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...

"Can you explain what you mean by epidurals which aren't medically necessary? Are there any circumstances were a labouring mother said she was in a lot of pain, and requested an epidural, where you would feel it was legitimate to deny her?"

There's no legitimate reason to deny a mother an epidural if it's possible to site one safely and if an anaethetist is available.

Ushy - there is no 'campaign' against epidurals.

I also feel it's not a good idea to form your ideas about the complex debates among birth professionals from reading articles in the Daily Wail, because they always distort and over-simplify the issues.

"It would have been lovely to have CD music of my choice playing during my DS's birth. It wasn't possible. I have not been left traumatised by this."

I think you've trivialised and distorted what I was saying.

I was talking about having access to water for pain relief in labour, being able to have your baby at home, and being looked after in labour by someone you know and trust.

For some women these things can make a difference between having a traumatic labour and having one they find bearable. I think it's just as valid to argue for increasing the availability of these things as it is to argue for the increased availability of epidurals. More so because there is clear EVIDENCE (at least in the case of continuous care and homebirth) of improved clinical outcomes and lower rates of PND.

Quite right, Chynah.

cleofartra, I apologise for misquoting you - the phrase you used before about some epidurals wasn't 'unnecessary' - you mentioned women having epidurals for 'non-medical reasons'.

It was in response to a poster suggesting that mothers wanting homebirths should have to pay for them. You retaliated: - " I'd agree with that ONLY if women wanting epidurals in hospital for non-medical reasons were also charged for the cost of the procedure."

Here (when you were posting as tittybangbang) - www.mumsnet.com/Talk/childbirth/1065093-Ever-wonder-why-so-many-women-are-scared-off-by/AllOnOnePage

Can you tell us what you would define as a 'non-medical' reason? And how you envisage MWs or other HCPs deciding what is/is not a medical reason for an epidural?

"I would have thought that in this day and age (in a civilised (?) country) a person in hospital and in pain would get pain relief when they wanted it (oh yeah, they do don't they .... just not if they happen to be in labour!)"

Well - generally women do get pain relief. But they don't always have access to the most invasive or expensive forms of it because of a lack of resources in the NHS.

This isn't just true of labouring women - this is true of other people using NHS services.

There are many people having to cope with pain and disability which would be relieved by physio and other sorts of therapies, who are currently languishing on waiting lists.

There are many things wrong with the NHS. The way women are treated in labour is part of a wider problem. And it's not going to get better any time soon.

Cleo -" I was talking about having access to water for pain relief in labour, being able to have your baby at home, and being looked after in labour by someone you know and trust."

appreciate what you're saying and maybe water and midwife cuts it for some women but the woman who started this thread ( and numerous others after) didn't want water or a midwife they wanted an epidural - and from the sounds of things they aren't getting them.

I believe women in labour should have CHOICE
to have our choice of pain relief on request or to go without if that is THEIR preference (not some midwife making the decision on your behalf)

Well - generally women do get pain relief. But they don't always have access to the most invasive or expensive forms of it because of a lack of resources in the NHS.

For "most invasive and expensive" read "effiecive".

I would think that the costs for treating all these women with PTSD or PND due to enduring an agonising ordeal with no effexctive pain relief etc probably adds up too (but it's probablycoming out of another areas budget so no one really cares)

cleofartra - a lack of epidurals is not just a question of NHS resources.

There are other, very important issues - there are plenty of stories on this thread, which I assume you've read, where labouring women have been denied epidurals by their midwives.

These are MWs who believe that women should give birth without epidurals because it is better for them, or the baby, or both.

That is not to do with resources.

I'm genuinely interested to see what you define as an epidural requested for 'non-medical reasons', as per my previous post.

What is the definition of 'medically necessary' anyway? The developers of epidurals and the doctors who administer them know women can theoretically get through childbirth without pain relief (and always did, through history). They just don't see the point when it can be safely accomplished otherwise. What they don't hold is the opinion that they somehow know best what is good for women, or try to persuade women that levels of bonding with their babies or how they feel about them can be measured and should be used as indications against an epidural.

And it does not necessarily indicate a higher risk for the ultimate intervention either. The '4 cm before an epidural' mantra was dropped by the American College of Obstetricians and Gynecologists in 2002; the development of the 'combined spinal epidural' and the 'walking epidural', and studies related to their development called into question the earlier assumptions that epidurals lead to a cascade of intervention, ultimately to more CSs.

Chyna - I don't know why you're being so combative with me.

The link you give is to a HYPOTHETICAL discussion about the rights and wrongs of charging for epidurals or for homebirths.

My point was that you can use the same arguments for charging for epidurals as you can for charging for homebirths.

cleofartra, I think you mean me, not Chynah.

Yes, the thread contained a hypothetical discussion about charging for homebirths - and you, posting as tittybangbang, posted to say that you would only accept that if women were made to pay for epidurals that were for non-medical reasons.

That's rather different to saying you can use the same arguments for charging for epidurals as you can for HBs.

I don't think asking you to clarify what you mean is being combative. I do think you have a tendencey to make contentious points, and then retreat from them - or disguise them in more general arguments.

Just my view. I would still genuinely be interested to know what you mean by 'non-medical reasons' for an epidural.

PS the reason I ask you cleofartra what you mean by 'non-medical reasons' for an epidural is because I think the view that epidurals (or some of them, in your view?) are non-essential medicine is partly why women are not given them when they ask.

There is a world of difference between something that is viewed as a necessity, and something viewed as an optional extra, or a luxury.

As I've said before, it's not just a question of resources. There is the idea that a woman could, or should, 'manage' without an epidural.

I happily admit I disagree with that. Wholeheartedly.

" posted to say that you would only accept that if women were made to pay for epidurals that were for non-medical reasons."

Meaning if an epidural was needed to improve clinical outcomes (for example for a c/s where general anaesthesia is more dangerous for mothers or babies).

I think the problem I have with some of the opinions expressed on this thread is the view which comes across that pain in labour is in some way INTRINSICALLY harmful. As far as I'm aware there's no good evidence that widespread access to epidurals - in isolation of other factors - is linked to an overall reduction in rates of PND or PTSD. For me this suggests that massively increasing the spend on this type of pain relief in labour - particularly in the absence of other improvements in maternity care - won't lead to a more humane system or mothers who are happier with their births over-all.

"There is the idea that a woman could, or should, 'manage' without an epidural"

There's a very big gulf between 'could' and 'should'. The majority of women 'can' and 'do' manage labour without an epidural and do not emerge from birth suffering from PTSD or PND, even if they've experienced severe pain.

Now, before jumping down my throat, I still believe like the rest of you that epidurals shouldn't be deliberately restricted or that women should be 'fobbed off' by midwives who think they know what's best for them.

But I do think that if tomorrow the government put a £100 million extra on the table for maternity services and I had to think about how best it should be spent to improve women's overall satisfaction with their births, I'd be blowing the lot on having extra anaesthetists.

Not the pain itself; that is not intrinsically harmful and no-one has said that, as far as I can see anyhow.

It's the ignoring of the pain and the request for pain relief going unanswered or meeting argument that is intrinsically harmful, the 'there there dear, count to ten, breathe..' or 'another half an hour and we'll check you' and finally the 'so sorry, the anesthesiologist is away taking care of drunk yobs so you'll have to grin and bear it/ it will all soon be over anyway and we'll get you a cuppa for your trouble' that is intrinsically harmful.

Women go into hospital expecting to be treated as they are treated outside of the hospital -- as thinking and feeling human beings, and the shock when that does not happen is what causes the harm. It is that that makes the adjustment to motherhood so difficult. Yes some see it as a rite of passage, and even if it isn't appreciated at the time that is what it really is, because a woman is changed forever when her baby comes into the world, but does it have to take the form of a 'hazing', featuring submission to authority figures, humiliation and endurance of pain?

I ove the idea that women 'can' and 'do' 'manage' labour without epidurals - like there is a choice and they can just cross their legs and decide not to continue giving birth. They (the ones who wanted one and didn't get one) manage because they have little other choice.

I expect a lot of pain experienced in hospital by patients in general insn't 'intrinsically harmful' but they still get pain relief for it.

"I ove the idea that women 'can' and 'do' 'manage' labour without epidurals"

Well they do! Most women have access to a birth environment where epidurals are available. Most women who request an epidural will get one within 40 minutes.

But most women don't want an epidural and a growing number are opting to give birth in environments (birth centre and at home) where the only way of getting one is to transfer during labour.

Mathanxiety - we are all singing from the same song-sheet when it comes to women being given RESPONSIVE care in labour.

Well ladies, our campaign has gathered ground and we have made it to page 12 of the Sunday Times. I think we could have got a slightly larger article or more prominent slot, but I was reluctant to have my photo taken Anyhow.....
Well done to you all!
The question is, where do we go from here?

Chynah makes a very good point - a lot of pain experienced through injury and illness isn't intrinsically harmful, if you simply define harm as physical.

When I was given painkillers after I broke my foot, it didn't help my foot to heal faster. It stopped me from being overwhelmed by a pain so severe that I couldn't think of anything else, that had me constantly in tears and feeling utterly miserable. Taking a holistic view, I feel they were necessary for my mental health.

Could I have 'managed' without them? In the sense I would almost certainly have survived, and my foot mended, yes. In the sense that it would have tranformed a shocking experience into a very traumatic one, with greater and longlasting negative consequences for my mental health and personal life - no.

If you map that template onto birth and motherhood, then you say a mother has 'managed' because she and her baby are alive when birth is complete. Never mind how atrocious and traumatically painful an experience it has been for her - never mind how that affects bonding with her baby, her relationship with partner, medical professionals and plans for future babies.

No. Because she has 'managed' someone's ideal of a non-epidural birth, and kept the hospital's 'on the day' costs down.

What an inhumane way to treat women.

liznay, that's great, well done! Any chance anyone can paste the article, what with having to pay for Times content now?

I agree with what gloyw says. Pain is almost never "intrinsically" harmful in the sense that leaving the patient in pain would make whatever is causing the pain worse.

In fact you could make a perfectly plausible argument that pain is the body's way of telling you that something is very wrong, medicating it will block those natural messages and the patient might not then behave in a way that gives them the best chance of recovery. Funnily enough, no-one makes that argument except in relation to labour pain. If I've broken my leg, not offering pain relief when the bone is set won't make it heal any worse, but most HCPs would think it was pretty inhumane not to offer quite serious painkillers.

I was sent home after my gallbladder op with a codeine Rx that my exFIL (a surgeon) looked askance at for the sole reason that codeine can be addictive and is too easy for an addict to get access to. He never made any objection on the basis that I should be feeling every twinge in order to determine how my recovery was going.

He was definitely of the old school attitude of grinning and bearing it when it came to pain, but his thought on postop pain was that with early discharge after inpatient surgery, denying patients pain relief resulted in more return visits to the hospital with imagined recovery problems, and too many phone calls holding up doctors with requests for pain relief Rxs.

I'm so glad that this issue has been highlighted in the press, thank u all. I'm due with #2 in 3 weeks and the PTSD I was diagnosed with after #1 has been crippling for months, panic attacks, flashbacks, feeling trapped etc. All due to, as has been mentioned, not just the actual pain but the way I was treated by health "professionals".
What can we do now? Any ideas of organisations, lobby groups? I've already written to my MP and had the unusual bland nonsense response. I just can't help feeling that there is a very distasteful undercurrent of misogyny, and that if it were men giving birth the appropriate pain relief and the appropriate respect would be built into the system.

I think your suspicion is justified, Sarah.

I'm interested to know what SPECIFICALLY you feel should be asked for or put in place.

Current NICE guidelines are:

"1.5.3 Women in labour who desire regional analgesia should not be denied it, including women in severe pain in the latent first stage of labour."

and:

"1.4.1 Healthcare professionals should consider how their own values and beliefs inform their attitude to coping with pain in labour and ensure their care supports the woman?s choice."

Do you think legislation is needed to ensure that all mothers get an epidural on request? How would that legislation be framed?

Perhaps the answer is for every woman to print out a copy of the NICE guidelines and take it into hospital when they're in labour and threaten to make a formal complaint if its recommendations aren't adhered to.

I think it might be necessary.

And a standardised report issued by every hospital detaining the percentage of women who ask for an epidural who get one, and if not the reasons for denial, listed in order of frequency, as I suggested above, just so that a woman could have some idea what she was really in for and gauge the likelihood of being denied her rights/dealing with a healthcare provider who had different priorities than hers.

1.4.1 should be self-explanatory for healthcare providers, but I think it's important to be careful when addressing the subject of risk to know what you're talking about, to take a good look behind the figures, and not to misinform.

"the appropriate pain relief would be built into the system."

With respect though - most women DO get the pain relief they request. This suggests the system works for the majority of women. In other words, there's no systematic attempt being made to deny women pain relief.

Overall 76% of women reported that they got the pain relief they wanted. (Healthcare Commission survey results)

I don't know if these figures take into account how effective the women found their pain relief. Given that in 1 in 10 women who have an epidural, there are problems with getting it to work properly, and that pethidine is only effective for about a half of women who try it. I'm wondering if the 76% who got the pain relief they "requested" includes those who had an epidural or pethidine/meptid and who found it ineffectual.