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...

DrMcDreamy - No I dont believe an epidural at 1cm shuould be standard. I do think if a woman asks at 5cm after >24 hours painful contractions that it should be delivered promptly.

I was told, when I arrived at the hospital to have dd2, that I couldn't be ready to have the baby, but because they weren't busy they would let me and DP sit in the room and someone would come and check me in a few hours.

DP then mentioned that DD1 had come very quickly and that I did seem pretty sure.

MW sighs and checks. Oh yes, I'm 10cm! Better be off to the delivery suite then.

Why did it take DP telling her for her to listen? Why was I dismissed as not knowing what I'm talking about? People don't normally treat me like that. Why suddenly am I stupid because I am now a woman giving birth?

The overwhelming impression I'm getting from this thread is not the epidural/no epidural issue, but more the - hey, I think I know what is happening because here I am inside my body vs. a don't be silly you can't possibly have the first idea, and besides don't you know we're too busy and overstretched.

The busy and overstretched I sympathise with, and think we should stand "shoulder to shoulder" to do something about it. The dismissing of a patient's feelings and requests has to stop though. If they are ill founded, the reasons have to be explained cogently and truthfully.

As do I. If it is safe to do so. By that I mean there are enough staff to adequately monitor the woman and her baby. I think we're on the same page here.

DrMcDreamy - I believe in giving women who are in pain the appropriate support and pain relief.

Much can be done through offering appropriate support and, as others have said it, nursing, during and after childbirth (I can't believe we have to advertise this fact!) I have a friend who had a horrendous 48 hour birth to the point of needing post-traumatic stress councelling) essentially because she were ignored and not listened to when she was in incredible pain. When the same friend was offered one-to-one midwife care during her birth (under the mental health act) she had a 4 hour birth, with no significant pain relief needed.

However, we are all adults, capable of knowing our needs and limits and if we ask for pain relief, that's what we should be given even if we are 'only' 1 cm. I have never really understood the point of refusing intervention in the latent phase 'because that can go on for days' - well exactly that's why women should be offered help and support to manage the pain!

And for what it is worth - I agree that we should sue if we have been refused treatment that should be forthcoming under the NICE guidelines. We should be pulling up hospitals on sub-standard care and unfortunately suing is a pretty effective way of doing that.

Unfortunately, NICE guidelines are only guidelines - afaik, individual PCTs/hospitals don't actually have to follow them. That doesn't in itself constitute a lack of care.

I recall a thread on this board fairly recently where someone (argh, I wish I could remember where this was - NE? Borders?) was shocked to learn that their hospital didn't offer any epidurals, full stop. It simply wasn't an option there.

Perhaps someone else here will know - if one was to approach a hospital when they felt their care had been very poor, with NICE guidlines in hand - would the hospital be obliged in any way to say why it didn't follow them? Are there any consequences to not following them?

Is it significant that two groups of patients are being consistently "let down" by the NHS - women in childbirth and the elderly? Surely it is the standard by which a civilised society is judged is by it's care of the most vulnerable? Judging by recent reports we are now heading towards third world standards if something is not done to halt and then reverse this lack of comapssion and care.

Did anyone else see that this thread was reported on in the Sunday Times page 11 this weekend?

However, we are all adults, capable of knowing our needs and limits and if we ask for pain relief, that's what we should be given even if we are 'only' 1 cm. I have never really understood the point of refusing intervention in the latent phase 'because that can go on for days' - well exactly that's why women should be offered help and support to manage the pain!

Absolutely, I do agree, however what I was asking was if people believed epidurals in the latent phase were the answer? An epidural is one thing in established labour, indeed it can be a godsend, I think to make them routinely available in the latent phase can never be a good thing. Aside from anything else we can get anything up to abot 20-30 women a day come through the doors in ?labour, if they all wanted epidurals where would the women who were actually labouring go? And who would be free to look after them and site their epidurals?

DrMcDreamy; should an epidural be given after 24 hours of painful but non productive contractions? ie only 3cm dilation?

Afterwards it transpires that baby's head was malpresented and all the contractions in the world were not going to cause cervix to dilate. I just couldn't tolerate that level of pain for that long, which is why I asked for an epi.

And yes, I had flashbacks after the birth, insomnia (PTSD) and still cry on my sons birthday. He is 6 now.

Sorry DrDreamy, cross posted! Glad to see your answer!

Of course nursing is part of midwifery - or it should be in a civilised society. The fact that the link is being dismissed explains a lot.

I am sick and tired of the argument that epidurals slow down birth. Even if this were true, I would personally have preferred a longer pain-free experience than the nightmare induction I experienced.

"But I am genuinely chilled by your on the wing definition of a MW as someone 'interested in the physiology of normal birth' - with the exclusion of 'nursing', as if that was insignificant, or not part of the role".

But nursing and midwifery are two completely separate professions. Midwives see themselves as 'the guardians of normal birth' (I know this idea might be repellent to you but there it is) in that much of what they do is simply providing the emotional and physiological support to give the mother the best possible chance of a healthy birth. Sometimes medical technology is the means they need to reach that end, but they start from a position of believing that in the right environment, and with the right care, the majority of women can give birth without the need for oxytocics and instruments. And they see this as a good thing because it USUALLY results in happier and healthier mum and baby. That's not to say they don't see nursing as a 'significant' part of their role. But there are many who don't see it as their primary purpose, which is why they became midwives and not nurses working in obs and gynae.

"I've remembered a very sad article in the Guardian by Emily Woof, which described how the independent MW she hired to help with her planned homebirth simply vanished when she had to transfer to hospital for an emergency CS."

Ah well - she's a journalist. She had an axe to grind and a good public forum to grind it in. I'd love to know the midwife's side of the story. And as someone who's had experience of giving birth under the care of an independent midwife (and who knows a dozen women who've done the same) I found her account completely at odds with everything I know about the profession. My midwife supported me through two difficult births, one of which involved a transport to hospital for syntocinon and monitoring. She did this for NOTHING (she delivered my second baby and did all my antenatal care and the birth for my third because she knew I couldn't afford to pay again). In fact all the women I know who have booked with IM have done so because it was the only way they felt they would be listened to and fully supported in their choices - whatever those choices were.

"I would have so much more faith in a MW who saw it as her job to support me, not turn me into a project, and potentially ignore my feelings and wishes as she did so"

You know I'm wondering why you've made it YOUR project on this thread to dig up previous comments I've made (none of which are actually controversial, unkind or inconsistent with what I've said here) and use them as a basis to mount a personal attack on me. I've found it puzzling and TBH quite upsetting .

I've said how important it is that women should be listened to. I've said some women need epidurals to have an birth they can cope with. I've said I'd like the government to hugely increase spend on maternity services so that more women could have good, responsive care in labour.

What is your problem with this?

Anyway - I'm abandoning this thread because I'm starting to feel rather hunted and bullied. Not nice. I suspect I've locked horns with you on some other thread gloyw, maybe said something you find personally offensive, and that's what's behind your attempts on this thread to vilify me with your talk of feeling 'chilled' by my comments.

Crikey

If ever I have had an incentive to have a second baby in the US this thread is it.

Had epidural at 4 cm at my request- i could have had it earlier but tried to tough it out.

It was heaven and i even enjoyed my emergency c section somehow.

But the bill came and it was 2000 bucks( we were insured) so i guess this is why they don't like giving them on the NHS.

The UK midwives were so full of doom and gloom about how medicalised it would be in the US- poor me.

It was amazing and I feel totally positive about the entire birth experience as i was not pressurised to do a drug free birth. I just do not get this sadistic push to have people do withour pain relief.

It's about money I guess- that is wrong.

cleofartra, you are not being hunted or bullied. You have posted a lot on this subject, under your current name and your previous one - as I've said before, I think you have a tendency to make contentious statements, then withdraw from them, or bury them in more superficially reasonable sounding arguments.

(Or not so reasonable sometimes - the idea that more epidurals on request will lead to more 'horror stories' of women giving birth alone in toilets and hospital corridors I called 'scaremongering', and I stand by that).

I have no problem with you saying how important it is that women are listened to. I do have a problem with you talking about the 'many' women who are denied an epidural, and are then 'pleased' they gave birth without pain relief, without saying how you reconcile this with listening to women.

And Emily Woof is not a journalist. To dimiss her traumatic birth stories with "Ah well....She had an axe to grind and a good public forum to grind it in" is callous of you, IMO. You say you found her account 'completely at odds' with everything you know about the profession of independent midwifery, as if you actually doubt the authenticity of her experience just because it differs from yours. I think she writes openly, painfully and honestly about her experiences and expectations of childbirth, and yes, I feel your attitude towards her is unkind.

Her article is here for anyone who wants to read it - www.guardian.co.uk/lifeandstyle/2010/mar/13/natural-childbirth-caesarean-emily-woof

And yes, I disagree with much of what you say, and how you say it. However, I have acknowledged throughout that you have a right to hold your views. You have no reason to consider yourself 'vilified'.

I was refused an epidural. I was 19. They even took my gas and air away because they said I wasn't paying attention. I couldn't shake the feeling I was being punished in some way for perceived irresponsibility in getting pregnant at 18. I was told many times when protesting it hurt that I should have thought about that nine months ago. I tore quite badly, I couldn't face the stitches to put that right after all that pain and with no pain relief on the horizon so I will spend the rest of my life mishapen vaginally. In the bath after the birth I nearly passed out from blood loss but was still too traumatised to accept any further pain in the form of stitches. When I first held my daughter it wasn't a beautiful experience, it was a distant and detatched experience I now know to be the aftermath of serious trauma. I had flashbacks, but I didn't dare tell anyone, I was already painfully aware how judged I would be, because I was 19.

I barely had sex for 2 years after that because the pain haunted me. Not the sex, the sex itself didn't hurt after a few months, but the memory of my vagina being literally torn apart as I was condemned by the professionals for not killing my baby off as a feotus when I had the chance. I found that beyond horrific. It was 11 years before I had my next child, in large part because of the birth of the first. No one has ever said sorry. When I raise it, as I periodically do, I am brushed off one way or another.

When I had my second child, at 30, it was a totally different experience. I got my epidural, I had DD2 relatively easily. I wasn't being punished.

Underachieving that's awful I'm really angry on your behalf.

This has been really fascinating to read, and I'm a bit ashamed to have only a tiny, N=1 point to bring to the table. But here goes ...

A lot of 'good' births on paper will have very different meaning to the woman involved. With DD2, I had a precipitous labour (90 mins from first twinge to baby) and arrived by ambulance. I climbed up onto the table, was examined, found to be complete with bulging membranes and two pushes later had my lovely, if 5 weeks early, daughter. My notes estimate my blood loss to be 100ml. As I pushed I was given the gas and air mouthpiece to bite on, but no gar and air.

Sounds pretty good, doesn't it? Healthy mum, healthy baby, minimum interventions - fab!! A midwife, reading my notes, told me how pleased I must have been to do it all naturally, and how lucky I'd been to avoid an epidural and all that.

I didn't feel very lucky. In fact, a few weeks after I was home I started a thread on here about whether or not it was normal or okay to scream during labour. This thread was prompted by the midwives who attended my delivery.

When I arrived at hospital, two midwives greeted the ambulancemen with rolled eyes and "so this is the one that called the ambulance. You do know it's not a taxi, don't you love?". I got further rolled eyes when I walked over to the bed, and with a sigh one midwife said she would check me to see if I should be sent home. At this point, she clearly felt waters and/or head, I'm not sure, but there was suddenly frantic activity. Nobody told me what was happening for a good few minutes, although most effort was devoted to telling me to sit absolutely still whilst the attached two monitoring belts. Predictably, the baby was too far down to get a good trace, but it did not stop them telling me not to move a muscle which as anyone would agree is bloody hard when you're about to have a baby. The midwife then re-checked me (why?) mid contraction, whereupon I screamed. She took her hand out sharply, my membranes ruptured and she informed me that I should push. I asked about pain relief and was given the gas and air mouthpiece to bite on but no gas and air as I in their opinion "didn't need it". As I pushed, I screamed again and the midwife sternly informed me that I was wasting my energy, to calm down and think about pushing. Another loud push later, and it was over.

I felt like an absolute fraud and a failure. I felt like I'd been an inconvenience to the midwives when I arrived, then a failure in their eyes for not being quiet and getting on with it. The birth was fast and furious but with the right support it could and should have been fanrastic - it had all the makings of one of those textbook births that DH learned about in medical school. Instead the feelings of shame associated with the event are only just now, a year on, starting to fade. I wished, and still wish, that I had simply stayed at home and given birth on my own / with DH's help.

That probably wasn't a point particularly well made (waffly, but mumsnet is a great place for birth catharsis) but what I meant to show is that a physiologically 'normal', no intervention birth in the statistics might mean something completely different to the mum - just as one medicalised up to the eyeballs (e.g. mine with DD1) could be fabulous. The common denominator in both occasions was a fabulous/not so fabulous midwife. I really wish more questions were asked about birth satisfaction. Whilst the results are suggestive of a complex interaction of factors(e.g. Hodnett, E. (2002) Pain and women's satisfaction with the experience of childbirth: a systematic review. American Journal of Obstetrics & Gynecology Volume 186, Issue 5, Supplement , Pages S160-S172) more needs to be done to elucidate these and to ensure they are reflected, as far as is possible, in current practice.

I have read Emily Woof's article. She criticises her IM for her first birth who, she says, cleared off because it wasn't a natural birth. She was then dealt with brusquely by a nurse on the post-natal wards.

She went to an obstetrician for her second birth, who made a mess of her delivery by doing a sweep which caused an ante-partum haemorrhage.

She then said "I am deeply grateful that I live now, when medical intervention has kept me and my children alive." This totally bewilders me - surely this obstetrician was endangering her child's life?

So is she calling for competent obstetric or post-natal care - both of which were sorely lacking? No, she slags off the NCT whose classes she chose to go to.

Still, it makes good journalistic copy.

Viva - if you read my post properly you will note that I said "most hospitals" when referring to a dedicated anaesthetist - this does not mean "all hospitals". Most hospitals do have a dedicated anaesthetist - if you share yours with another ward and this is leading to continual delays for labouring women requesting epidurals then this needs to be audited and the results presented back to the department together with a reminder of the NICE guidelines.

I have worked at a hospital which audits epidural insertions, including the time from request for epidural to the time the anaesthetist enters the room, together with a reason for delay if > 30minutes. It's not difficult to do when most epidural insertions are audited anyway - I would suggest getting it added to labour ward data collection if anyone is noticing a consistent pattern of anaesthetists busy elsewhere.

For the record, every hospital in which I have worked (deliveries ranging from 2000 to >5000) has had a dedicated labour ward anaesthetist resident 24/7.

Petsville - why lie? I don't lie exactly, I sidestep the question and concentrate on getting the woman pain free as fast as possible. Rightly or wrongly I feel that that isn't the time to destroy the relationship of a labouring woman with her primary caregiver. Once I've sited the epidural and she is comfortable, I'm leaving the room - she has to get through the rest of the shift or delivery with that midwife and it's not my place to make it more difficult for either of them. I do insist on correct documentation of times (including verification of pager records) in case there is a complaint made later on.

Effective labour analgesia is something I feel very strongly about (obviously, it's my job). I do think some women get a raw deal because I know some midwives don't approve of epidurals and therefore are more obstructive than they might be when they are requested.

Do I think an epidural should be available to someone asking for it at 1cm? This is a tricky one because you have to ask yourself if they are actually in labour at 1cm - which they probably aren't. However if the pain is so severe in the latent phase that they require an epidural to manage it this should trigger a lot of concerns about presentation, likely progress of labour (i.e. probably going to require augmentation with syntocinon in which case they will definitely need an epidural). If you're intending to get the woman into labour regardless then I don't think it matters if the epidural goes in at 1cm, 3cm, 5cm - if you're not going to induce her then waiting until labour is established is routine in most places (which is 3cm everywhere I've worked to date).

There are a few times when I think an epidural should definitely be sited early if requested (i.e. prior to 3cm) - tocophobia (extreme fear of labour/contractions), twin pregnancy, high risk labours (can be topped up quickly for heading to theatre), previous traumatic delivery.

If it helps at all - when I asked for my epidural with my first son I had to have the bath first, then pethidine x2 (which I hate, but wasn't in any state to refuse it), then walk around the hospital for most of the day leaning on my husband - about 5.30 in the evening having been asking since about 3am, my midwife finally agreed that I could have one. She didn't tell me the anaesthetists were busy (mostly because I had all their numbers in my mobile and could have called them all to ask what the hell they were doing that was more important!) - she said I couldn't have one because I wasn't in labour. Damn well felt like it (and having not been examined for ages, how did they know?) I was allowed it when they decided to start syntocinon (I refused to have the synto started without one). Point of this anecdote - doesn't make a difference if the patient is medical, in the system and knows who to call!

Hey guys, have been reading this thread but as I lack any experience of labour pain I didn't want to but in, but I have to ask...

Don't epidurals come with some side effects such as problems with back pain that lasts years? I have been warned off having one by a family member and two close family friends due to their post epidural side effects, the main being the constant back pain for years. They have actually said that they wouldn't have an epidural again because of it. I am asking as there is obviously a lot of pro epidural talk going on and it has sparked this question in my mind.

Also, shouldn't we be more upset at the lack of one to one care and resources for midwives available that is the root of this problem as opposed to the midwives and thier not wanting to give epidurals freely?

I have heard a lot of horror stories about birth experiences but I assumed it usually came down to overworked, overtired and underpaid staff and the lack of time or resources they had at disposal due to a lack of funding.

As I said, I do not have any experience of labouring to go on so my inexperience means I don't really understand, but just wanted to ask.

I don't think I will actually want an epidural and will try to ride out the pain, though when it comes down to it that may be easier said than done. I have many cousins who live in remote villages in other countries who give birth the old fashioned way, with the older women of the community on hand as opposed to midwives and pain relief. I am hoping I can do what they manage to accomplish. But like I said, most likely easier said than done and I don't understand the realities of labour and pain relief yet so feel free to school me, so to speak.

Oh BTW, I dunno if this stuff has been mentioned already as the thread is super long and I couldn't read it all! A very passionate subject for a lot of people.

underachieving your story highlights something I have suspected for a long time after hearing birth stories by teen mothers close to me, that you are treated differently and very insensitively if you are a teen mother.

LDNmummy There is no link between epidural insertion for labour analgesia and chronic back pain (in fact, epidural injections are often used to treat chronic back pain).

There is a short term (1-2 weeks) complication of bruising/soreness at the site of insertion but this is relieved with warmth, occasional over-the-counter painkillers, movement and sometimes massaging the area. Very rarely you can have a tender spot where the epidural was inserted which can last longer (some months).

There are many other side effects and risks of epidurals which were linked to earlier in the thread but here is another one:

Obstetric Anaesthetists Pain Relief in Labour leaflet

Well hospitals ARE dangerously short-staffed. And some are running out of essential equipment and supplies. And the NHS has been training people on the cheap for far too long.

My local hospital (Hemel Hempstead) shut down its labour ward several years ago. And its A&E. And so did another hospital nearby (St. Albans). All mums and emergency patients now go to Watford. So Watford is having to cope with a TRIPLE flow of patients. Without expanding its maternity ward. So of course when I rang in with contractions 5 min apart, they said, ring again when they're 4 mins apart. Then three. And a second-time mum from my town was sent home TWICE and eventually gave birth in the car.

AND IT'S ONLY GOING TO GET WORSE.
A public service is only going to be good if it's very, very, VERY well financed. While what both Tory and Labour governemnts have been trying to do for years now is to cut NHS budgets more and more, and at the same time drive in private medical care so that they can justify spending even less on the NHS. WHich will eventually destroy it altogether. Then all you and I can do is give birth behind the bush, with only cold rain and wind for pain relief. That's if the weather's right :o

'Midwives see themselves as 'the guardians of normal birth' (I know this idea might be repellent to you but there it is) in that much of what they do is simply providing the emotional and physiological support to give the mother the best possible chance of a healthy birth. Sometimes medical technology is the means they need to reach that end, but they start from a position of believing that in the right environment, and with the right care, the majority of women can give birth without the need for oxytocics and instruments. And they see this as a good thing because it USUALLY results in happier and healthier mum and baby. That's not to say they don't see nursing as a 'significant' part of their role. But there are many who don't see it as their primary purpose, which is why they became midwives and not nurses working in obs and gynae.'

What that sounds like to me is a bunch of women who know best, women with some sort of god complex, with a good deal of value judgement as to what constitutes a 'healthy birth' thrown in. It's very easy as far as I can see, if you see your role as Cleo describes, to cross the line from responsive to dictatorial.

The side effects and risks of epidurals were done to death upthread, and many of the alleged risks were shown to be infinitesimal. Basically you would have more of a risk of drowning in your own bath, an exponentially greater risk in fact, then some of the so-called risks associated with epidurals that were bandied about on this thread.

I had a spinal when I was 11 and had meningitis, and an epidural at 25 with DD1, and no side effects from either. I had a lot of shoulder pain from carrying DD1 around and again carrying all her siblings when they were babies, plus a good deal of back strain and ache, especially every time I put her down to sleep in her cradle -- leaning over and holding her carefully hurt quite a bit as she gained weight and I had to lower her over the side of the cradle and down with no chance to bend my knees as recommended for back health while performing such operations. Leaning over her in the bathtub had the same effect so I washed her in the kitchen sink for months. I had crushing hip pain during all my pregnancies that made sleeping well nigh impossible after 6 months. Backache and other pain is often a side effect of pregnancy itself and caring for your baby afterwards. An epidural will not normally result in lasting backache, not even frequently. It would be quite unusual.