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...

When told I would have to vaginally deliver my twins at 34 weeks because I had reached 10cm so quickly I thought I was going to pass out. I knew from my first delivery that I labour really well, but can not push for love nor money. For some reason it doesn't come naturally to me...

So after coming round slightly I asked sarcastically, suppose I'm too far gone for an epidural then??

Oh no, I was told, as its twins we can let you have 1. And I did get 1.

Ended up with a emcs anyway cos of wonky cervix!

I have read this thread with interest, even though I have not been denied an epidural I am more interested in the discussion about midwives.

I have just given birth to my son (6 days ago) in Torbay hospital and ALL the midwives were fantastic, helpful, supportive, empathetic and totally on my side. I was given my begged for epidural within 15 mins and whilst we were waiting for the dr all my drips etc were fitted and ready. The siting of the epidural took nearly an hour (ow), but the mw was fantastic.

I had a c-section in the end, but cannot fault any of the staff at all for all my time in hospital.

6 years ago I gave birth to my daughter in Northampton general. Same scenario, got the epidural when I needed it and ended up having a c-section. HOWEVER, that is where the similarity ends, apart from a couple of the mws I had, all of them were not really that interested in supporting me (thank god my mum and exh were there) and at least one was very nasty to me and derogatory about how much pain the VE's were giving me.

I had an epidural, but as it was New Year's Eve they all buggered off at midnight to watch fireworks on TV whilst I laboured. My Mum told me how at least one mw alluded to her that I was not being very brave about things (gee thanks). And don't even get me started on the after care! I was allergic to the dressing the put on my c-section scar and it took all my skin off when it was removed and I was denied a dressing, so left with a large open wound that stuck to my clothes for 3 days until I left hospital.

There are many more things I could tell you about my treatment at Northampton, and whilst the birth was not traumatic, being made to feel insignificant and pathetic by health professionals who clearly didn't want to be there made a lasting impression on me.

So I guess my question is, NHS resources aside, how can the care of midwives at 2 different hospitals be such polar opposites? It doesn't make sense, but thank God Torbay Hospital restored my faith in the whole birthing process, despite the birth being more difficult and painful than my first experience.

I'm a little surprised about people talking about one-to-one care for epidurals. I had an epidural from the get-go with DD3 (induced on synto, as I was a VBAC) but the mw left DH and I alone. I'm not complaining - that suited DH and I just fine. But are you all saying she shouldn't have left us? She popped in and out, making sure we were OK, and DH knew where the call buttons etc were.

All in all, it was a fab birth - DH was my one-to-one carer and, once I got to 10cm, the mw was great and really helped us to have a great experience. This was after having a failed epi with DD1 (ending up with em c-s under GA as the mw then would not believe me that the epi was not working).

I am so sorry for those of you who have had such terrible experiences, having been there with DD1

Any lady with an epidural or receiving continuous electronic fetal monitoring should have constant one to one care.

When I bilaterally dislocated my knee I was given morphine, but it wasn't even a tenth on the pain scale, or as prolonged, as my enforced pain-relief-free birth of dc1.

I am a rationale adult, tough cookie usually, have a good understanding of my body & do know of the amount of pain I can tolerate. To not listen and act upon a woman's desire for pain relief, when she is at her most needy & vulnerable, is a source of great sadness & anger.

By the time I left hospital after my first i was showing signs of PTS after a catalogue of horrible or just appallingly inept mw led 'care' that had lasting repercussions for me and my dc.

We were seriously going to drive 100 miles to a hospital with a good reputation for childbirth when I started labour, if consultants hadn't taken over and I agree with Expat, once consultants became involved in my subsequent pregnancies, my care immeasurably improved. I also have to add that once my births became radicalised the quality of mw care was excellent.

er medicalised, not radicalised!

I really don't think the quality of care a maternity unit provides can be measured on whether they provide epidurals on demand. What about all the things that have been proven to reduce the need for chemical pain relief, like one to one midwife care, good support, nice surroundings, encouraging homebirth. Bascially all that starlightmackenzie said except I have never had a pain free birth!

The thought that women might be offered epidurals in latent labour (except in extreme circumstances) horrifies me really. The implications for later interventions would be enormous.

I had a similar experience in Belgium, in hospital for 9 hours, first told it was too early to have an epidural, then told it was too late. But it was not because the midwives were lazy, far from it, they were incredibly supportive in encouraging me that I could cope.

And they were right, I did cope, and I had a far better experience then many of my friends who have had epidurals.

KangarooCaught - Maybe that's just what we need, Radicalised births!!!

That might be the mw aim...pain-relief free, natural birth...but it wasn't what I clearly wanted or needed. To counsel women away from using pain relief, because MW know better for my body, horrifies me.

I was induced for my last birth. I knew they'd get me to try other things first so I had the maximum dose of Diamorphine, still couldn't cope so asked for an epidural. She tried to talk me out of it with the usual "you're doing so well, you don't need one, etc etc" so I cried and flapped and asked repeatedly until she gave in!

My mum said it took 2.5 hours from when I first asked for it to when I actually got it. Very glad I asked ASAP - I'm pretty sure that if I'd gone into labour naturally & spent a long time at home before going in, I would not have got that epidural.

We've gone slightly off topic though here...
The point being that if a sensible, intelligent, woman in pain asks for something, then it should be given. Otherwise, there should be a discussion about why it's not available. The final decison should be made by the woman in conjunction with the doctors in light of the risks presented.
If you can cope with the pain, then great. If someone can help you cope, then that is also great. However, what is not so great is when someone tells you that should be able to cope and ignores you when you are at your most terrified. This is deplorable and shouldn't be current NHS practice.

Kangaroo, in my experience this isn't why epidurals don't happen. It is the operational constraints that prevent it being administered on demand. Like the mws who have contributed to thread have said, I have absolutely no problem with any form of analgesia as long as the safety of mum and babe are not compromised.

'I do not
believe it is always appropriate to administer one when
labour is not established because of the cascade of
intervention. Also labour is unpredictable and can
progress very quickly. The siting of an epidural can be
dangerous if certain positions cannot be adopted due
to advancing labour. An epidural can take up to a
couple if hours to be prepared for (Ivs sorted,
equipment obtained etc) sited and to be effective. This has to be considered along with if delivery is likely.'

So you're admitting that you make the decisions here regarding pain relief, not the patient who is in pain and asks for an epi early on. Even though NICE guidlines say it doesn't matter if she is in established labour or not. YOU are making that executive decision because you are trying to prevent this so-called 'cascade of interventions' (has there been any definitive study of women having had epidural pain relief and then requiring interventions and factors such as baby's size v. her pelvis, position of baby, cord round neck, etc. because it seems anecdotally that a lot of these women had deliveries which may have or did result in intervention anyhow) never mind what the patient wants.

We on this thread are saying the labouring women should decide that, should even decide the type of birth she wants.

You're upset and offended by comments here. How touchy! Are you like that in real life? That easily offended by strangers?

Because if so, it's not hard to surmise why midwives can get a bad rep.

Many of us are upset and some of us have developed serious conditions like PTSD, some have chosen not to have any more children, because of how they were mistreated by the very healthcare providers who were supposed to help them.

No, Expat. Nowhere have I admitted that I make the decisions - I was attempting to present some general info. I think I have been misunderstood. Like I just posted, dont care what pain relief a woman requests - it is her choice. I do care that safety is not compromised.

I have no problem believing operational restraints are a factor. But they didn't meet my needs re ANY pain relief and as I said upthread, I have problems today that had they listened to what I was saying could have been prevented. At my local hospital the rates for epidural (and this may include other pain interventions, not sure) it about 30% yet at an Oxford hospital where the anesthetist also worked, it was closer to 60%.

And this is why I want my mum with me when I give birth, as well as my DH. DH is v supportive, but there's a reason we've nicknamed my mum the Yorkshire Terrier and I want that fighting spirit fighting for me if I'm in pain and no-one's listening.

I really shouldn;t have read this thread when we're about to start TTC - it's putting me right off! Think I might just get DH to boink me on the head with a brick when it all kicks off (joke).

I agree that any rational woman should be entitled to pain relief when requested.

I always wanted an epidural, I never felt the inclination to try without. I just wanted to go in and have a baby as painlessly as possible.

Beatrice - the 'rational' in your sentence is annoying me. Are you suggesting that irrational women (whatever irrational is) should not automatically given the pain relief they want?

Lack of pain relief is not just a problem for women in labour; it's a problem for many people in acute and chronic pain.

I think rational is the best way of describing what I mean.

I don't know in what circumstances you would find an irrational woman, or as you say what irrational is.

I just prefer it to "sensible and intelligent" which the op used.

ra·tion·al   
[rash-uh-nl, rash-nl] Show IPA
?adjective
1.
agreeable to reason; reasonable; sensible: a rational plan for economic development.
2.
having or exercising reason, sound judgment, or good sense: a calm and rational negotiator.
3.
being in or characterized by full possession of one's reason; sane; lucid: The patient appeared perfectly rational.
4.
endowed with the faculty of reason: rational beings.
5.
of, pertaining to, or constituting reasoning powers: the rational faculty.
6.
proceeding or derived from reason or based on reasoning: a rational explanation.

The problem with using a word like rational is that it is open to interpretation, and many people may deem a women screaming and writhing in agony as irrational. A woman in labour probably isn't a calm negotiator.

The WHO definition of pain is very simply what a patient says it is and the pain relief should be given according to the patient's level of pain, according to the patient.

it's not about tricking, i totally agree with laluna....

it's a logisitcal staffing issue if you are not given the epidural straight away, not so the MW can see you suffer

I agree that it would be great if every woman got an epidural as soon as she asked for it, or could delvier in water, or at home, or whatever her particualr request mmight be

but on short staffed labour wards, its not going ot happen and mws can't always offer the support a woman needs to keep her going without the epidural, and that is a shame

Yes that is much better belgo - I really just tried to think of better description than ops which I thought was open to more interpretation.

Whilst I agree that many women suffer the consequences of not receiving the pain relief that they request, there are also a great many women who are really pleased and proud of themselves and grateful that midwives encourage them to manage without. Who end up labouring with gas and air and are Happy at the end to have done so.

They are SO many birth plans which state 'I don't want an epidural' yet a lot of these women underestimate the pain of labour so change their minds half way through. They (hopefully, and i know many don't) get their epidural.

There are also those who state in birth plans 'I don't want an epidural' who, perhaps in transition, beg for one, but it is often too late by then. They then end up without and are really fine with that because that is what they wanted in the first place.