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...

The rate of C section in the USA is however massively higher than the UK. They also pay for their care. The recovery time for C section is so much longer than vaginal birth. I understand where the OP is coming from, but please do not midwife bash, they do their very best in a system where they do not have the support that they fully need. Yes a woman should be able to ask for her epidural and be given it if the situation allows, but sometimes it is just not possible, be it because the anaesthetist is busy or the unit is understaffed. But one thing I am certain of, no MW will deny an epidural "just because it makes life easier"

"The best way to get an epidural is pay for it." - Barbarism at it's best!

If your rich thou shalt not suffer, otherwise too fucking bad!

'Go private next expat.'

There will be no next time. DH has been sterilised and received the all-clear and I still use a NuvaRing on top of that.

Guess that's just tough for all those women who are too poor to go private, though.

In those countries that manage much higher epidural rates on demand, how many of those are free at the point of access? The NHS is a wonderful thing but it isn't a bottomless put. By that I mean not just the expense of an epidural but the cost of the midwives needed to ensure everyone can have an epidural if they want it. I'm banging my head in despair that somehow the fact that if we say the anaesthetist is busy it's our fault, if there isn't enough if us to give one to one care it is our fault, if it is the wrong time of day, yep midwives fault again. Never the busy anaesthetist because he's a doctor off saving lives and that is terribly important work, never the consultants fault because they won't work a night shift leaving us with skeleton medical cover, never the managers fault for running a ward on the bare minimum to ensure nobody dues, fuck good care, who needs that?! No it's those pesky midwives who who like to see poor women suffer. I wonder why we bother.

For dues read dues. Decking sausage fingers and iPhone do not mix.

Many of them are free at point of access...epidural is the norm in Canada, France, Italy, Turkey, etc.

DrMcDreamy, I fully agree with you. Living in a country where we pay a monthly fee for private health insurance (practically compulsory) as well as fees up front - ?22 every time you want to see the doctor anyone? - I still don't understand why we Brits are so against it. The NHS is not a bottomless pit. Sure I pay a lot for healthcare but I can chose which doctor to see, which hospital to go to, no waiting to get tests done, very little for operations. But of course all this comes at a cost and even the French understand the government can't finance it all.

I would be willing to pay such amounts, Fenouille. I, too, have lived in France.

BecauseItoldYouSo of those countries you mention I wonder what the section/instrumental rate is? Or maternal/neonatal mortality and morbidity?

Where else in the NHS do you get to demand your own choice of medication? I'm not saying epidurals shouldn't be available, of course they should but sometimes we have to accept they are not appropriate for everyone. It is our job as midwives to educate and help people understand that, antenatally ideally. I know that might sound patronising. It really isn't meant to.

Reading this it really dawned on me what happened with DD. Meconium in the waters meant CFM so the MW was in with me anyway - ergo I got the Epi - no reason not to I suppose.

Expat - I went into that birth armed with every form of self help & pain relief that I could muster because I was convinced that I wouldn't be listened to. It is no way to go into childbirth is it?

DrMcDreamy - Educate and Understand?? Someone can understand fully what their own level of pain is, that is not for a midwife or anyone else to determine. Every person has a different pain threshold and nobody knows what that is except the individual. In any other area of medicine you are asked what your pain levels are and those are respected and the appropriate drugs given, this has nothing to do with 'Educating'. Yes it is a HCP's job to be understanding and that means LISTENING to women. This dosen't seem to happen very often here.

Oh and if you want to look at the rates DrMcDreamy you can do that here.

In Developed countries the rates are quite on par if not better than the UK (i.e. Canada).

Imagine other areas where you would tell people in agonising pain, 'This is the NHS, we must watch costs. Two paracetamol (or nothing) for you because your pain is temporary.'

I've broken bones and had 4 knee surgeries, 2 pretty major, where I was offered more pain relief.

'Expat - I went into that birth armed with every form of self help & pain relief that I could muster because I was convinced that I wouldn't be listened to. It is no way to go into childbirth is it?'

I went in, three times, believing I'd be listened to. I was only once, because I gave birth 20 minutes after arrival by pure chance, too late for any form of pain relief but G&A, which doesn't work for me.

I'm past childbearing now.

But that doesn't stop me concluding, 'Well, done now, sod everyone else.'

One of the MW from our local hosp. dislocated her shoulder badly. When she relayed the story at BF peer support training we took great pleasure in taking the piss with the "take 2 paracetomol & have a warm bath" quips. She was most disgruntled.

Yep educate. Not gonna apologise for choice of words in that respect. By that I mean women need to be educated that epidurals are not always available, it is not always in the best interests of the woman and baby for an epidural to be administered (ie, fully and pushing with vertex visible) and if an epidural is denied why this might be the case.

All this midwife bashing is really sad. I think one of the problems is that you will never have met the midwife until you are in labour. If we had proper 1 to 1 midwifery throughout pregnancy not just in labour, then you would be able to get to know each other, and the midwife would know which women were happier being encouraged to manage without and which would need an epidural. As it is, it's one size fits all.

But instead of bashing the midwives, bash the politicians who can't be bothered to do anything about it. And yes, the NHS has scarce resources but I am quite sure that they could allocate them better, if the will was there.

you do have a good point drdcdreamy.

there isn't enough money to provide epidurals all round with 10 anaesthetists on board and enough mw's on duty to provide one-to-one care.

we're reasonable. we understand that.

what we're objecting to is being patronised, lied to and treated like less than human.

Yes fine I can understand that. I really don't know what else I can say. I fear our points of view are never going to meet in the middle.

I am bloody annoyed by this thread!

"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."

How bloody sickening! Seriously! What an absolutely disempowering, paternalistic pile of BOLLOCKS.

I was referred to a consultant anaesthetist before I gave birth due to a potential spinal issue which might have impacted upon pain relief options. I was happy to consider anything but wanted to be informed/ready etc.

He said, bluntly: "there's no shame in it and the only shame there should be is on any professional who makes you feel that you are weak for having your own individual pain threshold. It's your body and it's your choice. We have anaesthetic blocks for many procedures that are potentially less painful than labour. If you want not to use analgesia, that's fine too. Just don't let anyone else make that decision for you."

Brilliant, brilliant man.

How dare you use your position of power to "coach" a woman who has no contraindications for analgesia into a position that she is explicitly verbally telling you she does not want to be in. If you have medical evidence for this, fair enough.

I am an NHS professional. I know all about resourcing issues in my own field. I won't make excuses for the impact that it has on patient care or justify clinically decisions that are cost-based.

As expat says, for many who request an epidural, a "cascade of interventions" might be an inevitability in any case e.g inductions/large baby and small pelvis/funny positioning etc.

There are women on this thread who have suffered PTSD as a result of their experiences and yet you write this? Shame indeed!

Margles - totally agree that any anger may be better directed at the politicians. Labour promised one to one care in labour by 2008. Has not happened.

Tory manifesto promised 3000 more midwives. Cameron has backed down now saying that latest birth rate forcast figures show a downward trend in the birthrate so he's saying there's now no need for these midwives. However the figures he's quoting were available when he made the promise. So why change his tune now?

NHS is run by accountants and politicians and this needs to be changed. In the patriarchal society that we're in obstetrics is the lowest rung of NHS budget priority.

"But instead of bashing the midwives, bash the politicians who can't be bothered to do anything about it. And yes, the NHS has scarce resources but I am quite sure that they could allocate them better, if the will was there."

Every clinician who defends decisions that are made on cost-based grounds without taking issue with it and pushing for better care for their clients is also culpable. They don't have to do it in public - there are mechanisms within the NHS to raise concerns about patient care with reference to dignity and patient experience etc. Nothing may ever come of them, but it is not just for politicians to address.

Justifying and colluding with decisions that are resource-led is unprofessional and against HPC standards. It is terribly sad when clinicians become so worn down by resource issues that they start to believe the "clinical" reasons underlying service delivert yet if they defend decisions that primarily related to cost, well... they deserve a bashing.

Any of us who begins to believe our unique service model rather than evidence/NICE guidance is guilty of this. If you train for years to know what to do, you should have enough knowledge to respect the evidence and should act in accordance with this, regardless of your personal views on resourcing. If you can't, you need to flag this up as appropriate, not just shrug your shoulders and say: "it's the NHS, innit?"

working9while5 sorry you feel this way. I will not apologise for doing my job. I don't coerce anyone, I don't deny anyone, I work with women, I listen to them. If they want an epidural they'll get one however it is in everyones best interests to discuss this first.

'Yep educate. Not gonna apologise for choice of words in that respect. By that I mean women need to be educated that epidurals are not always available, it is not always in the best interests of the woman and baby for an epidural to be administered (ie, fully and pushing with vertex visible) and if an epidural is denied why this might be the case.'

And yet, NO ONE on this thread was one of those people who first begged for an epi in transition. They were all people who were fobbed off till it was too late or who had to fight for their epi long before they were fully dilated.

This is not about women in transition begging.

This has all been people who were induced, OP, what have you, fobbed off till it was too late.

That is wrong, wrong, wrong.

And yet immediately, it's assumed they are all so stupid, it is midwife-bashing.

Still,the assumption they are stupid and ignorant.

I was one of those people, but I knew it was too late. I am not a moron.