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'd add a caveat though - 'support' shouldn't equal active persuasion away from pain relief at any stage if that is what the woman wants.

I'd see support more as giving the woman CONFIDENCE that

a) the health professionals who are looking after her are actually DOING that (by listening, performing examinations, being physically present and sympathetic etc)

b) keeping the woman fully informed as to what is going on with her body (if that's what she wants)

c) listening to women and responding to their requests

d) not making assumptions about individuals (eg I can tell just by looking at your face (rather than your fanjo) that you're not in labour)

to give just a few examples - I'm sure there are many more.

@ Elbow -- It seems very inconsistent to say the least to accept the medicalisation of pregnancy by avoiding all the forbidden food, drink, etc., but when pain relief is allowed it is eschewed.

And pain relief is fine, despite the opinions of some, because if there was any likelihood of it causing problems it would not be offered, thanks in part to the litigious nature of US society.

Why not epidurals on demand, DrMcDreamy? With the best 1 on 1 staffing in the world, I asked for and got one for DD1's birth. I didn't ask for one and didn't have one for DDs 2 to 5. I reckoned that after pushing out DS at 9 lbs 4 without one, I could probably deliver a can of paint sideways. I don't think the level of staffing has anything to do with it. It's all about the level of pain the individual woman feels she can take, and I don't know why this can be ignored in favour of some objectives that have nothing to do with good medicine ('first, do no harm') and all to do with some philosophical notion of what constitutes a proper birth experience.

Misty, totally agree that all women requesting epidurals should get them but not sure about the caveat that epidurals should be a rare request.

Childbirth pain is real and extremely severe for most women - it isn't in the mind. There is no other situation in the NHS where people are expected to endure that level of pain without proper pain relief.

Having had a birth with and without epidural (albeit administered by a skilled anaesthetist so itworked) I don't understand why there should be an expectation that woman won't want epidurals by choice. My non-epidural-pain-relief denied birth was horrific (followed by clinical psychology treatment for trauma) and the epidural birth was painless calm and wonderful.

There are a lot of women who have a burning desire to experience natural vaginal birth and there are those of us that don't. The experience of grunting and groaning in agony I found degrading and my overwhelming feeling on holding my daughter was not joy but huge regret that I had brought a female child into the world in a society that treated women with such brutality.
So yes, let's just have that health care professionals let women have pain relief when they say they need it - no caveats:)

I've had one hospital birth (with epidural) and three home water births.

I found the whole hospital thing completely disorganised, filthy, uncaring (apart from the mw who sat with me during the epidural, who was very professional and kind). I had to threaten violence in order to be taken seriously enough to get an epidural and I did actually attempt to fling the gas and air tank across the room at one point. I was in battle mode the whole time.

During the home births it would never have occurred to me to have any pain relief as things were organised, clean, calm and efficient and I just got on with it.

Moral of the story? Treat women like birthing cattle and stuff them in institutions, and don't be surprised when they ask for strong pain relief, as it is an alien environment.

As soon as I went into hospital to be induced (2nd child)I told the MW I would like epidural when the time came.

What a surprise, they told me no one was available when I could bear the pain no more. I found most of the MW's very uncaring. I'd had an awful delivery the first time around, I told them this. I have a bit age gap between my children as I was really put off giving birth again.

What is the point in birth plans? They are meaningless in reality!

Both midwives and nurses, (in the NHS), work extremely long hours, frequently without breaks,stay late are required to update themselves and learn throughout the whole of their careers.
Many a maternity/other hospital unit would cave in without the goodwill of these people and the negative and ill informed attitude of some of the public is something they face daily.
The majority of midwives are desperate to provide as good a service as they can, under extremely stressful conditions and often have chosen to become midwives so they could be 'with woman',trying to help her have the best birth experience possible, not because thay are control freaks who love to watch women suffer.
The reality of many services within the NHS is that if a unit stays open and the place is running, it is because of alot of goodwill by staff,a point always ignored of course by most,so services and staff can be cut even further. Never mind about the people on the front line killing themselves, sacrificing huge chunks of their own family lives and time to keep a place going.
What has this got to do with anything? Alot, epidurals do have their place, definitely, but there is usually a good reason why a woman may not be able to have one at the precise moment of request.

RUSerias, I don't think anyone is trying to suggest that midwives and nurses, as a group, want women to suffer or don't care, and it's quite possible that a lot of the insensitive behaviour people experience is because midwives are very tired, stressed and overworked. However, it doesn't seem helpful to imply that women who have had such bad birth experiences that they've been left with PTSD (as some posters on this thread describe) are expressing a "negative and ill informed attitude". I don't think anyone on this thread would dispute that maternity services are under-resourced, but you seem to be blaming women for the cuts in services.

Could you address the issue, raised by a lot of women on here, of women not being told the truth by HCPs? If there's a good reason why I can't have something, I would want to be given the reason, without flannelling. Clearly this doesn't always happen - see a number of women on this thread who've clearly been fobbed off as though they were nursery school children. There may be a good reason why a woman can't have an epidural, but don't you think it's reasonable, at the very least, to explain that reason?

Just to answer some of the above posts:

I never said that I know that another woman can cope just because I could.

"A minute or more" doesn't sound like continuous pain to me. Continuous means continuous e.g. no breaks, at all.?
Continuous, compared to 5:10, lasting a minute or more? is that not more or less continuous? It means that I had around 30 seconds to recover before the next set in. But to ?you? it ?doesn?t sound like continuous?. Hmmm, see how easy it is to not believe someone?

And I was one of the ?lucky? ones at 19, afraid, in a foreign country and totally oblivious to what was going on? Ok, if you say so. I suppose everyone?s experience was more horrific than mine then.

I agree that having a chemical induction which overrides your body's natural mechanism of labour. Not having an epidural was my way of gaining some control back. My personal experience, sorry for sharing. I was just trying to bring a bit of balance to the discussion, seeing as anyone who is pregnant and reading this thread may be terrified by the pictures some of you are painting.

On the whole I agree with some of the points being made here. Denying women pain relief on request per se is not acceptable. Lying or not believing a woman is not acceptable.

PYBF: ?I feel it is attitudes like yours that - unfortunately- lead to women NOT getting the pain relief they need in childbirth. ?
I never said that women should be denied pain relief. But let?s just bear in mind what an epidural can lead to before we go about selling them as the best invention since baked bread. In essence, an epidural puts you straight into a high risk category. It can lead to morbidity and even mortality, for mum, babe or both. They don?t always work and the ?window? of pain caused by an insufficient block can sometimes be worse.

I would like to see other changes to our system that may help women, such as true continuity of care, real support, parent education with realistic goals, and last but not least, women and midwives united in their goal to make childbirth a better experience for us.

Elbow grease "In essence, an epidural puts you straight into a high risk category. It can lead to morbidity and even mortality, for mum, babe or both."

This just isn't true - not in the normal sense of medical risk.

Severe injury from epidurals is vanishingly rare and in the case of labour pain analgesia most cock ups have been due to gross negligence (wrong drug, wrong place). I don't ever recall a baby death. That does not mean epidurals are risk free - there is risk of headache and various rarer side effects but in general it is regarded as a very safe procedure.

I do agree with your comments about changing the system though

RUSerias -- are you serious? These people are paid and are actually public servants if they work in the NHS. It's not a vocation and they're not just doing it out of the goodness of their hearts. They are no more altruistic than any other medical staff in the NHS, whether they work in kidney dialysis or post op for prostate cancer patients or pediatric leukemia. And their units are not going to be shut down if they don't have the attitude that they are sacrificing their lives for some higher purpose and make their patients adopt the same attitude.

Why do you think women's healthcare should be seen as different from anything involving other sections of the population? Women's taxes pay for the NHS just as much as men's do.

Why should it be women who must smile and accept that there are somehow not enough anesthesiologists or anesthesia to go round so they should be the ones to smile sweetly and let it be given to someone more deserving?

Elbow -- 'In essence, an epidural puts you straight into a high risk category. It can lead to morbidity and even mortality, for mum, babe or both. They don?t always work and the ?window? of pain caused by an insufficient block can sometimes be worse.'

-- please do not scaremonger about epidurals. If they were that risky and that ineffective, on the whole, they would not be offered. On the whole, they work. Occasionally they are ineffective. Women and babies are not routinely dying because of epidurals. I take specific issue with your statement that having an epidural places a mother in a high risk category. Here's a sensible discussion of the pros and cons of epidurals.

Elbow - recent research shows that epidurals are low risk. They have been associated with more intervention such as the use of a ventouse or forceps, although it has been noted that mothers experiencing longer and more difficult labours in the first place are more likely to request spinal pain relief in the first place.

As starlight pointed out earlier in the thread, childbirth is not about performance.

mathanxiety: I suggest you read past the potential benefits and read further down about the potential risks.....

Also, "I take specific issue with your statement that having an epidural places a mother in a high risk category."
Maybe you should read the NICE guidlines a bit more indepth.... Normal birth is defined as that without surgical intervention, use of instruments, induction, or "epidural" or general anaesthetic....

and "Before choosing epidural analgesia, women should be informed about the "risks" and benefits, and "the implications for their labour...."
Those being...It is associated with a "longer second stage of labour" (not so good for the bladder) and an "increased chance of vaginal instrumental birth....."
Also "It will be accompanied by a more intensive level of monitoring and intravenous access...." Now why would you have to do that if there were no risks?

I do belive that women should be able to access whatever pain relief they need to cope with labour...However, it should be "INFORMED CHOICE" and should contain info pertaining to the risks as well as the benefits.

Couldn't agree more Starlight, which is why I think it is time that we start to have open and honest discussions with the midwife, long before the baby is due, as I would have loved a pool birth, but didn?t fit the criteria (although my community midwife later said that I could have had one at home) and I don?t understand the need for starving women in labour.
Maybe then, we wouldn't get tricked out of what we want. Maybe we could start being treated like grown women with brains who have certain expectations and if these are not possible, then an explanation of why our requests are not possible to fulfill would be better accepted.

Jetli, where did I mention that childbirth is about performance?????

And that is the crux of the matter really. As a midwife you have no idea of the level of antenatsl education a women who walks through your door had had. He'll you don't even know if they can read. That is what I was alluding to earlier with antenatal education. If your midwife was sure that get client knew the pros and cons if each type if pain relief a whole lot of time and angst would be spared. As it Is your midwife meets you for the first time in labour and has to gauge how much you know re pain relief and what you need explained and discussed. I can understand completely the school of thought that says no matter what in those circs If you request an epidural you should get one but if we go down that road the volume if complaints we'd get saying "no one explained I might end up with a longer labour/forceps/ventouse/stuck to the bed on Continuous monitoring/could have had pethidine etc and I feel cheated" would increase proportionally . We're in a bit of a lose lose situation.

DrMcDreamy - would you say that what tends to happen then is that women are discouraged / prevented from having epidurals just in CASE they are too stupid / ill-informed to know the risks?

Not at all, i can't speak for anyone but myself though. I don't discourage or prevent epidrals, I try and make sure that anyone requesting one is fully informed of pros and cons of having one though. Ideally I'd know they were aware of these before hitting delivery suite but unfortunately I can't. I'm sure here on MN we're all educated women aware of our choices but it is surprising how many are not or do not have access to the appropriate information.

'Normal birth is defined as that without surgical intervention, use of instruments, induction, or "epidural" or general anaesthetic....'

In that case hardly any birth is 'normal' and hospital birth makes absolutely no sense for most women. Childbirth is risky in and of itself. It is also very painful and that pain itself can slow labour.

"Before choosing epidural analgesia, women should be informed about the "risks" and benefits, and "the implications for their labour...."
Those being...It is associated with a "longer second stage of labour" (not so good for the bladder) and an "increased chance of vaginal instrumental birth....."
Also "It will be accompanied by a more intensive level of monitoring and intravenous access...." Now why would you have to do that if there were no risks?

-- It's not a question of high risk with epidural vs. no risk without. And there is no risk associated with more monitoring, just the opposite. It may not be the same as labouring in your sitting room however.

More monitoring in itself carries no risk, maybe some discomfort but that discomfort may be far less than the pain the epidural has eased - a trade off that many women would like to be able to make.

Another article on epidurals here Not only is an epidural considered to be overall helpful because pain that a woman cannot endure is not considered to be a positive thing and character builders of this sort are not considered worthwhile inflicting on women by the medical profession in general, it is administered at the request of the patient, despite your dire prognostications that it might kill her and harm the baby. Obviously the benefits far outweigh the risks or no-one would get it.

And as for the increased monitoring -- yes, this happens, and the reason is so that there will be as few harmful side effects as possible. Most women are happy to trade off the increased monitoring and other (relatively minor) necessary precautions in order to alleviate the pain.

All patients who receive any kind of anesthesia must have their vital signs monitored and the baby in the case of a labouring woman will also be monitored. There is no increased risk associated with the extra monitoring. Most women who have an epidural, and their babies, are fine afterwards.

The increased risk of intervention, forceps, c-section are definitely present (though they can be necessary even without an epidural) but again, what is so horrible about any of these procedures and increased monitoring in and of themselves unless 'doing it all yourself', or going natural is your be all and end all; performance, in other words as one of the main criteria by which to judge the delivery?

'The reason that the problems are rarely challenged legally is because they are often not quantifiable. That doesn't mean they don't exist.'
There is absolutely no medical procedure available in the US, and no associated risk, that has not been subject to the intense scrutiny of the actuarial profession. Every procedure and every medicine that is available for pregnant women has been examined with a fine toothed comb and quantified by the private insurance companies (who operate with profit in mind) that pay for most healthcare in the US and who also insure OB/GYNs.

Neurosurgeons and obstetricians pay the highest insurance premiums because their specialties deal with the highest risk patients, highest risk situations, and the areas where the most can go wrong, with the most devastating results. They are the most likely specialties to be sued when the worst case scenarios happen. The procedures they may attempt and the drugs they may use are in effect regulated by the insurance companies that pay them. Best practice manuals spell out what they can and shouldn't do. Insurance companies have a huge input into these guides. In court, a neurosurgeon or obstetrician who has deviated from such a manual will have it waved in her face.

I do agree about the nonsense of telling women they can prepare a 'birth plan'. It is downright cruel. The only part of mine that had any relevance was the note that I am allergic to aspirin and latex. I only got to use the fancy birth center room that featured prominently in the brochures once out of 5 times.

MA "And there is no risk associated with more monitoring, just the opposite."
I think you misunderstood me here, women are monitored "because" of the risks associated with an epidural.

"Most women who have an epidural, and their babies, are fine afterwards." But there will alays be them that aren't.

"Most women will come through childbirth without feeling cheated at not having an epidural although they requested one and were denied one for various reasons." But others will carry the scars of PTSD and feel cheated.

"The increased risk of intervention, forceps, c-section are definitely present(though they can be necessary even without an epidural) but again, what is so horrible about any of these procedures....?" Are you being serious? Maybe a few mums who have ended up having these procedures may want to share how they found their experience, especially if it was an emergency situation. And what about the recovery rate and implications of said interventions?

"There is absolutely no medical procedure available in the US, and no associated risk, that has not been subject to the intense scrutiny of the actuarial profession." And yet they have the highest fetal mortality rates amongst developed coutries.
whqlibdoc.who.int/publications/2007/9789241596145_eng.pdf

Anyway, please read my posts more carefully, I am by no means implying that women should be denied an epidural and we shouldn't just make sweeping statements because we don't like the facts. If there were no risks, they wouldn't have to be pointed out would they?

I believe that in spain if you want an epidural you have to go to a session first to hear the disadvantages and sign a consent form before you go into labour

Everyone who has any kind if anesthesia is monitored. Including women who have epidurals. The risks are no higher than anyone undergoing any kind of anesthesia. All anesthesia carries risk. All patients have these risks explained to them before all surgeries. All sign statements that they understand the risks. Epidurals do not carry more risk than other forms of painkiller or anesthesia. The fact that there is some risk does not mean the risk is alarmingly high or should make you think twice about it, any more than you would be put off anesthesia for an appendectomy.

'What is so horrible about any of these procedures?' -- well I have shared mine upthread; I delivered DS who was 9 lbs 4 ozs having been induced early in the morning on a busy day in the hospital. No forceps used but a vacuum extractor helped pull him out, and a fetal scalp monitor was inserted into his scalp by a doctor with hands that were rather large. And I had an episiotomy, with a pudendal block. I recovered just fine, and so did DS. He had a high apgar score, born nice and pink, crying loudly. I could have done without the excruciating pain all day from the pitocin though, and I would have liked not to have felt every single inch of DS's progress through my vagina and also the insertion of the scalp monitor and the vacuum thing. I could have done without the feeling of being treated like a slab of meat that had somehow managed to get a baby stuck inside me... And I was monitored from the start, as once you are induced you get the same monitoring as you would for an epidural.

The fetal mortality rates in the US are very high, mostly due to lack of maternal access to prenatal care, and the resultant phenomenon of mothers arriving at public hospitals where their prenatal history is not known, where they may have serious complicating problems, where conditions like gestational diabetes are undiagnosed, where maternal health issues like inadequate nutrition or poor lifestyle choices have resulted in very low birthweight or premature babies. Additionally, many women take the risk of travelling to the US late in pregnancy to deliver there as citizenship is granted to all babies born in the US. For the majority of babies delivering in the US, a good outcome can be predicted.

Aaah MA, you are in the US?
As far as I am aware, women in the UK are not monitored constantly if they have G&A or pethedine. It's intermittent unless there is an issue with the baby i.e. the midwife may hear a deceleration and therefore start to monitor continuously.
I think there are many differences in how childbirth is achieved in the US compared to the UK.
For instance, women are not expected to undergo surgery as soon as they step into a hospital to give birth, so we don?t have to sign anything, unless we want an epidural or we are going to have a c-section. Then we undergo the same pre-op measures. It was the same in another European country where I gave birth.
Another difference is that midwives are the main caregivers in normal labour in the UK, not the obstetrician. They are only called in if there is an issue.
Well done by the way! 9lb 4 oz is a respectable size! You grew him well.:D But were you not allowed to get up and mobilise whilst being monitored? I wanted to move and I was helped by my midwife to sit on a birth ball and stand, leaning by my bed although I was monitored. I suppose things are done differently where I am.
I was offered an epidural when I was induced but I declined it. A few of my friends have had inductions and they were also offered an epidural, as it is an unnatural labour. Some had one and others declined. Maternal choice. It feels very different to starting off by yourself, I must admit.

I was for the birth of the DCs. Youngest is now 9. Childbirth is achieved basically the same way, but the waiver signing is definitely different. You sign a waiver stating you understand that the medical staff may perform certain procedures, and a HIPAA form with details about release of your medical information, before you are even admitted. They also ask for proof of insurance and you have to sign forms related to insurance too. I was signing the forms when my waters broke about 20 minutes before DD2 was born and the receptionist outside the triage area planted a form in my wet lap for me to initial because I had missed one of the Xs the first time round.

Women are not expected to undergo surgery in US hospitals when they arrive for delivery, just as in the UK. The expectation is that the birth will be vaginal unless there are previously known conditions that would indicate the contrary or unless circumstances demand it as labour goes on. The signing of waivers and consents to blood transfusions, administration of fluids, medically necessary administration of medicines, etc., are standard when you go to any hospital for any procedure. There are bits in the forms about waiving your rights to sue, blah blah, but there are loopholes of course I actually remember little about the various forms I signed (surprise, surprise) as my mind was elsewhere. It seems like another world with everyone looking over their shoulders at lawyers. However, the risk aspect of it both in the US and the UK has more to do with the looming lawyers than high medical risk, or risk that is higher than most medical in-patient experiences. Patients must be informed of the risks because theoretically they can opt not to be treated not really a choice for women in labour but they are patients and therefore have to be informed because informed consent is a cornerstone of doctor-patient relationships everywhere.

But the process of birth is more or less the same. (Although I have never heard of anyone having G & A in the US and had to look it up when friends mentioned it when we all compared notes.)

I was not mobile for any of my 5 deliveries. So much for the birth plans. I had monitoring for all, just as my sister and friends did in Ireland or the UK for theirs even though just one of mine involved an epidural, and episiotomies for all but the last one, birth plans tossed out the window and 'medical necessity' in their place. I was allowed to get up to use the loo once during labour with DD4, bringing my IV hook with me. That was the one and only time I got to leave the bed, ever, during labour.

I was induced 3 times out of 5, with no epidural for any of the inductions (twice because I opted for none, once because the hospital was really badly run and pain relief for women wasn't a high priority) but a shot of something for nausea during late first stage twice as the pain was making me sick and I was using my stomach muscles too early.

I used a midwife practice for the last birth too. Apart from the birth of DD1 and DS I was actually not attended by my doctors at all. DD2 (spontaneous labour) arrived an hour before my own doctor did at the hospital. A flaky first year resident attended (she kept on saying 'Don't worry, I can deliver this baby!' in a panicky voice and was steadied by a good nurse I kept on thinking, 'I'm not worried, I've done this before, probably more times than you, and actually I'm the one delivering the baby. I just need you not to mess up my rear end too much afterwards when you stitch me back together again..'). For DD3, I had one resident (second year this time) and a great nurse named Roxanne again an induction but with a cervical pessary, not pitocin, and no sign of a fully qualified obstetrician until the next morning. For DD4 I was induced first with the pessary and then with pitocin so I was there for 48 hours, with one trip to the loo before they started the pitocin. Midwives came and went according to their shifts. All the official doctors and the midwives sent bills afterwards. The residents were paid by the hospital so no bill from them.

AFAIK from the experience of friends, monitoring in the UK was constant at least a few years ago (maybe ten years ago?) when they had their epidurals, with the baby's heartbeat and their blood pressure monitored (which is what I had for mine). Most went through labour hitched up to monitors that beeped and banged the whole time. Maybe hospital policy or maybe their conditions required it? Two were private patients and one was NHS. None could get up and walk around, so in that our experiences were eerily similar. All had been shown the birthing ball and the pool, etc. Amazingly, it was empty and suspiciously spotless when they took their tours of the hospitals, but full when their turn came...