Anyone else 'tricked' out of epidural? (part 2)

[Chynah]

For those that feel the discussion still had some way to go........... please continue.....

I've lurked through the previous thread and wanted to share my two cents.

For me, having an epidural wasn't about ideology, and wasn't a decision made at a panicked moment in transition when I 'just wanted the baby out'.

I made an informed decision - I wasn't mobile anyway because of constant fetal monitoring, and after two membrane sweeps and having my waters broken, my labour was progressing pitifully slowly.

I was managing the pain well through gas and air, but considered how I would cope if the pain a) continued for another 10 hours (which it did) or b) got worst for another few hours - I decided that an epidural was the best thing.

For me, remaining lucid and coherent was the most important thing. There were lots of decisions being made about how to proceed and I could see that if I wasn't aware enough to make them, DP wouldn't know enough, and the consultants would just forge ahead. At one point the decision was whether to do a fetal blood sample, or start preparing for EMCS, and without the epidural I don't think I'd have been able to sit and have a proper conversation about that.

In summary - for me, the epidural was about making the best of a relatively complicated birth, and making sure that I remained in the driving seat. Luckily the consultants and midwives were pro epidural in my case, and I still feel it was the right decision.

My point is that if doesn't have to be an ideological decision, or something you scream for when you're panicking. I made a pretty calculated decision, and it worked for me. I'd like to see more consultants have an early conversation with women giving birth, so that they can think about pain relief while they AREN'T panicking, and make a decision that is more informed.

Apologies for the overuse of the word 'decision' in my post.

Imagine half of them read as 'choice'.

Mahraih swap the word consultants toward the end of your post with midwives and I completely agree. Which comes back again to the fact that we as women either need to fully educate ourselves or be fully educated antenatally.

FWIW my epidural in my 2nd birth was based on decisions similar to yours, I was transferred in from my home water birth, I had a baby who wasn't coping brilliantly with the contractions and was going to be strapped to a monitor and subjected to fetal blood sampling anyway. I had a back to back baby in there so being on the bed was always going to be more painful so I weighed up my odds of this labour ending up in theatre or with an instrumental delivery and deciding the odds were stacked against me I might as well have the epidural anyway as it probably wasn't going to hamper labour in a way that wasn't already being done. Does that make any sense. I was able to verbalise that request to my midwife and she agreed that an epidural at that point was unlikely to have an effect on labour.

"and women are made to feel ashamed for wanting not birthing naturally"

Wondering if you have any examples of this?

If there is a huge push for 'natural' birth then midwives would do better to turn their attention away from women themselves and towards the systems they're working in. The majority of births in the UK are very far from 'natural' - given that they usually take place on an obstetric bed, in many cases with the woman in stirrups, a fifth are induced, over one in four is operative and 15% are ventouse/forceps deliveries.

Actually in some hospitals less than 1 in 3 deliveries is 'natural' (ie - no episiotomy, no induction, no instruments, no syntocinon).

When you take these things into account, and factor in midwife shortages - well, no wonder women are begging for epidurals.

I read the longer thread and noted the number of traumatic births which involved induction, augmentation and monitoring. There are some hospitals whose induction rates are FOUR TIMES the rates of others. How is this acceptable? To put so many women through a labour experience which makes normal coping strategies ineffectual.

IMO the reason why there's such a need for epidurals is because of the very difficult conditions so many women are giving birth under. The anaesthetists and midwives administering these epidurals are probably spending a lot of their time fire-fighting in a system which is a mess from top to bottom.

It really doesn't make sense to agitate for a huge increase in the availability of epidurals without addressing what's going on in our system of maternity care that's making labour unnecessarily difficult for so many women.

Now before anyone jumps down my throat - I do appreciate some women will feel the need for an epidural even with optimal care, a good birth environment and a normal labour. Fine - they should have access to this. But I don't think many women fall into this category. I think that most women - if they're given optimal conditions for labouring in will cope without an epidural and be emotionally fine afterwards.

Cleofartra, the thing that stuck out in your post - to me - was, "no wonder women are begging for epidurals".

Isn't the point that no woman should have to BEG for an epidural?

I had a woman next to me who was given a pessary to induce - within half an hour she was in absolute agony, panicking, screaming that she could feel her insides tearing. She didn't even have G&A.

Clearly, she hadn't known that stronger, more painful consrtactions could be a side effect. And nobody had told her. At some point, there was a breakdown in communication, both antenatally and at the hospital. Had that been me (and my obsessive researching) I'd have demanded the G&A in my sodding mouth before we started, and made the midwife or consultant agree to give me an epidural as soon as I asked for it.

We should not have to BEG for pain relief. The system is flawed, yes, but I think that pregnant women could also do a little more to prepare themselves, think about their options and discuss it with the hospital staff, BEFORE they let someone put a pessary up them.

Maybe I'm just more demanding and loud than most ...

Mahraih, I 've found both of your posts interesting.

I respect your approach to your own births and I agree that an educated approach can vastly improve your experience.

This is something I have also discovered post-DS, when dealing with various other issues within the NHS.

The question I find interesting is whether we should have to undertake such 'obsessive research' in order to ensure a satisfactory level of care. Should it really be only those of us who are a) very lucky or b) capable of researching the information and presenting it in a way which shows we mean business who receive a decent level of care? And (as I can confirm that this issue is not unique to labour wards) if we foster this attitude, what happens if we are admitted with something which doesn't allow us that level of research beforehand?

the difference between private and NHS is extreme. I went private due to early complications and the fact that the NHS hospital had failed to tell me that i needed urgent treatment for E coli - i almost lost my son and lost complete faith in the system

my birth was easy because i had an epidural from the very start - i could still feel contractions and i still had some pain but nothing really

i had a consultant obstetrician deliver my son - there was one small sign of distress and he was out with ventouse

i had a midwife with me at all times

i had a dreadful pregnancy but a good birth experience - at a price !

I have to comment about a post made on the other thread- basically someone going in for induction and demenading local anaesthetic cream before she allowed venflon to be sited. I have been induced and had large venflon/drip put in my hand - it is sore for a few seconds and nothing compared to labour (i also had hypersitmulation with the synto which settled when they switched drip off )
Some women genuinely need epidural for pain relief, but someone demenading anaesthetic cream before labour even starts is just ridiculous!!

Also to comment on various posters who were told anaesthetist not available and assuming this is not true - do they have any idea how busy it can be on labour ward? Anaesthetist will also be covering other wards, often on another site. If they have to do an emergency section to save a baby's life then this will always tak priority over everything else. Surely noone would disagree with that?

I think a large part of the problem is lack of accurate information before birth about realistic expectations of what labour will be like, in terms of both pain and pressure on NHS due to lack of midwives, funding etc.
Also i think if women were better supported during labour then they might cope better with pain. Being left on your own for hours, feeling scared etc all contribute to pain feeling even worse. again this comes down to shortage of midwives.

Finally I think there is generally a bit too much emphasis put on patient choice. The NHS is there to serve everyone and lack of resources mean that a patient wanting something shouldn't always neccesarily result in that happening -esp if it is very early in labour which could then tie a midwife to a patient for the duration of the labour which could be days.

I do agree that women should be told the truth about why epidural can't happen at that time though and not just fobbed off with empty excuses.

Mummysleepy, you clearly have your judgey pants on! So you've had a venflon fitted once and therefore can authoritatively conclude that anyone who has had a different experience is just ridiculous? Just to present you with the flip side, I have had to have a venflon fitted at least 7 times over the last two years because of surgery and other health issues. I have very small veins and on some occasions the anaesthetist had to try up to 5 times before getting in. It hurts. Of course it does not compare to labour pain, but then again, infiltrating with novocaine prior to fitting the venflon takes a second - it's not like siting an epidural in your hand, just a subcutaneous injection.

Getting back to the point, I don't think anyone disputes that women/patients must be seen by order of urgency, and that there are times when the anaesthetist is not available. What women object to is being lied to, i.e. being told it's too early (contrary to NICE guidelines) or too late when they are, say, at 8 cm with potentially hours to go, when there is no such medical emergency taking priority over their needs.

Yes there are limited resources, and I agree even with the best will sometimes epis are not available. But it seems quite often the will is not there because some midwives think it is their role to limit access to medical pain relief.

My first birth experience - terrible pain, really thought I was going to die, just couldn't believe I could survive such pain. I had flashbacks after the birth and nightmares, and pnd that lasted 2 years.

My second birth experience - epidural, and a very positive experience of birth.

But after my first birth, people (always young women, never the older generation) were congratulating me on my birth whereas after my second birth I felt that I had to apologise to people for having an epidural, as if I was a wimp!

When were epidurals invented? Woman had been giving birth for thousands of year before that. Im not surprised some of you were refused with your spoilt, foot stamping, hissy fits.

My friend is a midwife and went into it with rosy specs on but now, in her busy hospital, it's a production line and they want you in and out without any whinging.
If you are healthy and there is no problem with the baby then there is no reason at all why you should have an epidural. That will slow the labour and can be dangerous. As has been said before - it's called LABOUR for a reason!

"Cleofartra Thu 24-Feb-11 10:42:02 "and women are made to feel ashamed for wanting not birthing naturally"

Wondering if you have any examples of this? "

Now come on, this has been done already in the previous thread. See Ushy's post on Sat 19-Feb-11 09:17:22 in answer to your question "Who's 'campaigning' against epidurals?"

Or have a read at Pr Dennis Walsh's article referenced in this BBC news report (sorry, can't post link to the article itself but it can be googled easily)
Dennis Walsh

You have yourself said in the previous thread that "Midwives see themselves as 'the guardians of normal birth' ... they start from a position of believing that in the right environment, and with the right care, the majority of women can give birth without the need for oxytocics and instruments."

My own experience throughout the birth and afterwards was that I was told I "had done so well" - as if getting an epidural or section would have been a sign of failure somehow. Many posters on the other thread said the same thing.

Or just look at Nonames' post if you are not convinced

Nonames, I do hope you take the same attitude if/when you develop cancer or circulatory disease, and refuse any treatment or pain relief. Remember, back in the days of Neanderthal, life expectancy was only about 20 years - who are we to interfere with nature?

My hospital was really good for my first child - they offered one straight away but had real trouble getting the needle in and took many many attempts to do it. I ended up with one dead leg and loads of bruising on my back, but luckily no pain in labour. That was just as well, as the lady doctor did a vontouse against midwife advice; she was going into theatre with someone else and wanted to hurry me along. The midwife was really cross.

For my 2nd child I was told they didn't have a member of staff to do it at that moment as they were busy with other ladies. When the midwife did come back with someone they asked me to sit forward over the bed. During several failed attempts to get a needle into my back I told the midwife I was pushing. She said I couldn't possibly be at that stage yet until I told her I could feel the head. She ended up rushing to put on gloves whilst holding my baby in. The lovely anaesthetist ended up holding one of my legs and my daughter was born seconds later.

For my 3rd child I had delivery problems. I was worried they wouldn't be able to get an epidural needle in due to all my past problems. They sent an anaesthetist straight away but the surgeon broke my waters instead.

Child birth is not an illness.

I was hospitalized a few years ago with abscess in my fallopian tubes. Now THAT is what you call pain. Childbirth didnt even come close and yes, I accepted pain relief. Pain of illness is very different from choildbirth. You are already starting with weakness. IF you are fit and healthy and your baby is healthy then why take a drug that can have horrendous side effects?

here are some listed;

www.childbirth.org/articles/sideeppi.html

lady rattles-

"I ended up with one dead leg and loads of bruising on my back, but luckily no pain in labour."

Sorry, but LUCKY???? It all sounds very UNLUCKY.

nonamesavailable - uncomplicated childbirth is not an illness - true.

Unfortunately women do not always have an uncomplicated birth for many different reasons. I am sure that for you your Fallopian abscess was more painful than childbirth. But, you cannot then assume that everyone else experiences the same level of pain. I would not be at all surprised to find a woman who has had a Fallopian abscess that was less painful than her childbirth. Every person is different, every pain is different.

Nonames, who's having a spoilt, stamping hissy fit? I had a straightforward birth (and didn't want an epidural: I'm hanging around on this thread because I'm interested in why so many HCPs are so bad at listening to women, rather than because I personally had an awful experience). It still hurt more than my dislocated shoulder a year earlier. No-one suggested to me then that people have been dislocating joints for thousands of years and of course I could get through having it put back in place without any pain relief.

That is why I put the word 'if' in both posts. I have friends that have genuinely had an awful experience but i also know woman that seem to believe they are the first person EVER to give birth and we jolly well better treat them like the princesses they are. I've read many posts on here that fall into that camp. You are giving birth, not checking into a five star spa!

petsville - a poster on the first page of the first thread for starters.

If the pain relief offered was a simple as an aspirin I would say go for it. But it isn't . It's a seriously unpleasant procedure. Just look at lady rattles for one example. Then look at the link I put up. Why anyone preparing for birth in hospital thinks this is a good option beggars belief.

Nonames - yes there are many hissyfit princessy women in the world, and of course that probably won't change when they are pregnant and giving birth. And yes, they are probably quite annoying all round. Doesn't mean that they shouldn't receive proper medical care though.

But I think that often the women that suffer the worst treatment are the ones who aren't inclined to make a fuss, who try and bear it all with maximum fortitude, who see the midwives as professionals doing a hard job. And get a nasty shock when their patience and lack of foot stamping means they get ignored and don't have their feelings or opinions considered AT ALL.

Nonames, you think you can extrapolate your own experience and apply it to every woman? I had a ruptured fallopian tube following an ectopic pregnancy last year. It was horribly painful. But not as painful as my labour the year before. Does that mean I am allowed to tell you off for having had pain relief for your abscess?

The link you have posted is very heavily biased and frankly packed with lies. Some of the so-called "side-effects" are really not worth mentioning - is it really that big a deal to have a BP cuff on? Certainly not for me it isn't. Ditto for continuous fetal monitoring - I hardly call that a side effect.

Epidurals are NOT associated with increased c-sections. Epidurals are associated with increased frequency of forceps/ventouse, but no causation has been established - merely a correlation.

Long term side effects occur in 1 in 80,000 women. Epidurals do NOT cause long term bachache. Most of the things listed on your link simply never happen - it is pure invention by the author.

Epidurals are NOT toxic to the baby and do not cause lower Agpar scores.

I could go on and on but if you bother reading the thread you will find all this has been said already.

Instead of believing and disseminating any crap you find online, maybe you should educate yourself by referring to actual scientific evidence. The Cochrane reviews would be a good starting point.
Cochrane

Shame on you for this classic piece of scaremongering.

The drugs in an epidural do cross the placenta though according to nice, stands to reason - since they are opiate based it could then have a knock on effect on Apgar scores.

noisylurker - you're absolutely right, it shouldn't be the case that a woman should have to research every single possibility (as I did) and essentially 'play doctors' with the midwives and/or consultants.

That's a very unfair situation.

What I'd like to see, however, is women asking MORE questions about what is being done to them, BEFORE it's done. And indeed when that woman is more vulnerable, for the hospital staff to make more of an effort in explaining. Sometimes it's an emergency situation, and I appreciate that that wouldn't always be possible.

Of course, some women will have less access to information, but I do believe that one of the ways we can gain better care is by arming ourselved with knowledge. Ask, ask, ask. If we want positive birth experiences, we must be braver in demanding the things we need, and more proactive in knowing what it is we want and the side effects of those. With 9 months to prepare for ANY event, surely one would do some research.

Of course, one could still come up against a midwife or consultant who absolutely refused to give an epidural, or lied. But it is much harder to refuse someone who comes at you with a sound knowledge of what is going on.

Using the woman in the bed next to me as an example again - she didn't ask any questions about what was being done to her, and English was her second language. Blind acceptance and lack of communication are not a good combination. Afterwards, she kept begging them to take the pessary out - they repeatedly fobbed her off, it was distressing to hear. But she was easy to ignore because she was hysterical, and vulnerable.

scaremongering? Im talking from the experience of having 3 children and having a lot of friends that have had kids. You know before they even go into labour the ones that will end up with the epidural/c section.

As for "believing and disseminating any crap you find online"?? So we shouldnt believe a word we read on the NHS website then? Almost the same info;

www.nhs.uk/Conditions/Epidural-anaesthesia/Pages/Sideeffects.aspx

(ps - maybe a ruptured fallopian tube isnt as painful as an abscess? Shall we play pain bingo?)

But, PedEgg, they don't - that has been studied and there is no evidence of lower Agpar scores for babies born to mothers who received an epidural.