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...

I don't know what the anaesthetist used when I had my 3rd but it was quite close to birth and whatever it was worked very very shortly.

The first time I had one, with my first, it was about 6AM. DD1 wasn't born until a bit after 4PM via forceps (she was OP and had her hand up cupping her head right above the ear) and it had to be topped up before the consultant began her work.

I had no pain relief with my second as she came very quickly and G&A made me sick and triggered a massive panic attack.

I don't know why they use that stuff. It doesn't relieve pain and, IME it's not even a decent high.

I also had diamorphine with DS, whilst waiting for my epi. Now that made me high, too, but it didn't provide much in the way of pain relief for me so I continued to request the epidural I'd travelled all that way specifically to get (as I had flashbacks and PTSD from my drug-free birth on top of PND).

I had the same experience with G+A. It didn't take the pain away just made me feel really distant as if I couldn't reach anyone for help. Very scary.

"have told me that they will induce at 39wks to avoid an emergency situation."

What - like you inconveniently going into labour when they've booked a family holiday?

"I think there is a place for midwives in the maternity ward but they should not be directing healthcare"

You might be interested in this study from the Cochrane database (the study was done by a researcher from Kings College hospital in London) - it's a meta-analysis of outcomes for different models of care in pregnancy and childbirth. It used evidence from 12000 births from Australia, Canada, New Zealand and the UK.

It found the outcomes for midwife led births were as good or better than the outcomes for obstetric led births for low risk or mixed risk mothers.

here

"Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality, continuity of care and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. All models of midwife-led care are provided in a multi-disciplinary network of consultation and referral with other care providers. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects.

The main benefits were a reduction in the use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know, and the chance of feeling in control during labour, having a spontaneous vaginal birth and initiating breastfeeding. However, there was no difference in caesarean birth rates.

Women who were randomised to receive midwife-led care were less likely to lose their baby before 24 weeks' gestation, although there were no differences in the risk of losing the baby after 24 weeks, or overall. In addition, babies of women who were randomised to receive midwife-led care were more likely to have a shorter length of hospital stay.

The review concluded that most women should be offered midwife-led models of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications."

The community midwives with all three of my births were fab!

Mine too - Community midwives and most of the hospital midwives were great. I don;t knock midwives - just this one midwife who really upset me.

Viva, we have a variety of options and each of us uses our personal preference. It's all a variation of bupivacaine strengths though. I add fentanyl to mine, I know others use morphine.

For early labour I use 0.25%, 10ml to establish and then 0.125%, 10ml hourly to maintain. I add 100mcg to my first 10ml and then prescribe a mix with 2.5mcg/ml fentanyl in 0.125% bupivacaine for midwives to give top ups. We're bringing in patient controlled epidural pumps so the patients can give their own top ups, those will use premixed bags of 0.125% plus 2mcg/ml fent.

For later labour you need a denser block - I've used 20ml 0.25% plus 100mcg fentanyl, or 10ml 0.5%. At fully I'd put a low dose spinal in first - instant analgesia plus less movement when putting epidural in. I then top the epidural up after an hour or so if they've not delivered by then. You get a lot of motor block with that level of analgesia but by this time most women don't want to be able to move, they want the bloody pain to stop and go away and someone to pull the baby out because they've Had Enough. It's one of the joys of being called at 3am that by the time I leave they are looking forward to their baby arriving again.

I'm completely horrified by this entire thread!!
During first birth where I was forced to have an epidural during my induction (despite begging not to [severe needle phobia]) because 'inductions are hard and painful'.
The mw did not stay with me, though they did check in every 15-20 minutes to see if I needed topping up (gave DH a button to press if it got too painful in between) and I hadn't been examined internally at all when they did it (although I did request no internal examinations).
I cannot understand why 'short staffing' is an excuse (although obviously the anaesthetist needs to be available to do it) as no one stayed with me, and 'no dilated enough' seems like a terrible reason too, as I had no exam.
I hadn't even had a go on the gas and air yet :0(

The more I think about this the more I realise my 2nd birth, despite being 12 hrs, back to back, etc was really quite good. I remember asking for an epidural and explaining to the midwife that I hadnt asked before now because 'I was scared it run out before the baby was born ???' and 'maybe I wasnt in enough pain yet'. She was lovely, and genuinely surprised and said ' dont be silly we all need pain relief when it hurts this much - you've been going full on for hours.'.

Why couldnt my first labour have been like the 2nd?

It was same hospital, same unit (3 years apart) so I am assuming same policies. Both were back to back. The first went on for days (5 shift changes)and required lots of intervention and the 2nd was 12 hours (6 in hospital so one midwife). The key differences - one labour was my 1st so was probably always going to be longer, and each had different midwives.

I think the male version of TechnoKitten gave me my last epi. :)

I could have kissed him!

Whatever it was, the pain stopped. By the time he left, I was also looking forward to my son's birth again, not having flashbacks of the feeling of being disembowelled through my vagina.

DS was delivered by ventouse, but again, he was much heavier than my other two and the cord was wrapped round his neck. I had a second degree tear and have zero regrets about the birth other than that it took hours to get the epi and I had to keep repeating my request as I was alone and had no birth partner.

Even now, DS's head is huge (like the rest of him)!

And no thanks to the midwife who earlier in the thread told me, then the pain musn't have been that bad after I stated that my epi worked right away.

It's that sort of completely unprofessional, out-dated miosgynistic attitude that's caused so much damage to the profession AND to so many womens' mental health following birth.

Women are too often not listened to by midwives when it comes to addressing and treating their pain, that was the entire point of the OP.

also both my ds were about 6 lb so not huge....

'I hadn't even had a go on the gas and air yet :0('

It does FA, IME. Makes you feel like you've toked on a spliff for about 5 seconds.

Following my experiences over the last year and a half, my concern is with the funding and the politics and the general ethos within the NHS, not with MWs in a general sense. We've joined BUPA and that makes me cross too.

I can think of at least 5 midwives (of the 12 or so I encountered) who were fantastic, certainly in the context of my experience with them. Unfortunately, none of them were around when I was giving birth.

And it's the minimum intervention, natural birth philosophy which keeps popping up which really puts me off having a second. I can understand people who choose to give birth this way... if you have the spiritual strength to meditate your way through the pain and maybe even have an orgasm at the end of it, then you have my absolute respect. I wanted to experience as much of DS's birth as I could, while keeping the pain at a manageable level. But I would no more rather have another birth without pain relief than I would have my appendix out.

I appreciate that women have been giving birth since the dawn of time (or something like that), but we also spent many years performing operations with nothing stronger than a whiff of alcohol. Nobody seems to be supporting the upholding of that tradition; in other areas of medicine, cleaner, sanitised, and managed pain in medical care seems to be generally accepted as a Good Thing - why should it be any different for childbirth?

This is worth watching it has 4 parts.

Its called The business or being born.

BTW just to be clear, I am advocating nothing more extreme than what seems to me to be a basic level of modern medical care.

It must surely be possible for a case like mine - a straightforward labour, healthy mother and baby, baby stuck and just needs a jiggle (as it turns out) to get him in the right position - to be handled in a way which doesn't involve so much trauma, shock and resulting anger.

I've just watched the first part of that link and it's what someone on there describes as 'macho feminism' - the idea that if you've done it without pain relief then you've done it 'properly' and should be congratulated on your 'normal' ability to cope with pain - which is so destructive. It's an interesting link.

"Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects.

The main benefits were a reduction in the use of regional analgesia, with fewer episiotomies or instrumental births"

Don't think most of the posters on here would see thatas a benefit....

Chynah, that's exactly what I was thinking - that is not a benefit at all!

Want2besupermum - why should birth be directed by a doctor? Women have been fighting for years to move away from the medicalisation of birth. Moving away from shaves, enemas and lying down in stirrups as mentioned earlier. In the US it is well documented that the level of intervention in birth in terms of c sections etc is very high due to the high fear of litigation.

I was lucky enough to have a private birth (induction, epidural sited before it even BEGAN, wonderful) and quite frankly would take out a mortgage to do it again.

One of the male doctors slipped out the comment 'the female obstetricians tend to be tougher on labouring women'.

So maybe this is another example of how we are tough on our own sex. I'd take a nice sympathetic man any day.

What you don't think a reduction in episiotomies or forceps is a good thing????

Fifitot, I don't think a reduction in the use of regional analgesia (which was the bit highlighted by Chynah) is a goal in and of itself, therefore I don't see why that is a benefit. I wasn't commenting on the reduction in episiotomies or forceps.

'Nobody seems to be supporting the upholding of that tradition; in other areas of medicine, cleaner, sanitised, and managed pain in medical care seems to be generally accepted as a Good Thing - why should it be any different for childbirth?'

Because it's not an illness maybe? Interested to know in what ways you would make it 'cleaner' or 'sanitised'. the majority of women on here are not saying that but there is an implication on some posts.

Yes but isn't it the case that a use of epidurals can and often does lead to forceps etc.

Epidurals aren't a magic wand are they? There are pros and cons.

What counts as regional anaesthesia? Would it be things like local anaesthetic when having your fanjo stitched back together?

Epidurals lead to lower tearing rates, which no-one ever seems to mention.

I have heard some horror stories about uncontrolled pushing leading to severe damage. Epidurals can reduce that risk because the woman isn't so desperate to get the baby out, can slow down, listen etc.

From Canadian Globe and Mail:

But a new study out of Australia has found that an epidural may play a positive role in women's health long after the baby is delivered by reducing damage to the pelvic floor muscles.

Australian researchers used two sets of ultrasonic imaging on a group of almost 500 women undergoing their first pregnancy and planning vaginal birth ? one taken during pregnancy and one three to four months after childbirth.

Because damage to a woman's pelvic floor muscles during childbirth is known to be a risk factor for future health problems including collapse of the pelvic organs (pelvic organ prolapse) and incontinence, the researchers wanted to see whether style of birth played a role.

Of the 488 women in the study, published last week in the British Journal of Obstetrics and Gynaecology, about 13 per cent experienced ?avulsion,? or tearing, of their ?levator,? or pelvic floor muscles. Women who had had an epidural had a lower incidence of tearing. A forceps delivery was associated with the greatest risk of injury. (Not surprisingly, the women who had undergone a caesarian section had no pelvic floor injuries.)

Co-author Clara Shek of the Nepean Clinical School of medicine at the University of Sydney suggested the epidural may prevent premature pushing, which is known to cause damage. Another potential explanation may be that the muscles are simply relaxed and less likely to suffer trauma.