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...

Margles In my humble opinion easy peezy:)

Get rid of the Clinical Negligence Scheme for Trusts and make individual hospitals resonsible for a much higher percentage of clinical negligence claims.

Suddenly, bean counters would realise that failing to provide adequate care is actually very expensive.

Hospitals penny pinch on pain relief and staff whilst the NHS wastes billlions damages payouts and legal costs as a result of overstretched staff. Interestingly, poor pain relief is now a common clinical negligence claim in obstetrics.

This wouldn't increase the overall hospital bill one penny.

arsebiskits - there's an awful lot that extract doesn't say. However, given the state of US maternity care, they are going to do EFM anyway, here's a nice bit of research to back it up. [cynical face emoticon]

It makes me think of the Hannah breech trial - it has been discredited but it still doesn't stop them applying its conclusions.

"Interestingly, poor pain relief is now a common clinical negligence claim in obstetrics".

But so are claims arising from poorly managed shoulder dystocia - which we'll be seeing A LOT more of over the next few years if an increasingly obese and diabetic population of women have more epidurals in labour.

Ushy - interesting thought.

It seems that one thing we all want is much more personalised and less fragmented care rather than the systems we have now.

You absolutely cannot dismiss research carried out in the US or cast aspersions on studies there because of some nebulous factor like an alleged 'different birth culture' there. You should judge a study by its own merits, methodology, etc. Dismissing US studies for highly subjective reasons is xenophobic and irrational.

If an extra billion was available for maternity services, I believe it would be possible to provide one to one care for women in labour. Why wouldn't it?

The objections raised to training and improving staffing are nonsensical. If the money was available it could be done. The reason the money is not available is partly because improved maternity services are not a priority, many women have a medically positive experience and even an overall positive exerience despite the care they receive in hospitals, plus hormones in labour have the effect of reducing short term memory (hence women having more than one baby).

There is also the very British cultural aspect to it of being expected to be thankful that you didn't have it as bad as the woman in the next bed, and the fact that you are expected to feel that since you and your baby are going home in one piece that is all there is to the story. In general, US attitudes to the patient are informed by a general tendency to view the patient as customer or consumer -- not necessarily a good thing overall, but a very good thing when it comes down to attitude of staff in maternity units.

I haven't read the studies mentioned (and don't intend to) but am curious to know if the 'home births' included those that ended in hospital? Also does it include only healthy full term women and babies women with no other problems that would make them unsuitable for home birth (OK I know everyone can have one but some are advised not to due to other risk factors) Otherwise 'hospital births' results will be skewed due to the inclusion of more high risk cases which may have ended badly regardless of where they had occurred).

cleofartra - with all due respect, I have seen you elsewhere on this board demand that people to provide evidence for their views, when they contradict yours - fair enough - but then when they do this in the form of research or studies, you ignore it or dismiss them out of hand.

OK, that tends to be a feature of all internet debate - but if you're now refusing to look at American studies because they are American...

If what you are saying is that you disagree with what someone has to say, and will find a reason for ignoring what they use to support their statements, then could you just say that at the start? Asking them to provide you with 'evidence' is a waste of everyone's time. 'Evidence' isn't just something you already know of and agree with.

There is research showing that homebirths are as safe as hospital birhs for low risk women.

www.nhs.uk/news/2009/04April/Pages/HomeBirthSafe.aspx

cleofartra - you didn't used to post as tittybangbang, did you? Just a thought - sincere apologies and just ignore me if this is not the case.

Chynah - as far as I'm awaret hey compared like for like. So low risk, term women some of whom chose a home birth and some chose a hospital birth.

Should we get back to the OP question about what we should do about so many women being denied epidurals.

Anyone got any suggestions?

Hospitals should provide stats on percentage of women who receive epidurals, how long after the request is made that the epidural is given, and list in order of frequency all reasons for denial of the request, including non-availability of the anesthesiologist. All hospitals should be required to adhere to the same format in providing these statistics so hospitals can be compared.

"but if you're now refusing to look at American studies because they are American... "

Oh come on - that's a bit unfair!

I googled that study and read the abstract and summary conclusions.

It's a reasonable point that obstetric research done in the USA can't necessarily be treated as universal - their system of maternity care is SO different to ours, and you have to take that into account when considering how relevant the findings of these studies are to us!

"alleged 'different birth culture' there"

There isn't an 'alleged' different birth culture in the US. There's a profound and real difference between our systems of maternity care which impact with the way women's pregnancies and labours are managed.

Your system is obstetric led. Ours is midwife led.

Midwives (whose training and practice is VASTLY different to obstetricians) have been the lead professionals in birth for healthy mothers in the UK for decades!

Ah yes - I see you did used to post as tittybangbang, cleofartra.

I thought I recognised the style.

IIRC, you had one birth which involved epidural, forceps, epi, which you were very unhappy with - then 2 births after that where you did not have epidurals, including I think a homebirth, where you were happy not to have had an epidural.

Were you at one point training to be a midwife, or am I imagining things?

I am very sorry you had a birth involving an epidural that you were not happy about. I am pleased you had subsequent births that were happier experiences.

I think you do need to allow for the fact that for some other women, an epidural when they ask for one is exactly what THEY want and need for a positive and non-traumatising birth experience.

SO different? The system is not the same, but 'SO different'? Baloney. And apparently you do not trust researchers to adequately correct for various factors in their studies?

Your objections are farcical. The populations served in both countries are all women. The women come from various different ethnicities and various different socio-economic strata and have various different levels of education and knowledge of English. And the women all have the same anatomy and basically go through the same physical experience, wherever they may be, of getting babies to leave their bodies through an opening that is only just big enough.

Do you use medicines developed or sold by US pharmaceutical companies or do you refuse to on the basis that the people they were tested on had different accents from yours and spelled 'colour' wrong?

Obstetricians' training is vastly longer than midwives' training, and more detailed. They do not, as suggested upthread, focus only on abnormal childbirth during their training. OBs who have been educated in Britain work in the US and vice versa.

Hi Ushy and others who have replied to my original questions.
I have been contacted by an upmarket broadsheet journalist looking to run a story on this.
I'm trying to decide whether to go ahead as they want to use my photo etc. Does anyone else want to do this, as I don't want to do it alone
Let me know

"I am very sorry you had a birth involving an epidural that you were not happy about. I am pleased you had subsequent births that were happier experiences."

Please don't patronise me!

My epidural was fine. Actually it was very much appreciated. It was my care which was crap.

"I think you do need to allow for the fact that for some other women, an epidural when they ask for one is exactly what THEY want and need for a positive and non-traumatising birth experience.~"

Have you not read this thread? I've commented several times here, and on other threads MANY times about how important it is that women be listened to and have their wishes respected - whatever those wishes are.

I appreciate it's more useful for the sake of argument to try to ascribe to me the belief that because I didn't like my epidural I don't think anyone else should have one, but it's not really a fair reflection of what I've said on this thread or anywhere else on mumsnet.

If systems of maternity care were similar in the UK and US, surely you wouldn't have a c/s rate which was 20% higher than ours, and an infant mortality rate which was about double ours.

Sorry - that last comment was directed to mathanxiety, the other ones to gloyw.

Obstetricians' training is vastly longer than midwives' training, and more detailed. They do not, as suggested upthread, focus only on abnormal childbirth during their training.

So if they are better trained then why do we get reports such as these:

articles.cnn.com/2006-05-08/health/mothers.index_1_mortality-rate-death-rate-world-s-mothers?_s=PM:HEALTH

www.medicalnewstoday.com/articles/181934.php

Oh yes, for the second one it's obese women who are to blame!

I wonder if we could go back to the OP question and what some of the early posters like starlight wrote:

"ALmost 8 hours I was begging for an epidural. They 'forced' (and I do mean that because I was given no choice as I was told I wouldn't be allowed an epi until I'd tried it first) a pethedine injection into my leg, which had be begging for an epidural but a lot more quietly.

Then eventually they told me that they had arranged one but I was 8cm and would have to transfer to another hospital for it and that would risk the baby being born in the ambulance, so basically no longer enough time ."

How can we allow this to go on in a civilised society and do nothing about it?

What can MN do about it? This site has muscle. There is inhuman barbaric treatment going on in what is supposed to be a modern western democracy. Are we going to just sit there and let it happen?

"Then eventually they told me that they had arranged one but I was 8cm and would have to transfer to another hospital for it"

Had this person been led to believe that epidurals were available at the hospital where she had chosen to give birth?

Ushy - there are campaigns to improve the quality of maternity care, which would make cruel, coercive and uncaring treatment of labouring women less common. But I don't think you can legislate to make epidurals available to all labouring mothers can you?

I do think all women should be told to insist that when they request an epidural it's recorded in their maternity notes. I'd also encourage women to go above the head of their midwife and ask to see the midwife in charge or a registrar if they feel they're not being listened to. Sad that we have to prepare women to be combative in labour - it's all wrong. Actually it would be better to prepare partners to take a more active advocacy role - definitely if I was facing labour again this is an issue I'd want to thrash out with DH before we went in to hospital.

Cleo Agree - I don't think anyone would expect legislation but equally I think there are enough organisations who are supposed to be maintaining quality in the health service to expect better than we are getting.

Getting DHs to argue our corner is a good idea but what about those without DHs?

All MN posters have internet connections so we're probably not at the bottom of the income pile and at least we speak English.

If this is the kind of crap care we are getting, what is going on with women who are not very articulate or can't speak English?

So not legislation you're right but equally not lying down and letting this happen.

Sorry to drone - I'll start humming that suffragette tune soon:)

cleofartra - yes, to be fair, you have said elsewhere on MN:- "Amazing really that there aren't more profound effects with epidurals, given that they profoundly disrupt the hormonal cascade involved in labour and result in most mothers being immobile and having supine deliveries - both physiologically absolutely abnormal.

I had an epi with my first and found it a very interesting experience. Wouldn't have done it again though - don't like people fiddling with my body or feeling physically disabled."

I wasn't patronising you. You didn't want another epidural for the reasons you mentioned. Fair enough. I respect your experience.

I think the basic fact here is that some of us feel that women have a RIGHT to pain relief including epidurals in labour - and others don't. They see it as an optional extra, not a priority.

A very serious problem arises when you have labouring mothers desperate for epidurals being cared for in a system, and by individuals, who see it as an unnecessary luxury. It is this I object to, as strongly as I possibly can. It is barbaric and dehumanising to deny a woman in labour pain relief. It can have awful and far reaching consequences for the mother, her relationship with her baby, and the well being of the whole family.

Not read whole thread, it's a biggy.

I was given an epidural fairly soon after asking for one. BUt then I had a shift change and the m/w who came on next clearly wasn't happy about me having it.

She knew if wasn't fully effective, and when it wore off point blank refused to top it off.

She sat there and watched an obstetrician cut me open with scissors and deliver my baby with forceps without a pudendal block, an functioning epidural or anything else to block out the pain, and probably worse than that, the sensation.