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...

No Expat, being referred to as a f@@king midwife, that's midwife bashing.

'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.

Bravo.

My husband had a vasectomy last year. His choice.

I showed him this thread.

He said, 'If that chap (the consultant) had told me he was going to cut my bollocks with nowt but gas & air, I'd have told him to get knotted, got up and walked out. I can't imagine getting cut in the fanny like that, it's not even on the outside. FFS.'

Oh, yes, lala. Focus on that to excuse a littany of other women telling you they felt fobbed off, patronised, not listened to, scolded, etc.

Go on then, do it and don't bother to ponder why this thread and the others like it even exist.

Dismiss it on that one comment the way so many here have had pain so bad it gave them PTSD dismissed.

Your job is not

"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 birth without the epidural they felt they could not manage without a few hours earlier."

vs

"I don't coerce anyone, I don't deny anyone, I work with women, I listen to them."

You describe a woman in an early phase of labour "demanding" an epidural, which you then help her to "cope" with (against her express verbal wishes). Again, as expat has said, there is no disagreement with you supporting a woman to cope without an epidural where there is a genuine, evidence-based medical reason why she should not have one.

You won't apologise for an anti-woman view that women "demanding" epidurals need to be coaxed into "coping" without with "time" and "patience" and "support".

Patience is an interesting choice of word here. You are being patiend with their demands, yet also listening to their views and not coercing?

First line should read "Your job is not to tell people that you have listened to them while doing something different".

Not by me, they weren't. You are making this personal. Don't judge me, you know nothing about me.

Oh fuck it think what you like. You're right, all midwives hate women, want to see them in pain and lie to them to stop them getting an epidural.

DrMcDreamy - You say that you don't coerce or deny anyone in one post yet you say "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"

That sure sounds like coercion to me.

When I had surgery last year there was no problem with putting me on a morphine pump when I complained about pain, so that I could control my pain relief. Most women are educated enough about the pain relief on offer and expect to recieve it when they ask for it. You are told in ante-natal appointments the pro/cons of having a baby in certain circumstances i.e. Homebirth - No epidural availble. Hospital Birth - Epiduruals, Pethidine, G&A, etc. You go into labour armed with this information and your decsions should be respected.

If someone does not want any pain medication or intervention then they will often opt for a MLU or Homebirth. If someone wants to know that various forms of pain relief are availabile to them (not knowing in advance what their pain levels will be of course) then they will opt for a hospital setting.

We are intelligent and educated grown adults and deserved to be listened to and treated as such during one of the most vulnerable times in our lives.

Yep mcdreamy, that's why I became a f@@king midwife!

"Oh fuck it think what you like. You're right, all midwives hate women, want to see them in pain and lie to them to stop them getting an epidural."

I had great midwives. I am judging your words, not the whole profession.

So, when anaesthetist is with another lady and unable to administer an epidural, what do you think the midwife should do? I am genuinely interested in what your expectations would be.

Incidentally, it is shocking that you would engage with women about your profession on a forum in this way.

It is wholly and deeply unprofessional. I post on a forum here with reference to my profession and very often, posters will mention shocking examples of poor practice carried out by fellow AHP's. Where possible, I put it into context in terms of the NHS etc but I would never deny or put down a service user's opinion of their own experience. I feel ashamed sometimes, yes.. I can often see both sides.. but this is just your job. You are interacting with people who have been very seriously affected by clinical care and denying their experience of their own life with no compassion, simply concern for your own point of view.

It is disrespectful and unprofessional and I can't understand why you would engage in an inflammatory way.

Again, I had great midwives. No issue getting an epi. All went well. So I am taking issue with the way in which you are representing your profession, not your profession.

*DrMcDreamy - You say that you don't coerce or deny anyone in one post yet you say "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"

That sure sounds like coercion to me.*

We must have different definitions of coersion then because in my book, listening to someones requests, offering them other options and then ultimately doing what they ask is not coersion.

Laluna:

You tell the truth and you don't try and spin it.

"I am afraid the anaesthetist is with another lady and we don't have anyone else who can offer this procedure. I'll keep checking for you."

Then ask her what she wants in the meantime with reference to coping strategies etc and if that involves her telling you to a) fuck off and/or b) the place is a disgrace etc, nod sympathetically etc etc and either just look and act empathetic and do whatever it is you do to help her stay as calm as possible while telling her that you will be happy to support a complaint later if things don't change etc.

However, trying to convince the lady that she doesn't want what she wants because you can't provide it is disrespectful and patronising.

In that case I bow out then working9while5. I might be many things but reckless with my job is not one of them.

I will however say this. I am sorry for every woman that has a poor birthing experience, it should be one of the happiest times of a womans life. I am sorry to each and every woman who feels the midwife was at fault. I am sorry if you did not get the pain relief you required and I'm sorry for those whose life has been tarnished because of this. We work within restricting conditions. Most of us do our very best. Sorry if that was not up to standard.

"I might be many things but reckless with my job is not one of them."

How is this reckless with your job?!!!

Thanks, I find that helpful.

working9while5, your assertation that I am being unprofessional, if that is the case then I will not continue, bring the profession into disrepute is a one way ticket to unemployment. I aint taking that risk.

I had this.I had been warned by someone that my particular hospital wasn't keen on epidurals and they would go out of their way to not give one. (I didn't really believe as it was my male boss and i foolishly thought he couldn't really know). I should have also taken the hint when the midwife at the antenatal was very anti an epidural. Again I thought it was just her personal opinion and wasn't too concerned.

When giving birth first time I arrived at hospital 7cm dilated. after about half an hour I asked for an epidural and got a little prepared speech about how the anaesthetist was currently involved in an operation at another location but she would 'try' and speak to him and 'maybe' he would be there in about an hour but it may be too late so we'd see how it goes.

Roll on nearly two hours. I was now 8cm (everything slowed down once I got into hospital) and in absolutely agony and completely losing it. Begged for an epidural and was it was now too late but they did give me pethadine (not sure if they'd already given it me at that point).

However it was another 4 hours and another lot of pethadine before I actual gave birth. DS was very groggy and lethargic and ended up in SCBU for 4 days. intially there was even talk of oxygen deprivation but I firmly believe it was down to the second lot of pethadine being given too close to the birth.

Second time round they said I was too late for an epidural but in all honesty they were probably right as DS2 arrived and hour and a half after my arrival.

working9while5 - Thank you for articulating so well. You have said what I am sure alot of us feel, very well.

Sorry, we cross posted. I thought you were suggesting that supporting a patient to make a complaint would be an example of being reckless with your job.

I think you do right. Mumsnet is a very public forum and unlike others, if you say something in the heat of the moment that is unprofessional you can not easily have it deleted.

It's a "do no harm" thing. I think you can share a lot here that you wouldn't with a service user as it is an anonymous forum e.g. you can be honest about the resource constraints in a more brutal way than you might if involved in direct care but your comments cannot be a personal response e.g. based on your reaction to the "fairness" or "unfairness" of comments made about the profession.

I don't make apologies for others in my profession either. Or the NHS. I do know I have offered care, especially in the early stages of my career, that I look back and shudder at and I would wholeheartedly apologise for that if I could. However, I do my best now and hope I am offering a good service, but we have to be ready to change if the feedback suggests otherwise. I know being a "reflective practitioner" is a bit of a cliche, but I do think we need to learn and not defend. I have found MN to be really useful in terms of really "getting" where we fall down in terms of patient experience and in changing my own practice as much as I can within the constraints in which I work. I hope I offer information that is helpful, in return.

Just think we all need to be as careful about taking things personally in this sort of context as we would in RL.

I do think this is misogyny in action.

I'm very lucky: I can't speak from personal experience of a mismanaged labour. I had DS in a MLU, he was delivered by a really good, caring, very experienced midwife, and I was fine with water and gas and air: I went in not wanting an epidural as I'm squeamish about the idea of a needle in my spine, and I didn't get to the point where I was tempted to ask for one. Even so, I'm pretty shocked at some midwives' attitudes to pain in latent labour. My personal experience was that getting from 1 to 3 centimetres dilated was the hardest bit: once I got to 3 centimetres my pain was taken seriously, I was allowed to get into the pool and actually, from that point on, I was completely fine. But until I got to that point, I was in the most pain I've ever been in in my life (other experiences include appendicitis and a dislocated shoulder) and was being told "well, take a couple of paracetamol" (not by the MW who eventually delivered DS).

I can't think of any other circumstances where a patient is in that much pain and HCPs dismiss it. There was a good article in the Guardian a while ago saying that obstetrics is about 50 years behind other areas of medicine, and I do strongly suspect that it's because there is still an attitude that women should put up and shut up. Yes, resources are limited - but pain relief is non-negotiable in most other areas of medicine. Childbirth is much more like emergency surgery than it is like elective: you can't put it off till the anaesthetist is available, so hospitals need to prioritise it, and they just don't.

Oh, and I had a meeting with an anaesthetist before DS was born, because I wanted to be as prepared as possible for anything that might happen, and she reckoned that it's hokum that epidurals slow labour down: women ask for them because they're having long labours and are exhausted and can't cope any more. And, reading this thread, it looks to me as though unless you have a long labour, you may very well not get one at all, which must also skew the statistics.

You tell the truth and you don't try and spin it.

"I am afraid the anaesthetist is with another lady and we don't have anyone else who can offer this procedure. I'll keep checking for you."

Absolutely. And in the meantime, helping with correct use of g&a, pethidine, back massage, well anything really than facing the god awful prospect that they are going to do absolutely nothing.

I also take issue that recovery times for vaginal birth are quicker than and c-section...not if you suffer a birth injury such as a 3rd degree tear. With my csection I was so well provided with meds, I was very rarely in discomfort and recovery was rapid. Yet after my 3rd degree tear, I was in more pain for weeks, and given nothing stronger but ibuprofen & I am not recovered now.

DrMcDreamy: ' If they want an epidural they'll get one '

This isn't necessarily true. That's the point.

Just don't bloody lie to us.

I went in to my first labour thinking I had choices. There was a lot of MW talk about pros & cons of epidural.

No-one - NO-ONE - ever said: 'But it's quite likely you'll be in screaming agony, the anaesthetist will have a higher priority to attend to, & you'll just have to get on with it.'

I eventually got my epidural 7 hours after the MW had agreed I needed one. I was fine after that.

I'd've had a far less terrifying experience if I'd been prepared. It was quite literally hellish; agony physically, but also more distressing & demeaning than I'd've believed possible.

& then I had PTSD & antenatal depression during my pregnancy with number 2.

In the event, I had a painful delivery with no analgesia (AGAIN no epidural available - until too late this time), but, well, I knew it hadn't actually killed me the first time, & I got through it.

I was quite relaxed about having number 3!

I'd say 95% of my terror, & subsequent trauma, was because I wasn't mentally prepared for 'no epidural, tough shit' being an option.

It comes down to honesty & respect. I didn't feel like I got much of either.

tell you what.

I think maybe a new system should be put in place. When you get your positive pregnancy test, you should book in for your caesar at 36 weeks. Under GA. Go to sleep, and wake up when the baby's ready to start school. No pain. No feeding problems. No pesky night feeds or nappies or potty training.

Childbirth is painful - it is common sense - think about the mechanics, about what comes out of where. The real problem here is not midwives or epidurals, it is that pain is not part of life any more. Our lives are comfortable, sanitised, we don;t have to cope with stuff, we just take a pill or sue someone and it all feels better.