitals ARE safest.

What we also know is that the baby's safety depends more on the number of obstetricians than on the number of midwives.

What good midwives do is improve the experience of women and that is hugely important so we do need more of them.

"The overwhelming majority of women - given a free choice - will choose to give birth in a hospital"

There is no such thing as TRUE 'free choice' in the UK at present when it comes to homebirth.

Yes - because over the last 5 decades low risk women have - despite all good quality evidence pointing to it being untrue - been led to believe that homebirth is risky and that the only safe place to give birth is hospital.

If a) women grew up in a society where homebirth was common (like in the Netherlands)
b) were fully informed about the pros and cons of having their babies in different settings
and
c) had free access to one to one midwifery care from midwives who were both experienced and confident in home births

.. then it wold be fair to say that they had 'freedom of choice'. The reality is that most women are free to chose to birth out of hospital like a child bought up in a workless household on a sink estate in Glasgow is free to go to Oxford university following a gap year travelling through Chile. In theory they have that option but in reality the prevailing culture makes it something they wouldn't even consider.

However - I do concede that women who want access to epidural analgesia should have access to it. I'm not arguing about that. Partly this would be achieved by a change of attitudes among midwives - for them to stop being paternalistic towards women and to start listening more.

But there is also an issue about the resources needed to fund a large increase in the number of epidurals administered. I personally feel that if there was a huge wodge of extra money available for maternity services it would be better spent on having more midwives rather than more anaesthetists in maternity. Think it would OVERALL result in fewer unhappy, traumatised women.

Would also like to add that the majority of women in the UK don't WANT to have an epidural when they give birth - and there is evidence to support this. They just want good care.

(I'll go and dig it out!)

Ushy - the overwhelming majority of women are not given a free choice; there aren't all that many birth centres and in many parts of the country you have to be extremely determined to get a home birth.

Hospitals are presented as being places where 'if it goes wrong they pull out all the stops' but as many of you are now finding what is promised and what you actually get don't bear much resemblance to each other.

How many of those women who chose a hospital birth because they could get a readily available epidural and then found that they couldn't would have chosen an alternative? I don't know, but I do know that a lot of women are being seriously misled.

Margles You said that the majority of women are not given free choice. The majority are. Not ALL women will be offered home birth or MLU because they might have complications. They can insist on it but it is not normal NHS policy to OFFER choices to at risk women.

This is from Care Quality Commission
?
"83% of women were offered a choice of location for birth (compared with 81% in 2007), with nearly three quarters (74%) offered a home birth"

Cleo You say that money should be spent on more midwives not more epidurals !!!

Cleo - why is it only women's pain that it is a 'luxury' to relieve? No-other field of medicine do we make it a CHOICE between care or pain relief.

Growl and double growl

"But on the evidence we have at the moment, consultant unit hospitals ARE safest"

Ushy - there isn't good quality, consistent evidence that neonatal outcomes are better for low risk mothers giving birth in consultant-led units.

Statement on homebirth from the Royal College of Obstetricians and Gynaecologists:

"The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.1-3"

Ushy - consultant unit hospitals ARE safest

As far as I am aware there is as yet no conclusive evidence of this. Majorie Tew, a statistician, set her students an exercise to work out the stats to prove this. She didn't believe her students when their analysis didn't show that hospitals were safer, so she redid the research herself and found that the students were right. However, this research dates from the early 1980s, so we badly need some more to show what the situation is like now.

What good midwives do is improve the experience of women and that is hugely important so we do need more of them.

So the midwife is just a glorified labour companion? No, what a good midwife does is anticipate problems and can help nip them in the bud.

"You say that money should be spent on more midwives not more epidurals !!!

Cleo - why is it only women's pain that it is a 'luxury' to relieve?"

I don't see it as a luxury. But the situation we have now is that WE DON'T HAVE ENOUGH MIDWIVES TO ENSURE THAT ALL WOMEN AND BABIES ARE SAFE during childbirth.

You can't magic midwives out of thin air.

Even if an extra billion quid was available for maternity services tomorrow you wouldn't be able to ensure the sort of staffing levels in NHS hospitals that would enable all women to have one to one care, decent postnatal care, and free access to epidurals on demand!

"What good midwives do is improve the experience of women and that is hugely important so we do need more of them"

Yes.

And one to one midwifery care from an experienced midwife who is not at the end of her rope with tiredness also results in both a mother and a baby in better physical and emotional condition following childbirth. One to one care is associated with better neonatal outcomes and lower rates of c/s.

"You can't magic midwives out of thin air."

Although of course we can always recruit (as we all ways have done) from impoverished countries with very high maternal death rates, so robbing them of the little expertise they have available to their own populations.

Ushy - the GPs surgery I used to go to refused to support either home births or the local MLU. No mention of whether you were high risk or not. Not much free choice there.

I very very much doubt that their patients were different to the practice half a mile down the road which did support the MLU and did support home births.

That's only anecdotal of course, but I suspect that the position is repeated up and down the country.

"83% of women were offered a choice of location for birth (compared with 81% in 2007), with nearly three quarters (74%) offered a home birth"

In our area 'being offered a choice of location for birth' means that at their booking visit their midwife hands them a leaflet and says - 'If you're at low risk of complications you have a choice of giving birth at the birth centre, on the labour ward or at home'. There is NO discussion unless it's initiated by the mother, who is likely to have no prior experience or knowledge of homebirth.

The RCOG estimate that nearly one in ten women would like to have their babies at home. At present the homebirth rate in the UK is 2%

In our area what doubled the homebirth rate was the creation of a specialist homebirth team of midwives who do case-loading. They promote homebirth at a regular open evening at the hospital.

I'm a bit behind with this thread now, but just wondered just how much the home birth stats are skewed by the fact that home birthers are:

• a self-selecting group of (mainly) middle class, healthy, educated women?

• who are more likely to be well nourished, not have drunk / smoked / taken drugs to excess during pregnancy, etc

• have a very positive attitude to the 'birth experience', and likely to be well-read up on coping strategies, and have good relationship support from partners

• be low risk by definition, as higher groups aren't allowed to home birth anyway?

I'm not against home births (though I wouldn't have chosen one myself as I didn't want to have to transfer if there were problems). But as others have said, you obviously do have to take a lot of factors into account when studying it or commenting on how successful it is and how 'satisfied' people are.

The satisfaction variable is also a tricky one - people who opt for home birth are usually VERY pro in the first place and so well-primed for being satisfied.

BUT I'd definitely agree that anyone who has one to one (good) midwife support from EARLY on in their labour, is much more likely to report a better experience overall.

That is where the big hole is in hospital birthing, both with inductions and those who are rushed in in a panic when they have reached the magic 5cm.

MistyValley - the studies on which the RCM and RCOG bases its recommendations on place of birth control for social class and obstetric risk status.

Not sure if these studies always control for age, but if they don't I'd think that this wouldn't go in favour of homebirth - women who have their babies out of hospital would, I suspect be older than the majority of low risk mums giving birth in birth centres.

"The satisfaction variable is also a tricky one - people who opt for home birth are usually VERY pro in the first place and so well-primed for being satisfied"

Not necessarily. Many women who opt to have their babies at home are actually quite nervous about the whole thing. I know I was! Many women opt for homebirths because of traumatic or unpleasant experiences of birth in hospital.

Cleo that statement is absolutely true - homebirth is safe within the normal meaning of safety for low risk women. I am 100% homebirth supporter for women who want that choice.

Statistically though, on the evidence we have, it seems a tiny bit less safe than hospital birth.

You're right - good quality evidence is hard to achieve but that is because it is always incredibly difficult to achieve statistical significance for rare events. . You need huge numbers and then you need to control for so many factors - a nightmare. However, this is what most of the reasonable UK studies say. There are loads of studies from the home birth lobby that refute this but you can ride a coach and horses through them in terms of research quality. It is a shame because everyone is saying homebirth is safe.

The problem occurs when some sudden emergency develops at home. In that scenario the time between recognising the problem and slicing the baby out is critical. This is EXTREMELY rare but the baby is generally better off in a hospital. (I take your point about useless hospitals and you are right but they are not the majority).

Women who choose hospital birth weigh all this up with the fact that they will have (or should have) epidural pain relief available and won't need to transfer if there are complications. A statistically larger number of women make this choice.

So basically we should support the choice the woman makes - whether it is where the woman has the baby or what pain relief she wants.

Cleo - yes I can see that studies will try and correct for the fact that there are no good control groups. I guess I'm just saying it must be a hard thing to do, given that the 'home birth' group is a pretty narrow type.

Ushy - yes agree, it's all about choice, and not being pressured into making one or the other without good medical reason (rather than ideology).

it seems a tiny bit less safe than hospital birth....... this is what most of the reasonable UK studies say. There are loads of studies from the home birth lobby that refute this but you can ride a coach and horses through them in terms of research quality.

I question this last statement. You can also ride coach and horses through many of the studies which say that home birth is not safe, but that doesn't stop people quoting them as though they are valid.

Women who choose hospital birth weigh all this up with the fact that they will have (or should have) epidural pain relief available and won't need to transfer if there are complications. A statistically larger number of women make this choice.

As a number of us have said - the majority of women don't get an active choice.

cleo "Many women opt for homebirths because of traumatic or unpleasant experiences of birth in hospital."

Exactly but that is an argument for improving hositals so that women can have both the best in terms of safety and not needing to transfer AND a good experience wiht available pain relief.

"Statistically though, on the evidence we have, it seems a tiny bit less safe than hospital birth".

Safer for whom? The evidence on neonatal outcomes is unreliable because of the overall safety of birth in or out of hospital (serious poor outcomes being rare).

What we do have when it comes to homebirth vs hospital birth is fairly good evidence that morbidity rates are lower for babies born at home - less fetal distress, and lower rates of admission to SCBU.

And for mums there's pretty solid evidence of better clinical outcomes - significantly lower rates of c/s, lower rates of instrumental birth, lower rates of episiotomy and lower rates of postnatal depression.

So really - can hospital birth be said to be even 'marginally safer' when it puts women at greater risk of needing emergency c/s, with all the risks (to the mother and to subsequent pregnancies) which accompany this type of surgery?

"Exactly but that is an argument for improving hositals so that women can have both the best in terms of safety and not needing to transfer AND a good experience wiht available pain relief"

You will never be able to create a hospital environment which offers similar benefits to homebirth. Doesn't matter how many birth pools you have or how many midwives. Hospitals are still, and will always be, large, protocol driven institutions where the needs of the individual will always have to come second to the smooth functioning of a medical system which is 'processing' huge numbers of women and babies every week.

Re: transfer from homebirth, women often give this as a reason not to have their baby at home. They assume it's one of the worst things which you can experience in labour. Having transferred in from a non-progressing homebirth myself, and knowing many other people who've done the same (including people who've had blue-light transfers) I have to say it's not usually anywhere near as bad as most people assume. And most women who do transfer in during labour are still glad they opted for a homebirth and many plan to try for a homebirth again the next time around.

Cleo Home birth was absolutely right for you and it IS a good choice for women who feel as you do.

But not everybody feels the same. Others prefer hospitals because they offer different benefits - like epidurals and not needing to transfer.

The key point is women need high quality balanced information and to have their choices respected - as Mistyvalley said several posts back.

I agree Ushy that homebirth isn't for everyone.

Actually I think that there are parallels between the issue of the availability of homebirth and availability of epidurals. Epidurals are one answer for women looking for ways of making labour bearable. Homebirth is another. Neither are suitable for everyone or available to everyone.

Nobody interested in the research I linked?
I'd have thought all the doctor lovers and technology worshipers would have been crowing with delight...

Absolutely Ushy - going back to the first post - one of the OPs problems was that she wasn't listened to but was treated like a small child.

Hospital birth experiences need improving - how do we go about it? It's more than promises of epidurals. Lack of continuity of care seems to be one problem, how could we improve that?

arsebiskits - (love the name by the way!) I'm afraid I see a bit of research like that and my response tends to be instant [confusion] and 'WTF'? Swiftly followed by deep suspicion - because it contradicts the findings of a huge body of good quality, peer-reviewed research.

I'm also a bit about any research into childbirth outcomes done in the US because the birth culture there is so idiosyncratic that it's hard to apply the findings to other systems of maternity care.