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

[Chynah]

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

DrMdDreamy - One of the problems in the UK is that the strongest union out there is the GMC. Subpar medical professionals are allowed to continue.

Personally, I have found the midwives I spoke to the UK to be very patronizing. DH was due to be relocated to Manchester so I called up the local hospital to find out what I needed to bring along with me. No one would speak to my doctor here (something my obn was willing to do in her own time) or confirm that they would follow my obn's recommendation that I am induced. One midwife told me that if I was too posh to push I should not have children. Her comment highlighted her own inabilities as she clearly had not listened to anything I had said.

My father ended up trying to find answers and drove 50 miles to visit the hospital for me. He said the staff were rude to him and he said he had seen a better run wards in Calcutta. DH also visited the hospital while on a visit. He was not happy with the level of care that he saw and told his new boss that I wouldn't be having the first in England. Another issue I have with the maternity care in the UK is being discharged so soon after delivery but that is for a different thread.

While someone from a 3rd world country might find it acceptable to have an epidural refused, I think in this day and age it is a crime against humanity to refuse pain relief for something as painful as labour. Study after study has shown how a traumatic birth greatly affects the mother and child. I wouldn't expect anyone to have a root canal done without pain relief so I have no idea why the NHS think it is acceptable to force women to go through childbirth without managing the pain.

DrMcDreamy has a very good point and tbh if anyone wants this issue to advance in anyway then the midwives need to be part of the solution. Saying they're all crap won't help.

DrMdDreamy - One of the problems in the UK is that the strongest union out there is the GMC. Subpar medical professionals are allowed to continue.

I'm really not sure what you mean by that, can you elaborate?

Want2besupermum, I am 100% in agreement that women should not be refused epidurals. However, I think your post is a bit inflammatory. I don't agree with you that denying pain relief is a "crime against humanity", but I think it causes unecessary suffering which, as a civilised society, we should be striving to eliminate. And given the choice to give birth in the UK or Kolkata, I would choose the UK any day of the week. Yes there are some bad midwives, and I am sorry you did not have a good experience - I would have been very offended too by the suggestion that I am "too posh to push". I didn't have a good experience either, but I don't think you can impugn a whole profession just on the basis of that.

Also, midwives are not regulated by the GMC are they? I thought that was the role of the NMC.

There is clearly a different approach in the way the process of giving birth is cared for in North America and in the UK. Both have their pros and cons. There are also subpar doctors in the US.

Hi,just to say I haven't read every post because it is a long thread...but as a mum who delivered in a busy hospital and a dr (not in obstetrics or anaesthesia) here's my 2 pennies' worth...

1)@want2bsupermum - just to clarify mmidwives aren't doctors so they are not under the GMC. They are under the RCM - royal college of midwives (more closely related to the royal college of nursing, nothing to do with doctors). The GMC is a licensing board, the union is actually the BMA (british medical association).My laptop is a bit temperamental when using uppercase letters, so that's why some are in lower case!

2)As an "older" dr who had a more hands on training that involved a lot of time in labour wards delivering babies with straightforward (normal health) deliveries, as well as taking part in emergencies, I can certainly agree that mothers in the UK in normal conditions get a very rough - and often NHS lottery type - deal. You can have state of the art teaching hospitals or district hospitals with labour or post natal wards that resemble Darfur, and district hospitals with labour wards that look like the Portland or the Ritz and are wonderfully run- just typical of our government and Dept of Health that they have recently closed one down!! Grr. I trained at one where the midwifery care was top class and looked like a private ward, and then another where I thought it resembled Sarajevo (when they had a war...gives you some idea of how far back that was!) with chaos, insufficient room, insufficient equipment and staff, you see why I likened it to a war zone.

I do think you get treated differently depending on who you talk to or where the unit is. When I went into labour, we rang the labour ward and a midwife told my husband that "baby was a long way away"..."tell her to go take a bath" - I could barely sit with the pain (baby was lying OP rather than the usual OA position) let alone climb into a **ing bath!! When I rang my (lovely) GP surgery asked my (wonderful)GP what to do she made me ring back - and a lovely male consultant picked up the phone and told me to come in straightaway. Now I didn't mind the pain - but I was getting more tired every time a contraction came, and if I hadn't had an epidural, the baby would have got obstructed and required a C-section (more expense on the NHS). The 4cm "dictate" didn't apply to me as I was already 4cm on arrival, having already been in labour for 9 hours. I decided to ask for an epidural because the gas and air did not work and was giving me nasty side effects...I spotted an anaesthetist on labour ward and decided to request one before she got called away to deal with an emergency and got one.

I was quite lucky in that my hospital was quite well staffed by the time the evening shift started (the time I asked for the epi) and sadly this is often a factor when care in labour is concerned - it shouldn't be but the NHS is like this because the govt wants us to run a 5 star service with 2 star funds. The rest of the labour was fine - no complaints...postnatal care is another story but this is just my epidural story.

I do think that when you are delivering you need an advocate with you - whether that is a sister, husband, mother, cousin, best friend or professional doula - but basically someone who is smart, tactful, effective at speaking to people and looking out to see what you need and what the facilities are. Bathroom too far to walk? Need a drink or small snack or where to get it? How to be firm without being rude? Not just a partner who is excited and nervous and only good for taking photos of baby. Basically the person with you in labour ward has a real job to do! A woman who has given birth herself sometimes helps if her experience makes her more reassuring but it can be someone who has never had kids. I do think it is ridiculous that women have to give birth under these conditions but that's the situation today. The lack of money and midwifery jobs being allowed by the D of Health/Chancellor doesn't help

3. Finally, to all those who have posted that epidurals and pain relief methods are not "natural" and women didn't have them in the past....they are obviously very ignorant of the fact that in the past thousands of women and babies routinely died in childbirth for this reason or were severely disabled as a result of not having these measures, and that communities in the world where these methods are not available still have one woman dying in childbirth every 50 seconds (a worldwide figure). So before you put on your hippie cap and say that mothers are wrong to want epidurals, please do some research first. Death may be "natural" but in this day and age we don't have to die just to prove a point! Pain in childbirth - and different deliveries - isn't like pain with a sprained ankle.....being too stoical and trying to tolerate high levels of pain increases stress hormone levels and can actually slow down labour or obstruct labour as well as hasten it. Getting an epidural doesn't make a mother a coward when it comes to pain, it helps to put the mother in a better state to do what labour requires of her (and in fact to take care of baby afterwards too). For me the epidural wasn't even about getting rid of the pain (which was **ing awful but I could actually coexist with it), it was about preventing the exhaustion that was building up as the labour went on.

"confirm that they would follow my obn's recommendation that I am induced"

So if it was the otherway round Want2bsupermum and you were coming from the UK, do you think your US 'obn' would confirm that recommendation without ever seeing you? I sincerely hope not - I sincerely hope he would meet you to discuss your pregnancy first. So why should you expect UK health professionals to be different?

In my limited experience of childbirth (I've had one baby so far -due again in a couple of months - and filmed 14 births as a cameraperson). The best labours and births are when the labouring mothers listen and follow the advice of their midwives.

Personally I believe that the mother-to-be has enough on her plate dealing with the discomfort and pain of labour without feeling she has to take control of 'the situation' when she arrives at hospital. For a lot of middle-class women who are used to being very much in control of their environments and what happens to them, this is difficult.

The main focus really should be the baby and mother's health and safety. It is going to be painful and I'm sure most mother's-to-be understand that, though sometimes I wonder by the way people here have been talking. Pain relief is surely an ideal, shouldn't we be talking about pain management instead? If you're worked up, combative and scared that you won't get 'your epidural' even before you get to the hospital, what are the chances of having a straightforward labour if for some reason your epidural is not available?

Maybe a little more faith in midwives - who are, after all, specialists - would allow things to run more smoothly and be less traumatic.

I do agree with want2bsupermum about one thing - definitely go visit the hospital's labour ward that you are planning to be delivered in long before your due date. See what the place is like, how it is run, attitude of all the staff, not just the person showing you around (who is invariably very nice and friendly and of course not on duty on the day you go in!). You do need to case the joint - to put it that way.

Giving birth in the NHS (whether in a ward or birthing unit or even at home) is a battle - it is not a dreamy, Hallmark card moment, sadly. Your mission is to get your baby and yourself through it so that you both come out alive and as complication-free as possible. Yes, hormones will make things that go wrong seem traumatic and insurmountable - as I said, it's a battle. Focus on what you need to do to get you both home and to the first week in as good health as possible. Once again, I reiterate that in some communities in the world, childbirth is indeed a battle to stay alive,so it is not so mad an idea.

If you feel empowered, you will have a happier outcome. Save the warm fuzzy cuddly moment for when you are home, say about 3 or 4 weeks or so and have bonded, got used to feeding and nappy routines, and can just enjoy being with your cute little one.

SouthoftheThames Midwives are actually regulated by the NMC - the nursing and midwifery council. The RCM are an inneffectual union and as such have no bearing as to how a midwife practices.

Also an OP baby does not necessarily mean a ceasarean and an epidural certainly does not mean you won't have an obstructed labour.

I can't disagree enough that childbirth and giving birth on the NHS is a battle. Apart from anything else, a large part of childbirth is hormonal responses, that instant rush of Oxytocin that gives you your 'fuzzy Hallmark moment', preparing for combat is not conducive to allowing your body to do it's thing. Which no matter how you look at it is a fucking amazing wonderful thing, you are giving birth to new life, you should not be preparing to go into a warzone. No matter how many times I see it it leaves me completely awestruck. It is amazing. Leave that to your birth partner if you must have that attitude.

As for the assertion that Your mission is to get your baby and yourself through it so that you both come out alive and as complication-free as possible well yes I suppose you can look at it that way or you could have faith that the people looking after you also have the same objectives and work together with them! Going to battle and fighting with your care provider will not make either of our jobs any easier. We work in partnership with woman and their families, we make plans together and we follow through together, to view birth as a war to be fought against the epidural witholding midwives can only be counter productive.

And I really really want clarification for wantobeadupermum as to what she exactly meant by this DrMdDreamy - One of the problems in the UK is that the strongest union out there is the GMC. Subpar medical professionals are allowed to continue. because if you are insinuating what I think you are insinuating you are quite frankly one of the most insulting uneducated people I have manged to cross swords with thus far.

Not to say you should be combative or aggressive, but you do need to be aware of what's going on. I do know of different treatment being given to different mums (even during the same shift) because some mums were too trusting and not proactive at all. They didn't ask what their options were, and had a worse outcome as a result.

I think it is also worth asking - if you feel you are being denied an epidural when you need one - what options the midwife would suggest. Try the options at least once -eg gas and air, or attempt to walk to the bath at least, if that's what they advise. But if you just sit there and keep insisting on an epidural and nothing else, they will feel you are making yourself anxious rather than in real pain. From my experience (about 5 or 6 posts up), it sounds like I got an epidural incredibly quickly and too easily, but actually I had been standing or walking around for hours with nothing more than a TENS machine for my pain relief, having thrown up a lot and lost my balance after taking gas and air (that drunk feeling it gives you) with no effect on the pain, and declining injected morphine and pethidine.

If they say "you are not dilated enough for an epidural", ask how dilated you need to be, if you are 3cm and they say they need 4cm, stay calm (as much as you can!) and watch the clock - give yourself 45-60 minutes, then tell the midwife that the contractions seem to be progressing or getting stronger and would they be free to examine you again?- it would be difficult to refuse someone reasonable. But if you leave it up to them to come back to you, you might not get examined for another 3 or 4 hours if emergencies occur - this is what I mean by being empowered; be responsible for yourself, be informed before you turn up, and don't be rude or aggressive to the staff. Remember you are all working towards the same mission and they have the same goal as you but you are not there to be pampered - you are delivering a baby, not getting a facial.

P.S. Speaking of being informed, I expect most mums read "What to expect when you are expecting"....I found that book fairly good, but it did have a rather ominous and doom-laden tone when it came to talking about delivery, as though it was something to be scared of! It isn't. No more scary than driving on a motorway - you take it seriously, but it's not something to freak out over. I would suggest reading about some of the drugs on Wikipedia, which is not as negative. Wikipedia actually is fairly reliable when it comes to discussing medicine and medication, unlike some other topics.

@Dr McDreamy - I guess you've read my post up there in response. Not once am I suggesting that just because childbirth is a battle that your enemy is the midwifery or medical team! The midwives are on your side! But that doesn't mean your combat unit can read your mind.(sorry to start delving into military terms - I've never even been in the military!! It's just a metaphor)
I think a lot of mums feel that giving birth is either going to be hell (well, that isn't the case generally!) or a fluffy, sentimental moment - more likely achieved if you are totally pain free or take up hippie aromatherapy methods (apologies to the genuine hippies and aromatherapists out there) to pretend emergencies and problems will not occur. Getting an epidural isn't the answer to all problems, nor is an elective CS or induction - you only arrive at those decisions after considering the situation carefully.
Maybe calling it a battle or a mission doesn't work for everyone - but it's the best compromise between the accounts that say "it's going to be awful! My experience was sheer hell!" and those that say "oh, it's nothing! You'll sail through it!"....maybe a goal, like learning to drive or doing DIY (not a great one again, as many mums don't do DIY, hmmm). But I think the point is, if you treat as something that will have negative points (yes, the blood and pain are real, although some are not as bothered by one or the other) but there is a good outcome, it is less traumatic when things don't quite go to plan. Isn't that the point of these posts - not to upset more readers by nitpicking and bashing everyone's posts - but to try to offer support or some info to people who genuinely want some info? I apologise if you are from the military or have military relatives for whom "battle" is maybe a far more loaded word but I think in day to day parlance most people agree you can use the term battle to refer to goals like staying on a diet, passing an exam or getting a job. Mumsnet is here to offer support to parents, not a site for bored individuals to fill up threads by criticising people, if you don't mind.

P.S. I didn't say that an OP baby should always be delivered by C section - whose post are you reading??! And for goodness' sake, quibbling about NMC vs RCN vs RCM.....

'having thrown up a lot and lost my balance after taking gas and air (that drunk feeling it gives you) with no effect on the pain, and declining injected morphine and pethidine.'

Yep, it did nothing for me wrt pain relief.

I did have diamorphine, that's what is used in Scotland, and then was just stoned and in pain.

I was left on my own with my 3rd for hours (no birth partner, DH had to stay with our children, middle of the night, and hospital about 1.5 hours away) so everytime they came in, I'd calmly (I was stoned) ask about my epi.

Anaesthetist came in, ran through the list, when he got to, 'You might deliver before I can get this sited,' I said, 'Let's go then! Oh, and btw, I had scholiosis up high, but you'll find that my pelvis isn't even as a result.'

I want to come back to something I mentioned on the previous thread but didn't have figures to back up then.

In the Canadian province of Quebec:

• the instrumental delivery rate is 11% and declining. The rate is 12.5% and rising in the UK;
• the c-section rate is 16% and declining - vs 25% and rising in the UK;
• the epidural rate is 70% and rising - vs 36% in the UK, also rising.

Does anyone want to venture an explanation on how twice as many epidurals correlate with lower instrumental and CS rates over there?

Is there any possibility that over here, the mindset of both mother and midwife is altered if an epidural is given, such that the midwife does not believe the mother can then go on to deliver naturally and does not provide the same encouragement to the mother? It is just a theory - would be genuinely interested in hearing the midwives' viewpoint. I keep hearing about the so-called cascade of intervention, just curious to see what causes that cascade to happen.

I think private epidurals (mentioned by someone earlier) is a really interesting idea. I would happily pay for that if necessary. The problem we have is that mixing private and NHS care is not usually possible, so unless you have the 15k or whatever to fork out for a fully private birth (or if you don't happen to live near a private unit, most are in London I believe) you have to take your chances with the NHS where it's anyone's guess whether you'll actually get an epidural or not.

This is a much bigger issue than childbirth alone though, and would raise questions about all kinds of other aspects of medical care where people might want to mix NHS and private...

@DrMcDreamy - if you think giving birth on the NHS is nothing like a battle, then you must have been extremely lucky to work only in well protected units, and not some of the places I have worked and trained in, where the midwives, doctors and other support staff - not to mention mothers - endure conditions we wouldn't wish on our enemy. I do know that some mothers who had a more prepared "battle" attitude - prepared for battle doesn't mean behaving like a battleaxe - did far better, as they knew the risks, they were prepared, and they didn't sweat the small stuff, so to speak. As for the unfortunate situations where patients and myself were fobbed off or got suboptimal care - it happens in all places, from shops to schools, and I think to treat the NHS as some kind of heaven where only infallible angels work is naive...errors and imperfections occur all the time. For a person working, it may not be a big deal - the shift still ended well, but for a trusting and unempowered first time mum, it can be traumatic and you can't tell them to feel better because you don't think their problem is a big deal to you. But I knew a mum for whom almost everything went wrong - both care-wise and medically - and she still came out of it with a positive attitude and never once held it against the staff, because she was prepared.

Primafacie - just a guess (I'm not medical), but could it be something to do with:

a) in the UK epidurals aren't given so readily or as early. So the women that get them are more likely to be the ones that will have had problems delivering anyway. (Hence the slight correlation of epidurals with increased use of ventouse / foreceps)

b) by the time women in the UK (finally) get their epidurals, they are so stressed and tired that this can CAUSE problems with delivery. (Again, hence the slight correlation of epidurals with increased use of ventouse / foreceps).

Could the fact that the Canadian figures don't appear to show correlation between epidurals and more ventouse / foreceps be something to do with b) ?

Primafacie, I'm not a midwife but wonder if that could be partly to do with the different types of epidural, lots of NHS hospitals still use the old ones where the woman is immobile on her back, as opposed to the mobile epidurals where she can move around a bit, change position etc?

Interesting idea about mindset and expectations though, I wouldn't be at all surprised if that was a factor, human nature being what it is (this is why we double-blind clinical trials etc).

There's a similar thing where babies born by C-section are more likely to be admitted to special care units after the birth, despite actually having higher agpar scores - thought to be simply because the SCBU staff are present by default at a section whereas they'd normally have to be specially called to a vaginal delivery, so the threshold for them intervening is lower in the section case. Maybe something similar is true for epidurals, because the woman with an epidural is more likely to be seen by a registrar/consultant, so one less 'barrier' to the decision to proceed to instrumental delivery or C-section?

Just speculating here, but I'm sure there are several reasons interlinked in complex ways!

And the reasons MistyValley just posted sound very plausible as well!

Primafacie:
'- the instrumental delivery rate is 11% and declining. The rate is 12.5% and rising in the UK;

• the c-section rate is 16% and declining - vs 25% and rising in the UK;
• the epidural rate is 70% and rising - vs 36% in the UK, also rising.'

So bingo it must be epidurals .

Is this causal though? Is this the only change? It reminds me of the example we had when I was studying stats - more bananas were imported after the war, longevity went up, therefore eating bananas prolonged life. Except of course it wasn't quite as simple as that - standards of living rose generally, of which better diet was a part.

More information about what Quebec is doing would help, so that we could see if we could learn some useful lessons as to how to improve our maternity services.

No one is saying the low intervention rate must be caused by epidurals, just that clearly a high rate of epidurals is not by definition always going to correspond to a high rate of operative deliveries...which seems to be the dogma among those morally opposed to them...

Very good points MistyValley and Ephiny, I suspect they probably all play into the equation.

As far as I know (I have dozens of friends who have given birth in Quebec but I accept this isn't data) they don't use mobile epidurals much there either, it tends to be the old-fashioned "heavy" type with everyone on their backs and nearly paralysed from the waist down. Again, I don't have figures to back this up unfortunately. Although I think they will admit you much earlier - as soon as you are a couple cm dilated - which presumably gives more time for siting an epidural.

Margles, I think I've been careful to avoid any suggestion of causation - on the contrary, I am trying to illustrate that the received wisdom here about epidurals leading to (i.e. causing) a cascade of intervention does not seem to verify in all places.

Labour and delivery in Quebec is very much under the care of doctors, with nurses providing the bulk of support until the delivery - so similar to the US model if you will. There are very few midwives and they don't practice in a hospital setting, only in separate home from home birth units, of which there are very few. Interestingly, demand for midwife services far outstrips supply over there - I don't want to mislead you into thinking everyone is happy with the medicalisation of birth there either.

"Although I think they will admit you much earlier - as soon as you are a couple cm dilated - which presumably gives more time for siting an epidural."

I'm absolutely convinced that earlier admittals and proper care from the FIRST stages of labour would make a big difference to a) how women perceive their experience and b) outcomes.

It's just such a bad start to the whole process when women travel to hospital only to be sent away again. Or are in huge pain and distress at home or the antenatal ward and told to 'have a bath' without even being examined. It's just so dismissive and massively increases stress if you think you need attention and are being denied it.

Many problems must be missed early on, and you hear story after story of women being 'disbelieved', not examined when they should be, etc. So yes, as birth is a hormone-controlled thing, how about stress hormones being properly considered as part of the equation?

It doesn't even always need extra resources - I was in a complete state of anguish when I went into labour (induced) on the antenatal ward, and was disbelieved and told to go and have a bath. But the midwife was there, she wasn't rushed off her feet, she could easily have examined me and realised that I was dilating. Even a more sympathetic attitude would have made a big difference, and that doesn't cost anything.

She was the only midwife I had a problem with incidentally, before anyone thinks I'm midwife bashing. The rest (and they were many) ranged from fine to great.

"I'm absolutely convinced that earlier admittals and proper care from the FIRST stages of labour would make a big difference to a) how women perceive their experience and b) outcomes.

It's just such a bad start to the whole process when women travel to hospital only to be sent away again. Or are in huge pain and distress at home or the antenatal ward and told to 'have a bath' without even being examined. It's just so dismissive and massively increases stress if you think you need attention and are being denied it."

labouring in the antenatal ward. 20 beds in a row, hearing other women in agony and the gallopping of numerous monitors...I'd rather bear the pain at home. (or in a nice room on my own with the epidural in place).