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...

When I went into labour spontaneously (waters broke 4 weeks prior to scheduled ELCS)and I went into hospital the midwife that I intially saw wanted to know why I was scheduled for a section when I explained that it was complicated and that all of the details were in my notes and that I would be having an EMCS if this very situation arose. The midwife huffed and puffed and left me, not to return. After 6 hours of extreme pain from labouring (still no EMCS yet) with no pain relief another midwife came into the room I was in to retreive a piece of medical equipment that was not in her room. I screamed and begged for some form G&A or and Epidural whilst I waited for a theatre to be availble. She tutted, open a cupboard and tossed the gas and air hose at me and said if you were in so much pain you should have just grabbed this!!

Ummmmm...yep like my DH or I even knew that the G&A was in the cupboard or that we could 'just grab it'. I was completely ignorned for 9 hours of labour. The shift changed, a new midwife and consultant came on and I was rushed to the theatre for my section as I was so close to birth. This proved to be even more stressful as my contractions were seconds apart and my epidural did not work the first time and they had to do it again! Had they been more prepared with the pain managment the rush and panic could have easily have been avoided.

I received a Diclofenac suppository for pain relief immediately after my EMCS and was offered no further pain relief. I stayed in the post operative suite for about 4-5 hours after the birth of DD while waiting for a room on the ward and then I had to walk to my room (no wheelchair, not wheeled on bed, no further pain relief and epidural worn off). Yep that's right I walked to my room.

It is interesting to see the differences in maternity care between here and in North America (where my family and many friends are) and the care is OB/Gyn led rather than midwife led.

All of my friends who have had children that wanted an epidural were given one before they were in any significant amount of pain. They are told to start the pain relief before they 'really need it' as this is when it is most effective and can be best controlled. This seems to make the most sense to me. I suffer badly from migraines and am under the care of a neurologist who time and time again tells me to ensure that I take my medication prior to the pain exacerbating as this is how pain medication should be taken.

Most of my friends back home talk about enjoyable family events where they experienced very little pain because pain relief was given early, topped up regularly if needed and if any interventions (episiotomies, forceps, etc) were needed they were often un-noticed because of the excellent pain management.

is it a conspiracy then?

think conspiracy is too strong a word.

but definite reluctance without a doubt.

i think it does take resources away as so many women are saying they were left alone for hours at a time.

with an epidural they can't.

Yep, I had to beg for gas and air, none was forthcoming, o was lay prone on the bed in agony... Went in at 9pm, didn't get examined til midnight when I was told it was too late as 9cm... I was a wreck, and then the worst insult was afterwards when the "lovely" midwife was stitching up my tear (3rd degree), I was basically told to get a grip and "focus" on my baby to get me through the barbarity... Ok so I h1d some anaesthetic at this point, how dare I scream?!

first time i was told to keep waiting until it was too late.

second time there wasn't an anaesthetist available.

third time i'll be going in with guns blazing.

I'm probably going to make myself pretty unpopular here but I have to ask, do women honestly believe that they should be given an epidural when not even in established labour? Seriously? The latent phase of labour can go on for days! It can be uncomfortable, yes, painful, sometimes, tiring? Yeah usually.

As for midwives making decisions on behalf of women? Well sometimes we are unable to offer a particular service, sometimes it is unsafe for us to do so and sometimes it is completely inappropriate for us to do so. If that is perceived as us making decisions on behalf of our clients then so be it. We train for years to understand the pregnant body, the mechanisms of labour and ways in which to help avoid that cascade of intervention as best we know how. I have no desire to trick anyone out of an epidural, at all. However I will first of all offer coping strategies as far as I can. I will offer 'lower' forms of pain relief to begin with, starting inevitably with gas and air, moving on to an opiate and finally to an epidural. Sometimes women find a level of pain relief they can cope with, sometimes a woman comes in demanding an epidural and with a bit of time and patience and support that woman can cope with the pain and give bith without the epidural they felt they could not manage without a few hours earlier. I am trained to help you cope with your labour. I am trained to offer you ways to cope. I am trained to be with woman. I am a midwife and that is always what I strive to do.

I am so saddened by this thread and the view that women have of midwives. We do our best with what we have to work with. Sometimes that is not enough staff, sometimes not enough equipment, sometimes not enough time.

I appreciate your point DrMcDreamy but you have no way of knowing whether she will be in this phase for hours or days.

If the patient is in severe pain NOW, something needs to be done to help her NOW - if that something is an epidural (ie G+A ineffective, she's exhausted, opiates not tolerated etc) then that is what she should have regardless of her progress measured on the partogram.

It doesn't matter what you are trained to do if your patients are left on their own in labour for hours and hours and hours.

Is it any wonder they ask for epidurals?

There's not a one of us here who wasn't left alone to labour for hours on end with no support at all.

I could train to study the mechanics of the male body from now till the world ends, but far be it from me to decide for him if and when his male bits are in pain. I'd like to see the reaction if a female urological healthcare profession told a man that!

It seems to be when it comes to labour women are made to feel they need to put up and shut up.

Nowhere else would you find an area where so many in pain are dismissed with approaches such as 'Well, latent labour can last for days (but also not) so if it's painful for you, take a couple of paracetamol and get on with it'. Or where people are offered only paracetamol after a major abdominal operation.

I mean, is it really that hard to puzzle out, that if someone is left in so much pain for days on end, they won't sleep well, so when they finally move into labour, they're already knackered, which probably means this whole 'cascade of interventions' which all midwives seem to think is the work of Satan, is even more likely.

A trained chimp could probably work that out.

I nearly asked for an epidural when I went into hospital with pains at 34 weeks. I had a UTI

Wow, rude.

So your answer is give everyone an epidural,if they want one, even in latent phase (which you acknowledge can go on for days)?

Labour is painful. If you don't want to experience any pain whatsoever we should probably be offering epidurals at conception.

Ahhhh Belgo, UTIs in pregnancy can be as bad as labour. I've seen people in screaming agony with them.

I had morphine for something that comparably to giving birth was a bit painful (busted kneecap/dislocation), yet for labour no you must suffer? Cos it makes giving birth so much more worth-while that you endure agony? It's bollocks in the 21st century. Must tell my dentist to just get out the pliers.

Some women I have cared for need epidurals to have their waters broken. Before labour even starts.

Not done lightly but when it is the labour can be so long and she is on the bed for ages with the much higher risk of DVT.

I agree with Dr mcdreamy that labour is painful, even the early stages. Everybody knows that. But some people are so taken by surprise by it. They think its just going to feel like strong periods pains. I often find myself thinking, God if only you know what's coming, this is nothing! BUT it is these women who you just know will probably need an epidural at some point down the line, so you just go with it and offer the pain relief. And that's absolutely fine.

Others come in at 6cm coping fine and only beg for an epidural during transition. It is these women who I really really try to get through with support and encouragement because they are so almost there and in all honestly, by the time the venflon is in, the drip set up, the equipment got ready, the anaesthetist gowned up, the epidural in the right place, the test dose given, the full dose given and then the pump set up, she would probably have had her babe in arms by then anyway.

yeah you're right drdreamy, let's leave them in agony shall we? After all, you do know best, I mean you've studied for years...

My 2nd birth was awful. I laboured and gave birth on my own with only a midwife there. My DH was an hour late after the birth. I wanted an epidural and was fobbed off and I am still cross about it now. The pain was herrendous .....crucifixion would have been kinder !! No joke! They said it was too early for an epidural althought I was well into labour with good contractions, and a good 'show'. When is needed to push they didnt even take my knickers off for me. . .i was in agony and could do nothing but hold onto the bed post , crying and screaming. I had PTSD and it was very traumatic. The pain was very scary.
So if anyone reads this and is having her first baby. . . .Have an epidural. . .its brilliant !! Just been really firm about the apin relief you want and push for it. I had no 'spokesman' (DH) there and I think that was half the problem .

P.S. I had epidurals with the first and third baby and its was fantastic. . . what a marvellous invention.
I commiserate and fully sympathize with you poor mums who like me didnt get one. . .

This thread does seem to pint towards the fact that in many cases, the pain relief available is not adequate. Epidurals may not be recommended before established labour, so what is recommended? Why isn't there more research and investigation into adequate pain relief during labour?

Many of my friends who had epidurals during labour were still not comfortable during labour, and some had serious side effects after the epidural.

point not pint.

As I previously said I find it very interesting the different attitudes and procedures in different countries.

In North America pain relief (usually epidurals, as G&A is not as commonly used)is given during the latent stage IF it is required and requested for pain. Yes, no-one can determine how long this stage will be but women are given this so that they can rest, sleep, remain calm, etc so that when they need to be awake, centered and have lots of energy to push they are able to do this comfortably and give it everything they've got.

When the G&A was shoved at me I had not been examined, nor was I examined at any stage. I only had a monitor on me for about 30mins (until the paper ran out), which I then removed and turned off (no-one else to do it) so I could move around to more comfortable positions as I wasn't given any pain relief.

'Labour is painful. If you don't want to experience any pain whatsoever we should probably be offering epidurals at conception.'

And that's not rude and dismissive?

Because that is a big part of the whole problem.

'Labour is painful,' is an umbrella used not to listen to women, not to meet their needs, much less attend to them.

Because guess what? In 2011, it doesn't have to be so much so, any consultant or anaesthetist will tell you this.

I don't think I ever advocated leaving women in pain. However I don't think it is appropriate for maternal choice to be the ONLY criteria for getting one. We have to work safely and in everyones best interests.

I'm also surprised to hear the one-to-one care thing as we were also left alone, but I gave birth in France so maybe the rules are different there. The other thing that differs from what I've read here several times is when the anaesthetist gave me an extra dose of the epi (without my permission, but that's another story) she justified it afterwards by saying it was to speed up the dilation - which seems to be the standard 'belief' over here.

Just for the record my midwives were lovely and looked after me very well, but equally the only pain relief available in France is an epi and most women have them so they're more geared up to providing them on demand.

DrMcDreamy - It's funny how they work 'safely' in other countries where adequate pain relief is offered to women when it is required. It is not just North America, there are other countries where epidural pain relief is offered automatically. Somehow women manage to birth in these countries and have positive outcomes.

Midwives in the UK seem to often think that somehow a birth is not 'worthwhile' unless you experience pain.

Utter Bollox!!!

'But some people are so taken by surprise by it.'

And some people have a baby that is in a tricky position that is known to be more painful.

My first was OP and had her hand up by her head cupping it above the ear.

I had to beg and wait 5 hours for an epi because 'It's after midnight'.

Even after I got it, they put a canula in and gave me NO fluids.

By the time a midwife called in the consultant, and the anaesthetist to top up the epi, I was 32 hours with no sleep and from eating and drinking. He went spare that I'd had no fluids and was exhibiting signs of dehydration in the June heat of the hottest summer on record in the new century.

My second was born with no pain relief (I took one puff of G&A and barfed) and it was 1/10 the pain of that first one.

My third, again, I knew something was off from even before the get go. I knew, and I know my body.

Still, hours and hours waiting for the epi.

It failed to bring my BP down. It was still 190/115, I'll never forget the look on the consultant's face. I had two pushes of Labetalol.

He broke out the ventouse.

The baby was over 2lbs. heavier than my eldest, who was heavier than her sister, and had cord wrapped round his neck.

I wasn't listened to the entire time except by the anaesthetist and consultant.

I was left, completely on my own as I had no birth partner, for hours, stoned on diamorphine.

I was told, since it was my 3rd, that I knew what I'd got myself into.

By 'one' I meant an epidural. Insert embarrassed face smiley.