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...

That's just a tick under one in four who doesn't get the pain relief she wants. I don't think that's very satisfactory at all.

If the Healthcare Commission report is unclear on exactly who/what they were counting, then it's not exactly useful however.

If the 24% who didn't get pain relief includes those whose pain relief didn't work or if the 76% includes women who got it but it didn't work and this is not clear in the report, then it's time for a new report. Two new reports really. One to gauge effectiveness of pain relief, in those who got it obv, one to gauge accurately who did and did not get pain relief whether it worked or not.

'.. whether it worked or not..' doesn't belong there.

That's a good idea, printing off the nice guidelines. I think though that one of the main problems is a women's ability to be an informed consumer at the most vulnerable point in their life. My main advice to first time mums is not to accept the midwife's edicts and to get their birth partners to advocate strongly for them.
What do I think we want?
Some ideas off the cuff:
Better staffing levels.
Change in attitude within the system- a tough one to bring about....by- Highlighting in the media (well done!!!) There has been a huge issue in the media over the treatment of older people. Should those of us with the worst stories go to the same organisation?
There must be lobby groups who have thought about this before!

Here is the article from today's Sunday Times.

---

Women denied epidurals in NHS cutbacks
NHS accused of tricking women out of having pain relief during child birth as maternity struggle with budget cuts and staff shortages
Jamie McGinnes
Published: 20 February 2011

The National Health Service is being accused of withholding pain relief from women giving birth because of staff shortages and cost cuts.

Scores of women vented their anger on the Mumsnet web forum last week, claiming they had been refused epidurals ? anaesthetic injections into the spine that numb the body from the waist down.

Some claimed to have been ?tricked? out of having the treatment and ?fobbed off? by midwives during childbirth.

The complaints followed one mother?s account of how she had asked for an epidural six times during seven hours of labour but was told first that it was too early and then too late.

The woman, identified only as ?liznay?, said: ?I am so angry ... I was ignored and treated like a small child. 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.?

Another woman claimed epidurals were withheld ?because they?re trying to keep their costs down ... and when someone has an [epidural], they can?t be left on their own?.

The Department of Health said it was up to healthcare trusts to maintain adequate staffing levels: ?Mothers need to understand their choice of birthplace will affect the pain relief available. Epidural anaesthesia will be available only in hospitals where there is a 24-hour anaesthetic service.?

Guidelines from the National Institute for Health and Clinical Excellence state ?women in labour who desire regional analgesia [ie, epidurals] should not be denied it?.

Liz Barnes, 33, from Surrey, endured a 27-hour labour when she gave birth to her daughter. Her repeated requests for an epidural were refused. ?Women are told in antenatal classes that pain relief will be an option during the birth, but the truth is that a sizeable portion of midwives don?t agree with epidurals and would rather you do it all naturally,? Barnes said.

Helen Payne, 40, from Chelmsford, Essex, said she was refused pain relief until the end of her labour, when she was finally given an epidural: ?I was roaring with pain and they just ignored me.?

Frances Day-Stirk, of the Royal College of Midwives (RCM), said midwives refused epidurals only when they believed they were doing what was clinically best. But she admitted that staffing cuts meant it was harder to cope with demand for epidurals.

?If a midwife is having to look after two women at the same time, it?s not possible for her to give one-to-one care to a woman who?s having an epidural, who must have somebody with her,? Day-Stirk said.

Nearly a third of maternity units saw their budgets fall last year and just under a third were asked to cut staff, according to a survey published by the RCM. Although midwife numbers rose by 12% between 1997 and 2009, the birth rate in England increased by 19%. The number of live births hit 671,000 in 2009.

Maureen Treadwell, of the Birth Trauma Association, is writing to the Equality and Human Rights Commission to ask if women are being discriminated against. ?There is no other situation in the NHS where people are left in such high levels of pain for such a sustained period,? she said.

I'm sorry, 24% of women not getting the pain relief they require is completely unacceptable. Especially combined with the treatment that often accompanies this.

There we are, the Birth Trauma Association.

Interesting to see official statements actually contradicted by other official statements, with the Dept of Health running straight bang into the National Institute for Health and Clinical Excellence, and through it all the refrain that when it comes to deciding where the available money will go, women's needs are sent to the back of the line.

Apparently there are more important things than women's pain relief during labour.

What I would like to know is if any labouring woman has actually been told that she cannot have an epidural because there is only one midwife between three labouring women.

Because Viva has said that that is often the case.

Do midwives say 'no, you cannot have an epidural because I would have to stay with you, and there are not enough midwives to look aftert he other women in labour'.

And are they allowed to actually say the truth, or are they instructed to fob women off and say 'yes the anaesthetist is coming soon' etc?

" Although midwife numbers rose by 12% between 1997 and 2009, the birth rate in England increased by 19%. The number of live births hit 671,000 in 2009.

Apparently midwife HOURS didn't rise - despite rising birth rate - because of increase in midwives working part time.

"Do midwives say 'no, you cannot have an epidural because I would have to stay with you, and there are not enough midwives to look aftert he other women in labour'."

Probably not, even when it's the truth and they're angry about it. Because telling a woman in the throws of labour that there aren't enough staff in the unit to guarantee her safe and appropriate care could send her into an almighty panic - not great in someone who's trying to give birth.

"I'm sorry, 24% of women not getting the pain relief they require is completely unacceptable. Especially combined with the treatment that often accompanies this."

But we don't know how much of that figure can be accounted for by women who got the pain relief they requested, but found it to be ineffectual.

If the figure of 24% includes these women then actually it's really not as bad as it looks, because a very large proportion of the dissatisfied 24% may be accounted for by those women who opted for opioids, and the 1 in 10 epidurals sited which don't work properly.

Would like to add - if you look at the HealthCare Commission findings, you'll see that well over a quarter of women report being treated unkindly during labour and postnatally

"of those respondents who stayed in hospital
after the birth, 42% said they were not always given the information or explanations they needed and 37% felt they had not always
been treated with kindness and understanding"

In other words - the problems go far, far deeper than just limited access to pain relief.

Thank you for pasting the article getOrfMoiLand.

What a horrible state of affairs - it's even more confused than I thought it was. NICE guidlines say epidurals should be given if a woman requests one, RCM say midwives would refuse an epidural if they believed that was clinically best -

• and what would be an instance of that? Are women told in NHS ante-natal classes or NCT classes what clinical circumstances would lead to one being refused? -

But then that gets mixed in with staffing levels, in a way that seems to need spelling out more brutally - that if MWs have several women to look after, none of them can have epidurals because one-to-one care can't be provided?

And no, 24 percent - TWENTY FOUR PERCENT - of labouring women not getting the pain relief they want is APPALLING. In what other medical/health circumstance would that be deemed alright?

If nothing else, this has finally prompted me to make a donation to the Birth Trauma Association. Thank god someone is being vocal about this. It IS a human rights issue.

gloyw - The stories on the Birth Trauma website are about far more than just women not being able to access epidural analgesia.

Read some of the stories.

In most of them there are a whole host of factors involved - uncaring behaviour or down-right cruelty from staff, severe birth injuries, lack of proper nursing care.

References to this thread (presumably) in the Daily Mail as well (at bottom of page)

link

cleofartra, I am aware of the BTA, and have read their stories before. I am aware they address issues other than availability of epidurals. Their stories certainly influenced my own birth choices, and I am very grateful they did.

For me, and for many other women on this thread about epidurals, epidurals being made available to labouring women who ask for them, is very, very important.

You have repeatedly said you don't place availability of epidurals as high up on your list of maternal services as other aspects of care. That's your view and you are entitled to it.

However, I personally do prioritise the availability of epidural anaesthesia. As I've previously said, I agree there are many aspects of maternal care that could be improved, but right now, from my POV, the fact that women are being denied epidurals to which they are, in theory, according to NICE, entitled, is appalling and should be addressed. And I welcome any coverage, publicity or campaigning which might help that. Hence my donation right now.

I hope that's clear.

pdf Womens Experience of Maternity Care in England from 2007 I believe. I couldn't link while in the document and the link I posted may or may not work.

There is no mention whatsoever of pain relief during labour but the availability of an opportunity to give birth 'naturally' (whatever that means) was described -- one Trust reported no women used the birthing pool though. Clearly the authors of this survey placed a high value on certain aspects of childbirth and not on others.

The high rate of disgust noted wrt cleanliness of hospital toilets is shocking. It is amazing that more women don't develop serious infections in hospital.

The quality of care and the attitude towards labouring women varies according to trust. Even such details as whether the bathrooms are clean varies. A lot of trusts publish the Healthcare Commission findings that relate to them specifically. Some trusts clap themselves on the back for an approval rating of 69% in a certain category while noting that nationally the rate is only 64% -- well whoop de doo for them. Who do they think they are fooling?

Statistics for individual hospitals are needed.

While searching for any overall and meaningful surveys specifically about pain relief availability, I did come across information related to birth position and tearing and episiotomies -- the more women labour and deliver on their backs, the more they are likely to have a tear or an episiotomy. So apparently that 'risk' is not all epidural related either.

Sorry, page not found.

"Statistics for individual hospitals are needed."

Here:

<a class="break-all" href="http://www.birthchoiceuk.com/BirthChoiceUKFrame.htm?www.birthchoiceuk.com/England.htm" rel="nofollow" target="_blank">birthchoice

They have detailed statistics on care in labour for all UK hospitals and birth centres.

"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.
"

The problem is, is that NICE guidelines are just guidelines and the hospital don't have to follow them. Therefore a complain would get you nowhere. You'd just get some letter of nothingness back from the complaints dept muttering something about they're very sorry you didn't get one but its impossible to focast workload on the labour ward, etc, etc. Hospitals can choose which NICE guidelines they follow and which they don't.

I have a condition that according to NICE guidelines states I should be prescribed a certain medication. I went to my GP and asked for it and was refused. I pointed out that NICE guidelines say I should have it. He pointed out that he's my Dr and the decision is his. I do understand that he has medical reasons for reluctance to prescribe it, though part of me suspects that cost comes into it.

I think it is important to find out too how many of the women in the 76% who did receive the pain relief they requested had to beg / plead / threaten for hours before they did receive it. It is not acceptable to make someone in pain beg for help, yet that seems to be the norm in the experiences on this thread.

BiscuitNibbler - there is also the fact that many women ask for an epidural during transition, and if they don't get one are often OK about it afterwards. Pleased sometimes. Generally not traumatised or angry.

How do we factor these women into the whole debate?

Typed a hugely long reply and then deleted it.

I am angry that people blame a lack of anaesthetists. Yes rotas are understaffed but there is always a dedicated anaesthetist for delivery suite (theatres and itu have their own anaesthetist in most places).

I have been the anaesthetist called in to find an exhausted woman at the end of her tether. I have been in the extremely uncomfortable position of being asked about the serious emergency that has kept me busy for 4h (since she started asking for pain relief). I have had to lie - because there was no emergency, I've been helping my colleagues or surfing the web for 4h and this is the first I've been contacted. And it makes me angry that I should be put in that situation.

I document clearly in the notes that I arrived within 10 minutes of being called and had not been called prior to that.

So while I'm sure none of the midwives here lie about the availability of anaesthetists - your colleagues do.

Technokitten, why do you have to lie? Should you be covering up for midwives who have so little compassion for a woman screaming for pain relief that they lie about calling the anaesthetist? Wouldn't it be better if those women had all the facts available so that they can make an informed decision about whether to complain of the treatment they've received?

technokitten, thank you for posting - it is very useful having an anaesthetist's perspective.

I see you do record accurately in notes when you were called etc - having a little knowledge of poorly run NHS sectors, and poor labour wards, I'm very aware there is a work culture that means rocking the boat/whistle blowing/questioning colleagues' behaviour can be incredibly hard. Have any women you dealt with ever questioned their notes, or the length of time it took to get their epidural after the birth?

cleofartra - I'm curious about your scenario of 'many' women asking for epidurals, being denied them, and then feeling pleased about it afterwards.

I'm tempted to do as you do, and say, evidence?? However, as you tend to ignore any evidence you don't agree with, I'm not sure how far that would get us.

My view is that it is a risk not worth taking. Why on earth would you gamble on a woman in pain being 'pleased' she'd been refused an epidural after the event, when the price of being wrong might well be a woman for whom birth was an awful, painfilled and traumatising event?

Crucially - if you don't believe a woman when she says she is in unbearable pain, and withhold anaesthesia because of that, on what basis do you deliver maternal care?

Why don't you tell us what you feel is appropriate when a labouring mother begs for an epidural??

one problem is, that you don*t get to see the notes, as they are taking for archiving more or less right after birth. (at least that was the case both times I gave birth).
so there is not much chance of the new mothers to read through. I would have loved to browse through my notes post birth.

Ha! This is exactly what happened to me, the midwife put her arm around me after the birth (after she had repeatedly ignored my requests for pain relief) and said, "I bet you are so proud of yourself for doing it all naturally?"
Me: "No, I feel traumatised!"

What right does anyone have to make decisions on our behalf?????

"I am angry that people blame a lack of anaesthetists. Yes rotas are understaffed but there is always a dedicated anaesthetist for delivery suite (theatres and itu have their own anaesthetist in most places).

"

Sorry but that's not true. Where I work now there is one anaesthtist for labour ward and gynae ward. So if there is an ectopic/other gynae emergency there will not be an anaesthetist available.

Ditto if someone is already having a section - elective or emergency, there will not be an anaesthetist available.

I have also worked in another hospital where afetr midnight there was only one for the whole hospital - so if there was an RTA and someone was in theatre due to that then women had no chance.