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

[Chynah]

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

Southofthe Thames 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.....

and if I hadn't had an epidural, the baby would have got obstructed and required a C-section

Sorry I misread your words, however an epidural does not stop an obstructed labour I think was what I meant to say. Sorry.

As for 'quibbling' over NMC/RCN?RCM, it's hardly quibbling, it is pointing out a glaring error in your knowledge, the NMC is our governing body, the RCM is a pretty useless Trade Union who have no say whatsoever in the way we practice. It is important to differentiate between the two as whilst complaining to one mught be beneficial, complaining to the other will do absolutely sweet FA.

MistyValley, I totally agree and had a similar experience of being disbelieved and left to labour alone. The triage midwife completely refused to engage with me - no eye contact, not asking how I was, not giving any advice whatsoever on how to deal with the pain, with her back turned to me the whole time she was in the triage room. I was left alone for 2 hours before I finally got transferred to a delivery room, with contractions every 2-3 minutes. At some point DH ventured out of triage room and asked another midwife if anyone could come and see me - the triage midwife overheard him and said he was not allowed to go over her head, that she was calling the shots, and to get back in his box.

Eventually I did get a midwife for the birth and she did a fine job. But it took hours before we got to that stage and I really don't see that there was anything empowering, gratifying or remotely positive about that. I think part of my issue is that some midwives take the position that we don't need epidurals because there are other ways to cope or manage the pain, but if they are not offering any support to deal with it, then at least they should give us the drugs.

"Eventually I did get a midwife for the birth and she did a fine job. But it took hours before we got to that stage and I really don't see that there was anything empowering, gratifying or remotely positive about that. I think part of my issue is that some midwives take the position that we don't need epidurals because there are other ways to cope or manage the pain, but if they are not offering any support to deal with it, then at least they should give us the drugs."

I'd agree with that. Which is why we need more (good!) staff! I can't say it often enough. So I'm gonna say it again, a campaign for epidurals on demand is not going to get anywhere, a campaign for more staff to be with woman whilst labouring could make a massive difference though!

DrMcDreamy, this is difficult, because you are making a real effort to engage on this thread (and others), and it isn't the easiest room to walk into -

But when half of the previous post is detailing how uncaring and basically poor a triage MW was, as well as the other half saying saying there was (eventually) a MW who did a fine job! Then I don't think 'yes, we need more staff with women while labouring' addresses the issue.

More staff, yes. But not more uncaring staff with atrocious attitude. There were plenty of posts on the other thread where the problem wasn't that they were left along, it was that they were with a MW who refused to listen to them, refused to call an anaesthetist, and patronised and bullied them.

And more than the issue of uncaring or badly trained staff.... a main issue, which I think some posts are obscuring, is that when you have MWs who see their job as caring for women in labour, sincerely, but also believe they are doing their best by persuading them (or tricking them, that was the original poster's experience) not to have an epidural when they really want one...

Then you have a problem. It's not numbers, it's not resources - it's attitude.

I think, reading these threads, that there is a difference between the women who see birth as an endurance feat, a challenge of mind over matter etc, and who want a very specific experience which allows them to embrace pain - and those that don't. There are women who see birth simply as a means to an end, and who want it to be as painfree, OR don't feel any desire to struggle with pain beyond a certain point. They may be happy, with knowledge and consent, to embrace the more medicalised aspects of birth.

They are at opposite ends of the scale - I think huge problems are arising from one kind of woman getting another women's maternal care, IYSWIM.

Unfortunately, with NHS care, there are certain standards and guidelines (although these vary wildly from PCT to PCT), we are led down particular paths whether we like it or not. Maternal care isn't tailor made to any one of us - so many threads on this board are either 'I want a CS but hospital says no' OR 'I want a homebirth but hospital says no'.

It makes me despair. I have NO problem at all with women who want to hve HBs, see labour as a unique personal trial, and are keen to refuse all pain relief etc etc. But I do have a huge problem when someone assumes those beliefs are mine, when they are not! and treats me accordingly.

Confused post, sorry. I'm trying to separate issues out here. My bottom line remains 'if a woman in labour says she is in intolerable pain, GIVE HER AN EPIDURAL as the NICe guidelines recommend.'

I know this is not a competition in any way shape or form. Just want to point out that it is not just epidurals where there is a problem. I was labouring with a back to back baby, waters had gone, I was collapsing to the floor with each contraction, could barely walk at all, and I was denied any pain relief apart from paracetamol - even gas and air. It was "too early" apparently.

The pain I went through in that labour before I was finally allowed any pain relief traumatised me for years. By the time I got gas and air I couldn't breathe and it did bugger all. I had a prolonged second stage, baby's heartbeat dipped, contractions stopped, etc., and yet my bad memories are all of the horrific pain of the first stage.

Fair point, gaelicsheep. Time and again, there's that refusal to believe that a woman is in pain when she says she is. Or, the acknowledgement that she is in pain, but nothing, or not enough, will be done about it.

I'm the pain left you traumatised gaelicsheep. I see no value at all in letting someone suffer like that.

Oh, gaelicsheep . So sorry, that sounds horrific. And it's more evidence that not nearly enough is done for women in early labour.

I agree with Gloyw and Gaelicsheep - in my view it is not just a matter of resources. No woman should be railroaded into a certain type of "natural" labour simply because their midwife that day happens to be anti-epidural, and for this to happen will require a change of attitude for certain midwives.

What I was trying to say in my post above, is that even if we accept for the sake of argument that there are other coping mechanisms that should be tried first or instead of an epidural, in actual fact very often these other coping mechanisms are not even offered to labouring women.

@gaelicsheep - my sympathies too. Back to back is very very painful...speaking from experience - gas and air no help too, and I was very lucky a friend had pressed her old TENS machine into my hand to use, even though I had no idea I would need it. Different sort of pain as it's going into your back. I thought I was pretty stoical (didn't think much really), but I realised I was getting more exhausted with each contraction and would not have been able to push at all by the time I had to. Maybe there is some pain research into this, but my personal (I wouldn't claim it's a specialist one) opinion is that this kind of pain requires epidurals - unless baby is about to come very soon (ie almost fully dilated). Or whether you wanted an epidural or not, they should have been able to keep coming back to you to see what they could give you and suggest to you might help - whether it was "too early" or not.

When I trained, we had to stay with the mother we were assigned to, and whether early or late stage of labour, we never left her (except to go to the loo!)and we never left a mother in a lot of pain to "deal with it" - we tried various measures and asked her if they helped. And that wasn't midwifery training, that was a doctor's training.(I'd agree there probably is variation in different medical schools). And manpower numbers in different hospitals are certainly different.

I do still believe labour wards are run as a Cinderella service in many - though not all - health authorities. Sorry prospective mothers reading this - that's not terribly reassuring! That's why in my earlier thread I advised being prepared and being informed, and be prepared to be persistent, polite but firm about what you need.

P.S. One final thing alongside the question of epidurals - I do think it is quite weird and not quite right that if you need to use a TENS machine in labour, you have to get your own beforehand and bring it to the ward. Sure, it doesn't help everyone - but the same applies to birthing pools, cushions, gas and air, pethidine and other measures we do provide on the labour ward. Surely it should be something women should be able to have access to on the labour ward if it turns out they really need it - by all means charge for a new one if there is an issue of hygiene/not resaleable, etc. I just find that really wrong when we (the taxpayers) pay for far more expensive equipment for patients' private use in other hospital departments. For some patients (like myself) it could mean the difference between a successful delivery or a traumatic one.

"there is a difference between the women who see birth as an endurance feat, a challenge of mind over matter etc, and who want a very specific experience which allows them to embrace pain"

Gosh - you make it sound like some sort of masochistic cult.

Most women I know who don't want an epidural just want the birth over and done with as quickly and as simply as possible - without having things jabbed into them, being fiddled with and spending extra time in hospital.

Yes - there are the 'silver lining' types like me as well, who hope that they'll experience some sort of personal growth by having to go through something so difficult under their own steam.

But IME the vast majority of women who want a natural birth don't intellectualise it.

Re: more midwives. You'd hope that if midwives felt under massively less institutional pressure than they do right now they'd be able to respond more humanely to women in their care.

I think that midwifery is a sick profession right now - record rates of bullying, absenteeism and very high staff turnover at many hospitals. Being under unendurable pressure can make some people behave in an uncaring way and even cruel way - we see this in other professions, not just midwifery.

"I do think it is quite weird and not quite right that if you need to use a TENS machine in labour, you have to get your own beforehand and bring it to the ward. Sure, it doesn't help everyone - but the same applies to birthing pools, cushions, gas and air, pethidine and other measures we do provide on the labour ward".

I think it's because there's such a lack of good quality clinical evidence for TENS - they can't justify spending NHS money on things that don't appear to work.

There is evidence on the other hand for the efficacy of birthing pools and entonox for pain management in labour - less so for pethidine (which is why some hospitals aren't offering it routinely any more).

I think birth balls and cushions - well, we're talking about furniture here aren't we? Not specifically aids for pain management?

I didn't want an epidural as it happened - too scared of the procedure. TENS was worse than useless for me. I wanted gas and air, and I wanted the birth pool. The answer was no on both counts.

For a long time I wondered if I was just pathetic, since that was the attitude of the midwives I had early on (not the one who delivered DS naturally after 3.5 pushing, she was fab).

But then I had a normal labour 8 months ago and I couldn't believe the difference. I remember when I got to hospital, almost ready to push actually, and they gave me gas and air. I actually exclaimed "so that's what it's supposed to do". In transition it was no help, but that was 5 or 10 minutes. In my first labour I had that pain for 5 or 6 hours.

There seem to be a few topics going on in this thread here...1)being denied an epidural, 2)labour ward care, 3)problems with NHS provision in maternity care.

@DrMcDreamy - you are still misreading what I posted. I think even a lay person knows that an epidural - being a form of pain relief - will not have any bearing on an obstructed labour. That's not at all what I said. What I said was that a woman who is so exhausted that she is nearly passing out from pain, will have a lot of difficulty pushing at the end. If she is not be able to push at all it leads to -what else? a C section.

'If she is not be able to push at all it leads to -what else? a C section.'

Or instrumental delivery (I've had two).

Gloyw I just think the post above is fantastic and SO true.

I wonder if part of the problem is that midwives are a special group.

Only people who see birth as deeply meaningful life event would be attracted to midwifery. Probably just as well - having your midwife faint at the sight of the afterbirth would be a bit of a bummer. (Personally, although the baby bit may be nice, I would actually find the idea of sticking my fingers into someone else's ladybits and squiggling around in blood and poo seriously off putting}.

I asked at work today whether anyone would want to be a midwife and there was pretty much a divide on the issue - lots of wincing and 'UGH...gross' but two people thought it would be a magical job.

I suspect that part of the problem with midwives is that in their working life they don't meet any of us in the 'other' camp. We never become midwives!!!

I wonder if this could explain why there is such a gulf in communication.

@Cleofarta - TENS machines cost nothing if all you are doing is selling them on the premises. By the time you are in labour, you're not really in a position to drive to the nearest large branch of Mothercare to get a machine because nothing else works.Yes, it might not work beyond the first stage, if it does work, but for many the first stage is the worst.
@gaelicsheep - I do agree, I am appalled you couldn't even get gas and air. Can't see the reasoning behind that. Nothing medically wrong with having it early. If a patient in pain gets pain relief early, the need for it lessens, whereas one who is denied pain relief until quite late will find that their pain relief requirement escalates. Using the birth pool of course depends on whether it's already being used but of course there's nothing worse than being told the pool is empty but you're not allowed in. I suspect that the way you felt you were treated exacerbated the pain too. Sadly, some hospitals are better at making the mother feel she is being cared for than others.

Ushy - isn't birth a meaningful event for everyone? Going through such a difficult experience and meeting the person who're you're going to be madly in love with until your dying breath?

Forget about the fact they spend half their time wiping poo off women's legs and doing paperwork. I think midwives and doctors are HUGELY privileged to have even a small share of that moment in someone's life.

Just like vicars are, seeing people through christenings, marriages and funerals!

"TENS machines cost nothing if all you are doing is selling them on the premises."

Well - it's a thought! Write to David Cameron and suggest it as a money raising idea for the NHS. They could have them in vending machines on the labour ward!

But there is the issue of women only accessing them in that case once they're in established labour - less effective then than if they're used from early on.

Could be valuable for women being induced though.

@expatinscotland - yes,I agree, instrumental delivery is another possible outcome....if baby is nearly out. But if baby is still far from being out and is beginning to get distressed, then it would be a C section... I think I was better at tolerating pain than being confident in my stamina. It happens!

Oh, believe me, south, I never felt any less of a person for my epis and instrumental deliveries.

Cleo you said "Ushy - isn't birth a meaningful event for everyone? Going through such a difficult experience and meeting the person who're you're going to be madly in love with until your dying breath?"

No. I think the deep meaningful event to a lot of women (myself included) is the baby not the birth. I actually think we are not well designed for producing babies, no part of modern life is natural, we have babies far later than nature intended and babies are way too big for the intended exit hole. I do not see suffering a lot of pain as being empowering - in fact I think it is a lot of mysogynist bull!t and entirely cultural in its origin. You take an exactly different view to that. I accept you do. You are in the midwife camp.

All we need to do is listen, understand and accept that people feel differently. We will never be able to FEEL what the 'other camp feel - we just need to accept our differences. Health carers in particular need to listen, understand and accept.

This topic may have been discussed earlier on already, but we've mentioned it in some recent posts - the issue of it being a contest, or how some mothers and women try to talk others out of admitting they want epidurals, gas and air, induction, etc. Or women being expected to just put up with pain and be given any pain relief at all. There is no other area of medical care where we expect patients to do this! - ONLY in the area of delivering a baby. And certainly not in the area of men's health either.

For my part, and I think, deep down, for pretty much every mother, all we want is for baby to be born safe and sound, and (if we get round to thinking about it), for us to get through labour and delivery well enough to go home and take care of our baby (and other children at home, if we do have older kids already).Deep down we know there are no prizes for being able to get through childbirth with little or no pain relief really. I just find it strange that there is this culture of trying to get mothers to give birth with as little pain relief as possible (yes, I even saw a few friends "indoctrinated" into thinking that - frightening. Two ended up with the whole panoply of operative intervention and drugs as a result - look how well that idea turned out.) And if there simply is a shortage of staff, then more staff need to be hired (maybe we will soon be asked to contribute a top-up fee for having sufficient midwives and anaesthetists around to accomplish this).

I am sure statistics about which countries have more instrumental or C-section deliveries or give epidurals makes compelling reading for some, and every now and again gets the media and the Royal College of Obstetricians and Gynaecologists (the body conferring specialist degrees for obstetricians in this country)worked up, but as a mother it does baffle me. Why not concentrate instead on the maternal and infant mortality rates, the number of successful births, the number of mothers who report complications like tears, urinary problems, etc, the number requiring corrective surgery after massive tears resulting from a misguided belief in persisting in a vaginal delivery that should not have taken place, etc. Probably because due to a combination of poor staff numbers and the culture of wanting mothers to put up with as little pain relief and intervention as possible, we can't really achieve such good results for our mothers and babies in those areas. (Fear not, UK patients who feel I am bashing the NHS.....there are actually a couple of EU countries that are worse in this regard....of course I'm not saying which.)

I agree, expatinscotland - I think any mum who gave birth to a healthy child has done well, whichever way that was achieved! Although I might appear to talk about a C-section for a vaginal delivery that hasn't progressed well as though it were an unfortunate thing, it doesn't mean that I think it is failure on the mother's part - quite the opposite. (Once again, am bristling at the culture that says that if a woman ended up having instrumental or operative delivery it is somehow a failure on her part - utter nonsense.) But a C-section can keep a mother in hospital longer, could result in a longer post natal recovery time, and is slightly more risk to her health overall......and in instances where it is attributable to poor patient care in the first stage such as denial of pain relief (including epidurals), then health professionals must take responsibility for this. Instrumental delivery is slightly more risk to the baby, no more risk for the mother. So if as health professionals we can avoid making a mother undergo unnecessary operative or instrumental delivery where possible, that would be beneficial to herself or her child. It's the caregiver's job, not the mother's.

But somehow in today's maternity service, that has switched from health professionals being vigilant and supportive, offering the appropriate pain relief measures at each stage, to a form of bullying and deception. Mothers are simply not given much at all and are told that a natural birth with nothing at all is best, so that the statistics somehow look better, or so that costs (of employing fewer staff, having fewer theatre lists and planned inductions) can be driven down. (Natural isn't actually best. A large number of natural births result in death. Something that propagandists of natural births seem blissfully ignorant about.) In some labour wards where experienced staff numbers are not even sufficient - care is so minimal that sometimes one even worries whether the basic requirement (mother and child coming out alive) can be fulfilled.

I met a beautiful woman (a graduate and a professional, and clearly intelligent and confident) at a party who was the mother of 3 healthy and lovely boys. She'd had C-sections for all 3 births....the 3rd of course being due to the fact that she'd had to have C-sections the first two times for medical reasons. She made this statement I found astounding: "I feel as though I've missed out on the full experience of childbirth somehow - like I haven't done it properly". I looked at her and answered "It's pain. Trust me. You haven't missed much. You have three healthy boys. You've done very well."

In response to today's Evening Standard's report of a woman who ended up giving birth in a waiting area of a district general hospital....get this - with no help whatsoever other than assistance from a female visitor (!) ......I must say that surely someone in charge somewhere must have sensibly deduced that if you are even needing to do midwife triage in a labour ward, you must be seriously short of midwives and delivery rooms.
(Oh yes, they have. But Dept of Health won't listen - much less the Chancellor)

www.andoverbirthcentre.co.uk/node/166

A fantastic article by the late Tricia Anderson that I think is very relevant to this discussion we're having.