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...

My advice to anyone about to have a baby would be not to have any expectations and dont tell them you want a natural birth without medication. Tell them you are open to any options during the birth.

I wanted drug-free for my first birth and it was horrible, went on for days and left me with depression following the trauma. Eventually I had an epidural and then ventouse. I feel the midwives should have used their experience and helped me make a better choice, giving me an earlier eipidural.

Many nurses I have spoken to since have told me I probably would have had an EMCS in their hospital.

There has got to be a cultural shift, you don;t ration out pain relief for any other experience in hospital do you? You donlt say, sorry we can't give you morphine to re-set your ankle/ shoulder etc as it requires someone to stay with you and monitor you??

Maternity care needs a lot more money pumped into it to avoif thses situations.

Mathanxiety, I am uk based. You are obviously not. We don't use Pitocin, we use Syntocinon. Augmentation is very painful and I quite agree that an epidural is necessary for some women (although I have seen women cope without).

Your experience of pushing with an epidural, will not be the next woman's. (and I disagree with your comments about vaginal trauma, 80% of the women I deliver without epidurals have an intact perineum).

NICE guidelines are the National Guidelines that as a maternity service we aim to work to and are based on the best evidence that is around at the time they are written.

As for my comments about transition, I stand by them. A woman in labour that has not been interfered with, does not need an epidural, she needs support to get though those 20-30 mins before her contractions change. Spending that time actively moving around the room, sitting on a ball/toilet, having a shower is much more productive than having her midwife out of the room trying to convince the anaestheist to come. Our Anaesthetist's will not site an epidural with a fully dilated woman anyway.

Canugess - thank you for the advice, I will try and book a meeting with the consultant midwife.

I am worried though about your suggestion that I develop "coping strategies". I do not want to "cope" - I want pain relief! I have coped before, so I know it can be done - I just don't want to do it and I see no reason why I should be forced to when ther is a perfectly adequate alternative.

I have never heard before that epidurals in transition "do not work effectively". Please can you give support for that statement? And is it therefore your view that an epidural can only be given between 4 (beginning of active stage) and 7 cms (beginning of transition)? If so, it is no wonder that so many women are denied pain relief as that window can be very short, even in a normal-duration labour.

I also echo mathanxiety - I completely disagree with your statement that women who ask for epdidurals in transition "do not really want them". This to me denotes a deep-seated view that epidurals are intrinsically a negative thing - otherwise why would you fight a mother's wish to have one even if she is 7 or even 10 cm dilated? You seem to think that you are doing the mother a service by ignoring her request for an epidural. The only way to justify this view is if you think a mother who goes drug-free is more deserving, therefore by not giving in to her request she will somehow feel "prouder" for having managed without pain relief. This is very patronising and a self-fulfilling prophecy: it is because of this attitude that so many women feel they have failed their labour when they ask for pain relief.

You think your endorphins are good enough to get you through labour pain - fair enough. But do not impose that belief on all patients. That is simply not a choice for you to make, in my opinion at least.

I spoke about coping strategies, more as a way of coping until there is pain relief available.

I'm not sure where you got 7cm = transition from. For someone having their first baby 7cm could mean still 6 hours to go (working on 1/2cm an hour ish). If an epidural was wanted and available then I have no problems with this. However, a 8/9 cm Multip could be one/two pushes away from birth. This is not appropriate for an epidural.

Midwifery is about so much more than the numbers on a page and ticks on a chart, it about being 'with woman' and know where she is at; how she is coping. It is about building a bond with the woman you are supporting. It is about trust.

Just to add my own experience and echo many of the other ones. Like many others before my first labour I wanted to go drugs-free. I am from Spain and there epidurals are almost the default position, I know no-one who would choose not to have one. My doctor friends could not understand why I would not have one. But I told them about the longer recovery, the intervention cascade, etc, etc. So, with DD1 I wanted to tough it out. However, I had to be induced, as my waters went with no sign of labor after 24 hours. No one told me it would be worse with the syntocinon. Within a couple of hours I had more pain I thought it was possible, but my midwive, who I liked to certain extent, told me that it could not be bad because I had not starting swearing at my husband. I took it as a joke and I hoped that she was not measuring my pain by that as I would never swear at anyone. When she examined me next she said with surprise that I was 6cm dilated. I asked how much longer it could be and I was told 4 more hours to dilate. I asked for an epidural as I knew I could not take that much pain for that long. Both my DH and myself felt that at that moment we lost her respect. She told me that labour is pain, although she did go and ask for a anaesthetist. I was told she would be with me in 30 mins. She took 90 mins to appear, during which time I became like a wild animal. My dh did his best but I could see in his eyes the horror of watching someone he loved experiencing that kind of pain. When the anaesthetist appeared I was examined and I was almost 10 cm. Magic! I pushed for two hours, had an episiotomy and I was left so numb and exhausted and somehow a failure for not having the perfect birth experience. For three days I did not want to look at my baby much or at myself, but luckily for me, I was able to put everything on the balance and know that I was well and baby was well and move on.
Two years later, I had to be induced again for DD2. I had planned to try drugs free if I didn't have to be induced, but once I was on that route I asked for an epidural before being on the synto. My midwife was great, told me "of course". I had such a better experience, I pushed in a very controlled way because she guided me, and even though I had a hefty baby, 9lb 10oz, the whole thing felt much more positive for both myself and my dh because I hadn't spent 6 hours writhing in pain and scared.

I think the basic problem here is womens perceptions....its called labour for a reason its hard work...and by throwing a hissy fit and being rude to the professinals certainly isnt going to enhance your care.....or improve your outcome.
often women have said i was 10cm within two hours..hello this is brilliant and normal...nhs labour wards are running on increasing numbers of women and decreasing numbers of staff and do the best they can with limited resources...if you want private then pay

'I am worried though about your suggestion that I develop "coping strategies". I do not want to "cope" - I want pain relief! I have coped before, so I know it can be done - I just don't want to do it and I see no reason why I should be forced to when ther is a perfectly adequate alternative.'

I felt the same with my third. They didn't check me again when the anaesthetist got there, after I'd specifically travelled by ambulance 1.5 hours expressly to get one and banged ON and ON about from the second I got there for hours, but my water's broke the second I sat up - and the other two times they broke as I was giving birth - and I felt like I was actually expelling the baby on my own.

But I had such trauma from my drug-free birth that it was literally mind over matter for me, the mind is that strong.

I was not going to have that baby with no epi, and my mind is more in control of my body than anyone else.

My son's head was enormous, he was well over 2lbs. heavier than my first (the second was smaller than the first). He was 9.5lbs.

I am so glad I did not feel that. I didn't want to.

My body, my choice.

'and by throwing a hissy fit and being rude to the professinals certainly isnt going to enhance your care.....'

Did you even read the thread?

Equating asking, even begging, for pain relief with throwing a hissy fit and being rude to professionals is one of the most misogynist things I've read on here.

So is the whole, 'Thou art woman, thou shalt suffer in labour' Genesis crock of shite.

Not even worth engaging with except that this type of backwards misogyny is a major part of the problem.

So those advocating epidurals on demand do you believe that there is any situation where one could be refused and that refusal justified?

Canugess, I always thought transition was the process of dilating from 7 to 10 cms? What is your definition of transition then, and how do you know whether a patient dilated at 8 cm still has 4 hours or 15 minutes to go?

If I can be so presumptious as t oanswer on behalf of Canugess. I refer to a woman being transitional just prior to beginning to push. That is often when women who up until that point have been coping brilliantly throw their metaphorical hands in the air and exclaim they can no longer do this, it hurts too much, get this baby out of me, I don't care how you do it, pull it out if you want, just get it out, I'm going home, I can't do it, I want my Mum.... You get the picture.

Midwifery is an art, as you become more familiar with the art of midwifery it is often little more than a gut feeling that leads you to the conclusion a baby is going to be born soon. Sounds mad when you say it like that huh?

A woman having her first baby, on average tends to take longer than a woman having second and subsequent babies. I say on average before I get a deluge of posters telling me about their BBAs with their first. A woman who has cracked on in labour with her second baby and starts asking for an epidural at 9cm is likely to have had her baby before the epidural can take effect. The more time you spend around birth the better you get at guauging situations.

Liznay Yup, I felt like that with my first child, it felt like the MW wanted me to write an essay on why I deserved to have an epidural. Funnily enough it was at the One Born hospital so I'm glad I didn't catch it this week!

I diagnosed myself with Post Natal Post Traumatic Stress Disorder, which is often mistaken for PND. Many marriages have been wrecked by it even. Have you visited Birth Trauma Association website? See Jessica's story under the Caesarean heading. I managed to cure myself by having my next baby the way I felt most in control - by elective caesarean at a different hospital and by avoiding midwives right up til I went in (GP did all my antenatal checks).

It does seem that midwives think they can look into your eyes and see how dilated you are. It's just foolish and potentially psychologically damaging to take anything for granted when it comes to someone with no birth history.

Wow, I'm suprised at the amount of national media response we've had. Well done everyone!
Lucy BTA, thank you for supporting this campaign and appearing on TV!
I think that the aim of this campaign should be that every woman giving birth in the UK gets support, advice, compassion and above of all, is listened to, with her wishes respected. This would allow all women to have the birth that they want, whether that be pain free, or completely unmedicated.

Thanks DrMcDreamy. I have to say though, it fills me with dread when you write that "midwifery is an art". I don't want artists to give me health care - I would much prefer to receive professional, medical care that would be science and evidence-based.

Sorry if this sounds flippant, but given the number of horror stories on this thread it does seem like miwives' intuition as to whether a woman needs pain relief can be - and very often is - wrong.

'I think the basic problem here is womens perceptions....its called labour for a reason its hard work'

Women are under no illusion that its hard work and unspeakably painful - that is why they want pain relief.

The problem is that women are being denied access to pain relief.

Why? Some people seem to be blaming it on money - although there seems to be no shortage of pain relief in other areas so I can't see this is really the case.

Which leaves us with the people who think that labour should hurt, women deserve the pain etc etc.

DrMcDreamy has summed up transition well.

liznay "every woman giving birth in the UK gets support, advice, compassion and above of all, is listened to, with her wishes respected." This is what I would say that most midwives would say they aim for. We do understand though that for some women this doesn't not happen. Through no fault of the woman or the midwife, more by the circumstances of the unit at the time.

Primafacie - The women I look after are well women. They are not ill. They just happen to be having a baby. Social convention dictates that we have our babies in hospital (many of whom could just have easily given birth at home) Therefore we don't refer to our women as 'Patients'.

NellieforBush - interesting comment on "no shortage of pain relief in other areas", I understand from a friend who is a staff nurse on an acute surgical ward that many of her patients are now coming back from surgery with epidurals in place, many having undergone bowel surgery.
This begs the question if there is money for epidurals in general surgery why is there insufficient funding for this pain relief in maturnity services?

Nellie there is insufficient funding in Maternity generally.

My gut instinct has always been not to have pain relief I was/would be scared of the loss of control of pethidine or epidurals. I want to be in charge - my body, my labour. I'd be frightened of not being able to move about and do what I needed to do to manage the pain - even the time it takes to administer would be enough to throw off my control - and once you let it go it's much harder to get it back I think.

On the other hand, for anyone that wants pain relief I support their right to it and they should be listened to. It would make me absolutely furious and depressed if I thought my mw was lying to me. I would much rather be told the anesthetist is too busy or we can't spare a mw to look after you. Straight talk builds trust.

I have just come back to this thread after a few days. I was a bit shocked to see (what I think are) my own words on the TV screen during BBC news this morning.

"I think the basic problem here is womens perceptions....its called labour for a reason its hard work"

I am medically trained, I have worked in obstetric wards. I was well aware that labour is painful and hard work. That is why I practiced hypnobirthing and spent the first 29 hours of contractions either standing or on all fours. There was a limit to how much I could take though and I recognised that I needed support.

When I went into the hospital I was shocked to discover that the midwife didn't seem interested in how I felt or how I had coped so far just what the monitor and internal told her. Despite a forceps delivery due to fetal distress and a PPH, it is this woman's lack of compassion that haunts me to this day. She made me feel like a failure.

I find the calling of midwives "Lazy arse" extremely offensive.
The amount of ignorance and misinformation set out here in so many ways is perhaps partially the failing of midwives.
However giving birth is an inexact science- some women cannot except this.

Canugess, I think what a lot of women are saying on this thread is that it is NOT just the "circumstances of the unit at the time" - it is often the attitude of the midwife towards pain relief that dictates whether or not it is made available.

I know what you mean Nomorefrizz. I am a mum too. But I spent 4 years studying at my families expense so that I can support other mums though a lifechanging experience.

To be called Lazyarse makes a mockery of all that stress, and blinking hard work. Makes me wonder why I bothered tbh.

i really do not understand why this mostly happens in UK.
I'm from Italy and all my friends (including one that is an anesthetist herself) gave birth with epidurals and highly recommended it...
for some labor progressed fast and there was no time but for most of the others there was and they had great experiences without slowing down labour or needing forceps (which by the way is not used in other countries, only by the barbarians in the NHS as a cheap alternative to expensive EMCS!)

people here seem to make of childbirth an ideological issue, with midwives fighting political wars to regain responsability about childbirth away from doctors. (by the way, did you know that you cannot sue a midwife, but you can sue a n OB GYN consultant?) and everyone treating women in a very patronising way,

with women making you feel guilty if you want to feel less pain or want to have the certainty and the lack of hassle of an ELCS. )both epidurals and ELCS are commonly recognized to have very low risks these days in most other countries... but if you listen to people here, they are really demonized)

I keep on meeting very opinionated people that just cannot rationally talk about childbirth and breastfeeding without a large dose of ideology.
My experience in other countries (i lived in France, Italy and USA) is quite straight forward. You choose your birth if you want, if not you delegate to an infrastructure that is funded well enough to be able to provide what's in your best interest. And when it can't (some hospitals abroad are also understaffed) they admit they cannot do that , so you try and hire a private anesthetist if you want an epidural.

why does it have to be so difficult here and full of all these rage, guilt, almost religious devotion to ideas like natural births, no pain relief etc ?