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...

oh forgot to mention the bit when the MW stuck both her hands up there and had a good go at turning him herself... still no pain relief. I was screaming by this point which just seemed to antagonise her

fifitot, I don't see on this thread a trend for a birth without 'inconvenience'. With all due respect, I think that belittles much of what has been said on this thread.

There is post after post after post here from women who were in extreme pain during labour, who begged for epidural anaesthesia, and were either denied it by their MWs, or were unable to have it (DESPITE NICE GUIDELINES) because it was not available in their hospital as a matter of policy, or there was no anaesthetist. OR they feel they were lied to by their MWs about lack of anaesthetist etc.

And an anaesthetist has posted to say they have been asked by a labouring mother what the emergency was that kept them away for 4 hours - when there was no emergency, and the MW had simply decided not to contact the (available) anaesthetist.

DrMcDreamy I appreciate that as a MW you have attempted to engage with other posters and explain your attitude, and talk a bit about midwifery in general. With so many bad experiences here MW care, that isn't easy.

However, I don't think that 'epidural no matter the costs' 'gang', whoever they are, getting their way means "maternity services in the UK will be taking a massive step backwards. back to the days of routine shaves, enemas and episiotomies, in a bid to keep childbirth sanitised, clean and painless"

And I think that post is very alarming. It suggests to me that there is an attitude in midwifery where epidurals are so associated with the 'bad way' of giving birth that MWs simply aren't dealing with individual women humanely. There is no earthly reason why epidurals should be connected to being shaved or having an enema (and frankly, if I was having an episiotomy, I'd bloody want an epidural - I find it shocking and barbaric that some women on this thread have had their genitals cut open without anaesthesia).

All women are asking for is effective pain relief when they are in pain. I don't want to hear another MW say their job is to be 'with woman' when they say in the next sentence that sometimes a women will beg for pain relief but of course, she doesn't really mean it, or that she will feel proud after the birth if she 'manages' without.

I don't see at all that women who want to deal with pain in labour will be prevented from doing so by other women having epidurals. It's just a non-argument. If like fifitot, they have an epidural and regret it - well, that's a genuine shame, but they might at least make different decisions with subsequent DCs.

But to say 'I had an epidural and regretted it, therefore I think there are circumstances where other women should be denied them' is just not humane or sensible.

I can only speak for myself but throughout this thread I have agreed that the experiences relayed here are terrible and should not have happened in many cases. I have tried in relation to some stories to discuss why that situation may have come about. I have also tried to explain why epidurals may not be appropriate and why antenatal education - GOOD - antenatal education is key. I have listened and empathised and yet am still met by many posters with venom and a scathing attitude.

I'm bowing out. I've done my best.

Technokitten - I did read your post properly thanks and have been back and read it now. You didn't say that most hospitals have a dedicated delivery suite anaethetist, you said that hospitals do. Further down the post you said that most hospitals have a dedicated anaethetist for theatre and ITU. If by that you therefore meant that there would therefore be another one for dellivery it wasn't clear.

IME ITU and main theatres do have a dedicated anaethetist but I have yet to work in a hospital where labour ward does, always shares with gynae theatre where I've worked.

Bollocks I have to respond to one further point. Episiotomies are very rarely done for anything other than a complete emergency, ie, your baby will die unless it comes out. That is really not the time to get an epidural. And before anyone accuses me of scaremongering that is how I practise, I don't like cutting anyones genitals more than you like the thought of it but if it's the difference between a live baby and a dead/brain damaged one I know whatI'll do. And pretty much only in those circumstances.

Right that really is me done. For my own sanity I can't read any further on this thread. Good luck to you all, I hope you get whatever you feel you need from the maternity services in future.

Meant to put that I'm suprised hospitals get away with a situation where they're having to prioritise crash sections against emergency ectopics. Never mind trying to fit pain relief in as well.

Sorry noisylurker, I cross-posted - that's an awful story, I am very sorry you had such a traumatising birth.

SO many shocking and sad stories here, it's overwhelming. Thank god people are speaking out. I think it's taken some women a lot of courage to post here.

I think that if I were TTC my first baby and read this thread I would go back to using contraception, save up to go private and have an elective csection.

And if anyone dared question why I would print out this thread and hand it to them!

I was told that no anaesthetist was available because it was a Saturday morning. They should have told me this before they induced me late on a Friday night.

I was also told I was being too polite and so couldn't be in so much pain - i just didn't want to antagonise the person who could get me pain relief.

Top dog of RCM said on BBC breakfast news this morning these issues arise because of a communication breakdown between the mother and midwife. I don't think so.

Noisylurker - your post resonates so much with me. I remember shaking uncontrollably as they tried to get a Spinal into me for the EMCS and when this was unsuccessful the complete and utter desperation I felt to get enough sucks of the General to ensure I really was out of it all. I was so terrified of being awake and in agony any longer.

Yep, still traumatised here after pain relief was refused (and then they went on about how well I was doing, and how they knew I could manage without). They offered me paracetomol, which I threw up, they then tried to put me off a suppositry of pain releif because I might be embarrased. By this point I was begging to be killed. The baby is nearly four and I am still now shaking at remembering it.

I ended up with a section, and I was 10cm. I had such a rare type of section (an inverted T cut)that the hospital where I had my next baby refused to beleive me.

It was terrible treatment, and made even worse by the birth afterthoughts woman coming round and praising me for how well I had coped. That was after two years of intensive psychriactric treatment to get over the failiure of care.

Thanks, gloyw. I was about to respond to your earlier post, but even typing 'well said' takes me longer than it takes for another 5 posts to appear :)

Interesting responses from DrMcDreamy. I am certain that there are good MWs out there - my SIL is one of them. But the experiences of the women on this thread are inexcusable.

Biscuitnibbler I know exactly what you mean. I would have taken General in a heartbeat although it is the one form of pain relief that I think I may have felt sad about in retrospect. I never know how to explain this to people without sounding either whimsical or melodramatic; but I was certain I was dying and I wished I could just hurry up and get on with it. That's shocking.

As a final plea for 99.9% of midwives-we do our best. It seems we can not do right for doing wrong. If we tell how difficult labour can be antenatally we are accused of being negative by some. If we try to be positive and encourage women to be positive about labour then we can in retrospect be accused of with holding the truth.
I hope that all women who want an epidural will get one straight away. I hope all women who prefer the support of a kind skilled and engaged midwife instead of/as well as an epidural will get that.
I work really hard to give good care what ever the circumstances and have read this thread in dismay.
We are mostly child bearing women ourselves.
Some of us can empathize with some of the comments here as service users. Some of you seem to forget that.
Child birth can be complicated on so many levels. It can be straight forward.
Resource problems which have been described here several times have to be addressed politically.
Thankfully we receive 100's of thank you letters so not everyone feels dissatisfied with their care.
Midwives keep on keeping on- tomorrow's another day.

Has this been covered in the press at all? It's shocking. Where are the journalists lurking on mumsnet when you need them?!

I experienced a birth when you want an epidural but can't get it, but for different reasons.

I did get an epidural - 5 attempts in fact. But none of them worked, not one bit (I suspect perhaps he didn't get the spinal tap going into the right bit). I didn't know pain like that existed.

I'm shocked to hear so many of weren't allowed to have it, I didn't release this went on.

Is there something in the culture of midwives in the UK that causes some to be less compassionate than we would like?

I can't really comment so am wildly presuming but the few I dealt with before leaving the Uk for the US were really clipped and kind of ungracious and they really scare mongered about what a medicalised birth I would have in the US " You won't have a midwife deliver your baby you do know that"

I secretly thought....well if they are all as clipped and humourless as you that might not be a bad thing.

It was like they were in competition with the doctors or something. Another told me to watch that rikki lake documentary- the business of giving birth which was just a really biased bad piece of documentary frankly.

Some of the stories on here are really dreadful.

I am sure there must be good midwives out here but why has not one of my friend's in london had a positive birth experience?

Something needs to change.

I would happily site an epidural for someone at 8, 9 or 10cms dilated. If they can be pain free to allow for an hour's painless descent it gives them a rest before pushing. It also allows for painless suturing if required, a top up for forceps after 2h pushing and no sign of the head descending, anesthesia for removal of placenta should it get stuck. I would not refuse an epidural based on being fully dilated but in my consent chat I would mention the likelihood of delivery before it becomes fully effective.

Epidurals in transition do work but you need to put the right stuff into them - the dilute mix that is fine for early labour is not adequate for later labour and drug choice needs to be amended. Some more junior anaesthetists may still use dilute mix at 9cms which won't give an adequate block at all.

For the benefit of an earlier poster - I am an anaesthetist, have sited several hundred epidurals and would always recommend them. I had 2 textbook normal deliveries (induction with first) and an epidural for both because I preferred not to be high as a kite on G&A or exhausted from pain.

I don't know and have not worked with any doctors who would not choose a hospital delivery. We see what happens when things go wrong far too often (and are obviously not involved when things go right which they do far more often!) - this gives a skewed view of life and we tend to err on the cautious side with ourselves and families.

There are some very few women in whom I would refuse an epidural. Anyone with blood clotting problems (low platelets or had had recent heparin injections - risk of bleeding into the spinal canal), anyone with previous spinal surgery that had rods, plates or screws still in place (risk of infection in the metalwork), anyone with severe sepsis (high fever, white count, low blood pressure - risk of seeding infection from bloodstream to epidural or spinal space), anyone with a specific heart valve disorder (aortic stenosis - complex reasons but they do badly with regional blocks), anyone with known severe allergy to local anaesthetics.

I would hope that these women would be referred to clinic early on in their pregnancy to discuss pain relief strategies and whether an epidural would be appropriate, plus anaesthetic plans if they need a CS. Some people who I wouldn't put an epidural into I might still try a single shot spinal, for example.

I have read through this thread with interest. We currently live in the US and have been very happy with the healthcare provided.

DH was due to be moved to the UK but his employer have now changed their mind on that as they don't want us to be apart while I am heavily pregnant (well thats their official excuse!). We were never going to have our first in the UK after I had such a horrible experience over the phone with the midwife units in Manchester.

While US healthcare isn't perfect you get what you pay for. I have an obn group who manage the health of the baby and myself during the whole pregnancy and hand over to the paeditrican (for the baby) at the hospital and my primary care physician (GP) after I finish breastfeeding. In my group there are 4 obn's and I have had appointments with two of them so far. My appointments are every 4 weeks, with appointment times available from 7am-9pm during the week so I can fit them.

So far a couple of huge differences have been noted:
1 - I don't pay a co-pay while pregnant. Normally I have to pay $50 to see a specialist (ie a consultant) that my GP hasn't referred me to.
2 - My obn group has insisted I take prenatals. I swear they have enabled me to stay cold free during the winter months.
3 - The obn's who have been seeing me during the duration of my pregnancy will be delivering the baby. They will have gotten to know me. Already they have determined I am not the right candidate for a late term pregnancy and have told me that they will induce at 39wks to avoid an emergency situation.

The attitude of the NHS stinks. Residents pay a lot of money through taxation to fund the system. I have calculated that by the time we include all costs we pay roughly the same here in the US but we get fantastic healthcare, have a pension worth something and enough left over to have a pot to piss in.

I think there is a place for midwives in the maternity ward but they should not be directing healthcare. That should be left to obns who spend years in training to treat the mother and the safe delivery of the baby. At our local hospital the job of the midwife is to help the mother bond with the baby, breastfeed and show the mother how to take care of the baby (ie how to hold, wash, change the nappy etc etc). The ratio is 3:1 and all mothers get their own private room (with wifi so you can skype family and friends).

Another thing that shocked me. The maternity unit at our local hospital is a non-profit unit. If you don't have health insurance the cost of delivery is a flat rate of $7800. If you can't afford it they have assistance available through their charity fund.

OP, my experience was almost identical to yours.

Had to accept it and be thankful my experience was still a positive one ultimately.

I could go on but I'm sure you would have had a similar range of feelings about this.

Technokitten thank you for posting on the efficacy of epidurals during transition, it is very interesting to have an expert's point of view - and reassuring to see they work! Can I give birth at your hospital please

W2bsupermum, as a student midwife in the uk I would rather be cared for by a midwife than a doc as they often have much more experience than a junior reg. The idea of a system as you describe in the states horrifies me.........maybe we should all pack off to NZ to be appreciated!

Technokitten - out of interest can I ask what drug/epidural mix choices you have where you work? Where I am we have preloaded epidural syringes that are a fentynal/bupivicaine mix. These are the only things I've ever seen being used. Not sure if The Drs have access to other stuff and just don't use it but I've never heard of other stuff being available.

Want2besupermum - I wish I worked in the USA! 3:1 care sounds amazing. I normally work on labour ward but when I am on postnatal ward the ration can be 12:1 on a bad day, 8:1 is normal.

I wish technokitten had treated me first time around.

DrMcDreamy - I do understand your points and I can see why you feel no-one is listening. If you come back, can I ask a question? On the discharge sheet I remember the times for transition phase etc, were wildly different to what DH and I felt I experienced. One of the midwives I saw (out of 5 shifts) was also surprised. How long after a birth can you ask for your notes?

FWIW - I had an episiotomy with my first DD. Several days of labour, G&A, pethidine, epidural (eventually), ventouse, baby in SCBU. I was physically and mentally exhausted by the end the time the baby was born, and then we had uncertaintly as to whether we would have a healthy baby - low apgar, blue, not crying etc.

I should point out that my communiy-led midwife care pre-natally was excellent. But I had hospital midwives for the birth as the community ones werent on shift.

FunkyGlassSlipper - you can ask for your notes for years afterwards, I think they keep them for 25 years.

My computer summary of my labour is also wrong - it says I had entenox and I never did. I now work with the midwife who looked after me and one of the things I was pissed off about my labour is that I wasn't "allowed" the entenox when I asked for it. I sometimes think about ordering my notes and seeing what was written.