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...

Am yet to meet an anaesthetist who doesn't recommend to everyone to have an epidural. They are paid to perform them after all. However, if everyone had an epidural then the service would collapse. There are is not enough staff to facilitate that level of care. Nor are there the resources to fund that level care. The maternity services are running on a shoestring as it is.

My particular labour ward, should run with 8 midwives per shift day or night. We run with 5/6 regularly. It is not safe for women to have epidural's in these circumstances. The risks to women and their babies is too great.

What are the actual risks of an epidural? You hear so much about them but never hear of anyone who actually experienced them.
I know tons of people who have had them (inlcuding myself) and I have never heard of the tinest problem.
Women are posting on here because they did not get an epidural when they asked for one, and Sagefemme, you say that it 'not being able to birth their baby how they wanted to' that left women traumatised.

Maybe the issue is more about expections not being met. Again we come back to the notion that our desires and needs should be respected, whether we wish for pain relief or not.

Maybe the MWs are talking people out of epidurals then, because they know they don't have the staff on duty to give one-to-one care. If that is the case, then it doesn't matter what you put on your birth plan, or how well you communicate with your MW, you are not going to get it unless there is sufficient staff to look after you. If this is the case, then we are blaming our MWs for not respecting our choices, when really this is not their fault, but the fault of successive (male dominated) governments cutting services to the bare minimum.

DH backed me when I said I didn't want pethadine as I didn't want it to make baby drowsy and my mum had a bad reaction to it so I just wanted to skip to and epidural - mw tried to tell me it would make the baby drowsy just like peth which my research hadn't said! She also told me I was only early stages - 20 mins later baby was in my arms - mw didn't listen to anything I said and the trauma left me seeing a consultant to arrange a c-section for 2nd dc before we'd even conceived. If I had to go through a labour (not the pain) with that lack of support through out again I would rather adopt. The thought of my dd's birth still has me in tears 3 years on and dh was pretty traumatised by the care. I could actually cope with the pain but the confusion and panic from the mw was horrific.

Suzeyshoes Technokitten link in a leaflet about epidurals in labour today at 3:37 am. If I remeber well, serious headaches, back pain, etc.

I had an epidural. It was scheduled, and after birth they even asked about my experience as a kind of customer feedback. I was very impressed. Had no side effects so far. I was in a big hsopital though.

I was so grateful for the anaesthetist turning up, as the midwife really struggled putting the needle in my hand for the oxytocin. I think I coped well with the labour pains, but somebody unsuccessly poking needles into me was quite annoying.

'sagefemme': 'In line with current evidence, and contrary to what the BTA state, most women who had self defined trauma had actually HAD an epidural, and out of all the women only a handful described pain as a contributory factor.'

Just to clarify, the BTA is not 'for' or 'against' epidurals and nowhere do we state that having an epidural will guarantee that you have a non-traumatic birth (I'm not entirely sure what you're referring to when you say 'the BTA state'?) I'd be very interested to see the study you worked on. Is it possible to provide a link?

As you say, sagefemme, it is perfectly possible to have a traumatic experience with an epidural. I had one myself, as mine was turned off needlessly. And yes, lack of control is a huge factor in finding a birth traumatic. That lack of control can occur if you are desperate for an epidural and denied one, or if you are given one when you would prefer to avoid it. Post-traumatic stress disorder following birth, as I'm sure you know, is a complex condition. It can arise from a whole range of factors.

Can somebody switch Droid m185874 off please. It appears to have malfunctioned.

bbc this morning

This is what NICE guidelines for parents have to say.

Epidurals:

• Don't always give 100% pain relief.(very distressing for the mother)
• Mothers/Babies need extra careful monitoring (ie BP's every 5 mins following every top up) Continuous fetal monitoring.
• A Urinary Catheter inserted. (to prevent bladder distention problems)
• IV access required.
• There is an increased risk of instrumental delivery ie forcepts/Ventous/Kiwi (with episiotomy/stitches).
• Can effect your babies breathing immediately following birth and make the baby drowsy (this in turn can interfere with feeding)

I have also seen an epidural become dislodged and cause maternal respiratory arrest. (vary rare but it does happen)

Oh and really bad headache that necessitates another minor procedure to cure.

Interesting thread juxtaposition.

How frequent are these side effects though?
They are there in black and white but, and maybe this is just an impression, they seem to happen so rarely in practice.
I also mentioned earlier about CSE's, the type of epidural which allows you to remain mobile during labour. These are common practice in other european countries and would reduce the occurance of intervention and tearing.
I'm not trying to encourage epidurals at all and I am certainly no medical expert, but it feels like there is so much fear driven into women about epidurals which then adds to the anxiety and stress during labour. Add to that the reluctance of midwives to give them (whether a cost cutting measure or personal preference) and something which is considered normal practice in many countries is considered the devil in the UK.

I was in hospital for 5 days slow labour things got moving and there was one midwife who came in to check the progress she then left it was another 2 hours I pressed the buzzer as it hurt she came in and refused to check me as she and one other person previously had checked and she was worried about an infection. I was like WTF? She was a nightmare my mum stepped in and said look she is in pain sort something out. She checked I was 6cm. Although she might of been right (I work in Microbiology) its thr fact she was rolling her eyes at me when saying it. I found this very rude. She was in the wrong job. I went to the delivery area after this and the midwife there was amazing she offered me and epidural as I was sooo tired. Bless her she was fab she was in the right job. I have moved now and worry this hospital/midwives will not be as good. I had a good experiance and now worried this one wont be! They dont seemt o check things here very well and suggested a home birth did not look at my notes saying I was high risk.

As for being short staffed thats fine but I have worked in Labs for the NHS and if were short staffed its tough! We have to get on with it and not only that get lots of abuse on the phone for results if there not done quick enough!

m185874 you have pointed out that we do not know whether you are male or female, to that point, we do not know whether you are even a parent or a mother who has given birth before. Have you given birth before?

A genuine question as I feel that someone who has would be much more tactful in putting forth an opinion such as yours.

Oh and thank you to those who answered my questions. Much appreciated as they had already been covered further upthread though I had not seen that bit. I cannot remember who said it but I lol'd so much at the giving birth behind a bush in the cold remark!

This thread as I follow it is definitely informing me ahead of time on what to possibly look out for when the time comes and ways to handle situations that may arise. I am definitely going to be quite assertive in what I want ahead of time to try my best and avoid people making decisions on my behalf. Of course birth will not always go according to plan but its worth trying.

First of all I'd like to thank Liz, Lucy and everyone else who have brought this unacceptable situation to the media's attention. I have been following this thread since its beginning and I have been very troubled by the number of women who receive inappropriate care in labour.

There seems to be a prevailing orthodoxy, largely fostered by midwives, that pain in labour is somehow "good for you", or at least unavoidable. In order to support that prevailing view, the risks of epidurals are massively overrepresented. In fact, epidurals are nearly risk free - a recent study showed that permanent sequels only happen in 1 in over 80,000 mothers. This is much less risky than previously thought. news.bbc.co.uk/1/hi/health/7821056.stm

Pain in labour is NOT a good thing, no more a good thing than getting your teeth knocked out without anaesthesia would be good for you - unless you want to suffer, in which case of course you should be allowed and encouraged to go drug-free. The fact that so many mothers feel like failures because they have had to request pain relief in labour is deeply regrettable and sad and is indicative that that misinformation and scaremongering has worked.

Perhaps more inspiration should be drawn from the Canadian health system which as the NHS is publicly funded. In some parts of Canada the epidural rate is well over 80%, yet the CS and intervention rate is much lower than it is here, and maternal/infant morbidity is also lower.

My experience of giving birth in a London hospital is sadly similar to what so many others have posted above. During my antenatal care and when I visited the labour ward, I was repeatedly assured that epidurals were always available. However, when in labour I was denied appropriate pain relief for no medical reason. I was 4 cms when I was first examined. After having examined me, the dragon triage midwife asked me what was my birth plan in terms of pain relief. I said I wanted an epidural and while they were calling the anaesthetist could I have a shot of pethidine please. Her reply was that they had no room for me to labour in, and therefore could not offer any pain relief at all. Why ask then ? She said my only options were to labour alone in a triage room, or to agree a transfer to a midwife-led unit where at least there would be a midwife with me - but no pain relief. She then warned me that if I agreed to a transfer to the MLU, they would refuse to take me back to the CLU, even if a room became available later. I asked to be transferred to a different hospital so I could get my epidural - the dragon triage midwife laughed at me and said if their ward was busy, every other ward must be and no other hospital would let me in. I therefore reluctantly agreed a transfer to the MLU under what felt like duress. I was scared and I found the pain atrocious, all the more so because I had not been prepared for it given what I had been told antenatally about the availability of pain relief. Over the next few hours and until the birth I repeatedly asked to be transferred back to the CLU for an epidural but was fobbed off for the rest of my labour. I must be the only person in the country who had an unplanned water birth she did not want.

After the birth I spent months of sleepless nights playing the pain of labour again in my head. I eventually wrote to the head of midwifery to outline the above and get closure. She met with me and formally apologised and agreed policies had not been complied with. In the same breath though, she suggested I consider a home birth next time as she thought, going through my notes, I had "done really well"! I was speechless and felt completely misunderstood - surely given the trauma from the pain she should have realised a home birth was the last thing I would want? And I really resent the suggestion that giving birth without pain relief is a badge of honour.

I am now pregnant again, and again having sleepless nights thinking about the pain I am about to go through. If anyone has suggestions on how to ensure I get appropriate pain relief this time, I would be grateful for them.

Well I started my training at the end of 2006, and have seen one respiratory arrest and heard of one other in that time. Feeding problems following epidurals are very frequent and not just confined to breastfeed babies.

The headache problem probably one or two a month. As with any risk, it could be 1:1000 but if you are the one it isn't funny. If you are caring for that one in one thousand it isn't funny, nor is it the midwife's fault. Stitched perineums are also more common in women who have had epidurals (no feeling means, that pushing is uncontrolled)

I personally have seen many a midwife encourage women to have epidurals (sometimes inappropriately). It depends on the woman and her circumstances.

As midwives we all know that an epidural in transition does not work effectively; and that the whole palarva that goes with its siting, causes the midwife to leave a woman, just when she needs you the most. Often continuous positive support will get a woman through a sticky bit of labour long enough for her endorphins to kick in and give her the natural pain relief she needs.

Women used to ask to go home at transition - nowadays they ask for epidurals.... it doesn't mean that they really want them, rather it means that they can't cope with this stage for much longer. It is a sign, that she is really getting on with her labour and is almost there.

Primafacie - May I suggest that you contact the hospital you gave birth at and ask to meet with their consultant midwife and ask to go through your notes.

Second babies often come much quicker than first babies and there may not be time for you to have an epidural. If you plan some coping strategies now, you will be better prepared.

all this talk about if women have the right encouragement and support n the early stages more would be able to give birth naturlly could well be true - but it dosent happen thats the point. i was 12 hours to get to 3cm with first labour, OP, and was told - go home take paracetamol have bath - was crying in agony was awful, eventually admitted at 3cm and midwife came in said 'your doing FAB' without even looking at me and left us alone just popping in every hour to tick boxes on the paperwork (she also told us she had never had kids herself - just what we wanted to hear). eventually ended up having two pethadines, then epidural then forceps over the course of next 24hrs (multiple midwife shift changes no continuous care), so it obviously wasnt progressing properly anyway. But with NO one on one care, being ignored and left in the room, being told everything was fine when clearly wasnt and not knowing what the hell was going on - the simple courtesy of being spoken to like a human being and having things explained to us would have saved a lot of the trauma of this birth. have had successful text book labour since then, but am no way gonna risk doing it again as will never forget the awfulness of that first time!!

well I had EMCS and my experience was good in general apart from rant by theatre organiser as had EMCS at 8.30am as obs theatre not open till 9am so was done in main theatres and obviously I was not out by 9 so had messed up his schedule for the day and he will not be able to complete ticky box exercise so running on time I sort of understand as he will miss target and that gets penalties but if you had waited 18 weeks for your knee replacement would you really be that heart broken at being 20 mins late becasue of EMCS!!

however NICE guidelines are not just guidelines that you follow if you want to

I am a dentist and there are NICE guidelines about extracting wisdom teeth, if you do not follow the guidelines and there is a problem afterwards it can be extremely difficult to defend your actions if you do not follow guidelines, the way it is judged is did the healthcare professional do what a similar healthcare professional would be expected to do, as a dentist I would be judged on extractions as a dentist not a consultant oral surgeon however if i did something that i had insufficient experience of I could be blamed for not recognising my limitations and referring.

So a midwife should follow guidelines the management of a hospital can not decide not to implement or follow the guidelines ( something on news yesterday about 50% of hospitals not following some medical protocols and some even ignoring more than 10 of these routinely)

We expect pain relief in every other branch of the health service occasionally if someone has very badly inflamed nerve in tooth can be difficult to get numb but you can't say you had one injection you must be wimp get on with it ( ok dentists did say that in 1960's but we have moved on) sometimes it is difficult to take time when it takes 30 minutes for someone to go numb and you are running late and waiting room full and when numb still have treatment to do,

so why are women treated so babdly regarding pain relief? too hormonal excited to make rational decisions, they should be honest to every one " we do not have enough staff or anaethetists to offer any epidurals before 4pm" for instance

did not james simpson do his research on anaesthesia to help pregnant women? and got knighthood from queen victoria as she thought it was best thing ever when they say women have given birth for centuries without pain control so you can do it well yes we probably can but we don't use that argument re central heating, running water etc

so the midwives need to stop being so defensive and look at the complaints and see them as a way of improving things and show some compassion that said in my experience about 85% of midwives are great

Demand, demand, demand. I had a hideous experience with DS1 - was induced, left on antenatal ward for 36 hours with broken waters, contractions, throwing up etc, writhing in agony, but no rooms... Eventually got a room and they wanted to put me on drip to speed up contractions (still only 3 cm) but I INSISTED on epidural first - knew I coudln't take more pain. Got epidural and an hour later, with no drip necessary, I was at 10cm.
DD1, two years later, we raided our savings and went private. So expensive we're still reeling from it, and we're the lucky ones who could make that choice. Worth it, though. Not only was epidural available on demand but the pain relief afterwards was way better (co-codemol etc)
But it isn't just maternity. My mum was in hospital last year for major operation and her pain relief wasn't working/made her sick. Took me and DH insisting on seeing consultant and fighting her corner for her drugs to be changed - as soon as they were she started to recover and within a day was sitting up - before, she'd been in a really bad way.
It's money, time, resources. Iknow the NHS is wonderful and everything but it simply can't cope with the demands we place on it and what we've got is a service that gets the outcomes required, but with often really inadequate care. Did anyone see the documentary on hospital food last night? Part of the same problem I think.
But who's going to be brave enough to suggest changing the beloved NHS even if it's creaking under too heavy a weight?

The Independent Midwives association has been pushing for a new system for several years now. Similar to what they have in New Zealand ie Caseload midwifery were Midwives would have a set number of women to look after and see them at almost every appointment and either deliver them (at home or in hospital) and then look after them postnatally.

www.independentmidwives.org.uk/?node=11338

www.aims.org.uk/

I didn't have experience of epidural personally but I was really angered by a midwife that came to speak to our NCT group. She told us all about a woman who didn't speak great English, who came into the labour ward screaming for an epidural as she was in so much pain. This midwife then went on to explain how she'd basically talked her out of it, given her back massages, walked her around etc and every time the woman asked for an epidural she distracted her. The baby was apparently born with no complications and an intact perineum, which the midwife entirely put down to her "natural" birth. Our NCT teacher was beaming away at this "great" example. Ok, she may not have had complications, but the whole point surely is that in years gone by, women did not have a choice. They had medical births as that's what was decided, by others, was best for them. And now here's an example of the same thing, but to the other extreme. This midwife was so proud of herself, but intact perineum or not, she still took away that labouring mother's choice, at a time where she was most vulnerable. Which is exactly what the NCT (or our teacher at least) demonise "the medical profession" for doing. Having had my baby I now have a huge problem with how the NCT operates.

Women's decisions should be respected, whatever they are, and they shouldn't be talked out of pain relief by midwives who somehow think they know best. This is what we fought for years to avoid.

Canigress, funny enough, a link posted not too long ago (a pdf epidural leaflet) stated in flat out contradiction to what your NICE 'facts' say, that there is no adverse effect on babies' breathing associated with epidurals.

It is also grossly misleading to suggest that an epidural goes hand in hand with a catheter. It is not necessarily so at all.

IV access is required for many women who do not have an epidural, and frankly IV access is not a big deal. A canula goes into your hand or arm and remains in situ until after the baby is born. You may get a bit of bruising. What's the big deal?

Again, a very rare thing that can go wrong is cited (but thank you for stating that is very rare) as if it should somehow factor into a woman's decision to have an epidural. If the very rare things that can go wrong were to be a factor in how we live our daily lives, we would all spend our days hiding out under the dining room table in fear of being shat on by birds, hit by busses, run over by cyclists. You are far more likely to drown in your bathtub than to fall victim to any of the alleged risks of epidurals.

A few more points from your posts, Canugress:
Pushing can always be controlled. It takes vigilance and a good deal of work from the nurse, doctor or midwife directing the patient, but in every single delivery of mine, including the one with the epidural, I pushed when I was told to and the final push to deliver the baby's head was always done in a very controlled manner. For the delivery with the epidural, my doctor gave me feedback constantly as DD1 made her way into the world and I was able to follow instructions wrt strength of effort. I had a small episiotomy each time except for the last delivery, done to prevent larger, less predictable, and harder to repair tears (episiotomies are not the horror they are cracked up to be either). Very few perineums survive delivery intact, epidural or no epidural.

'Women used to ask to go home at transition - nowadays they ask for epidurals.... it doesn't mean that they really want them, rather it means that they can't cope with this stage for much longer. It is a sign, that she is really getting on with her labour and is almost there.'

GASP. After all that has been said here, that statement is incredibly arrogant. It does so mean that they really want an epidural. They have been told they can have one, and they want one. Give them the bloody epidural and don't patronise them. They are only seeing it from their own pov when they ask for an epidural. It sincerely does not matter to them what their pain is a sign of. Epidurals were designed so that they would not have to feel that pain that makes them ask for help, by people who do not think pain is a necessary part of childbirth. (i.e. people who are humane)

What you personally have seen and heard of do not constitute actual quantified risks. If you as a medical professional are going to talk about results of epidurals you need to give figures here. As has been said before, no it isn't funny if you're the unlucky one out of 100,000, 10,000, or 1,000 who has the bad experience, but the fact remains that when you're deciding as a patient what to do, it's your judgement that counts. FWIW, I had meningitis as a child and had a spinal and survived the headache afterwards. It's bad but it's not as bad as labour on pitocin, not by a long shot.

Primafacie, thank you for your great post. Yes, the risks of epidurals have been massively overrepresented and I believe shockingly misunderstood by many who posted them.

I think its appalling - if you want an epidural then you should get one, unless there is a specific medical reason why not. After all, no one would expect anyone to have a tooth out without pain relief, so why a baby??

I feel very lucky. I got an epidural more or less as soon as I asked, and there was an anaesthetist available. My midwife was brilliant.