Women should be told that they may not get an epidural before labour?

[lostintransition]

A friend of mine recently had her 3rd dc. She had an epidural with her first 2 dc's and had positive birth experiences. Her plan was to have an epidural with this one too.

However, despite hours of contractions, when she got to the hospital she was told she was not in labour (2cm dilated) and so could not yet have an epidural. When her contractions ramped up the midwife told her she was probably now in labour but she could not have an epidural because there were no rooms availible on the consultant unit (she was admitted to the birth centre on the same site).

The midwife then told her she needed 4 things to meet the criteria to get an epidural.
To be in 'active' labour
Have a room availible on labour ward
An anaesthetist availible
A midwife to give you 1 to 1 care

She ended up giving birth without getting an epidural, is quite traumatised and feels very let down and annoyed that no-one ever told her that an epidural may not be an option for her on the day. She was aware she may not get one if she had a speedy delivery but she was in angony for hours . Most women I know have always just been smiled at by midwives and told 'Yeah, you can get an epidural whenever you like!'

Now, I understand the need for all of these things to be in place before getting an epidural but why aren't women informed of this antenatally and just lied to?
I've encouraged her to complain but she say's 'Whats the point, its done now'. I wonder how many other women this has happened to and also don't bother to complain because its over/ they are too traumatised/ to exhaused looking after a new baby.
Is there a conspiracy to withhold the truth so that women won't/can't complain and demand better services?

I would have thought it was pretty obvious that you might not get an epidural. Obviously there will be times when there is no anaethetist available, or when you are either too early or too late in labour etc.
And I'm pretty sure that anyone planning to go to the a birth centre/MLU etc will have been told that they don't do epidurals, its standard.

Really, do you need every bit of information handed to you? You could, like, ask about this stuff?

Well I knew with mine that I could ask for an epidural - but that I might no get one

Tbf I would have thought that being in agony or hours there would have been at least one moment in all that time where one would be available to her :(

*for hours

She always planned to have an epidural but in our local hospital if you're defined as 'low risk' you are automatically admitted to the MLU- the labour ward is on the same floor.

She had never had a problem getting an epidural before and assumed it would be the case again. During the 'birth plan' appointment she was asked what she would like do this time and the only thing written in the birth plan was 'epidural'. The mw just answered 'OK'- no mention at that point that ther may, just may be the possibility of her not getting one. Just a smile and a scribble in the notes.

I remember my AN apointments before I moved house and decided on a home birth. They were more like going for a (very quick) MOT with no opportunity to talk and no additional information given.

When pain relief was discussed there was always the final 'or you could have an epidural, the hospital offers a 24 hour service', not 'we have an epidural service but often you will be unable to get one due to staff shortages or high workload'.

How women are aware of this labour?

aware before labour

If a man was in that much pain in hospital, there's no way he would be refused pain relief.

she might have chosen to go to a different hospital

I'm amazed that anyone would go into labour thinking an epidural was guaranteed.

But I do think there should be a franker discussion of issues surrounding pain relief at the 36 week appointment. Shame it doesn't always happen.

Hi LOSTINTRANSLATION,

I completely agree with your post. If you do a search of my earlier posts, you'll see that I started a thread which ended up being on the BBC/National Press. It is primarily because of these sorts of stories that I ended up talking to the Press. I feel that too often, women that get a poor deal from our maternity services (which we pay for through our taxes). We put up and shut up and we should be demanding better services. I, for one, don't believe that access to pain relief should be dependent on a whole list of outside factors.
Where else in the NHS would this happen? Can you you imagine being brought into hospital in an abulance after a RTA and being told, "Well we'd love to give you some morphine, but there really isn't anyone to administer it at the moment, they're all busy, plus we've got no suitable rooms!"

It's just a bloody joke. I'm due to have my 2nd child in 2 weeks and If that experience is anything like the first (where the midwife refused to give me pain relief) I shall be going back to the Press to get this all out in the open.
If you want a natural birth with whale music and candles and no pain relief great - you should get it, if not, then when pain relief is asked for, it should be available, immediately.

Tell you friend to make a complaint, it's the only way we can change the system.

It has to depend on many factors, you can't just throw epidurals and stuff at anyone who wants them. It has to be clinically possible for a start, and there has to be someone available to do it. And its the NHS, so you can't have one anaethatist per woman, sometimes they will be too busy. Tough luck.

Morphine is a shot in the arse, any nurse can do it, in any room. Do you really want anyone to stick an epidural needle in your spine, in a corridor, with no midwife to catheterise you, and with you unable to walk?

For gods sake, grow up a bit. Very few women clinically need an epidural, and I actually find it rather pathetic to hear "nobody told me I might not get one" wailing. Ask! Take charge of your own care. If you feel you absolutely have to have an epidural, arrange it properly, don't wait and then be utterly traumatised because you're in the wrong place or someone took priority for the anaethetist.

Ahhh I love the smell of compassion in the morning.....empathy for our fellow (wo)man's suffering, isn't that what mumsnet is all about??

No. And "suffering"? Don't be a victim.

I have empathy, but don't see the need for compassion because people don't ask simple and obvious questions.

Siamo,

The lack of midwives is a real issue for mothers in this country, as is the lack of consultant cover in some maternity units.

I think we should be campaigning for better maternity services all round, so that women have a safer and more humane experience of childbirth.

I just don't think the way to do it is to focus our anger on the single issue of women not getting epidurals when they request them.

It's a much wider problem than this.

Re: comparing women's requests for pain relief in childbirth with requests for pain relief following injury elsewhere in the NHS - the issues are not the same. Most women don't request or need epidurals in labour hence routine administration for all mothers isn't something that anyone's going to put protocols in place for. Opioids are available in all hospitals for mothers - on request, just as they would be for anyone else who was in intolerable pain. Entonox is also available. There are other people in hospital who are not getting the most expensive and sophisticated pain relief available because of cost and availability issues - this is not just something which applies to labouring women, so they're not being singled out for specially poor treatment.

"Tell you friend to make a complaint"

Make a complaint about what?

Not being admitted to hospital in early labour?

There being no room free on the labour ward?

An anaesthetist not being free to administer an epidural?

Not getting a midwife to herself?

Good luck with that.

Then campaign about the lack of midwives?consultants etc, thats an actual issue. But "I forgot to ask about pain relief but no-one explicitly told me something fairly obvious" is not.

There are real problems that need addressing. Picking one that makes women look like daft children seems counter-productive.

I think your friend was extremely niaive considering she had had 2 children already.

I had an epidural with DD and it was lovely but with DS there were none of the midwives I had seen throughout my pregnancy available and I went from 1st to 2nd stage very quickly - too quickly to wait for the anesthesiest who was busy in theatre with an emergency caesearian.

I completely understood this resources aren't finaite in the NHS and epidurals sometimes are not given for very good reasons - if the there wasn't a qualified professional available she couldn't have an epidural - shout and scream and complain as much as you want but she should have gone private if she wanted an epidural so much.

As for ruining a birth plan well birth plans are a complete waste of time IMO - they rely on the baby doing exactley what you want and the professionals being available at exactley the right time.

My boss sits on a panel that decides what to fund and the individual cases that they have to turn down would shock you - your friend was lucky to have a labour where pain was her only bloody problem but really women cannot expect pain free labur - it is hard work and painful.

FFs labour isn't agony - we are built to go through and withstand labour without pain releif as most women in this world have to.

One thing that does make having an epidural different to pain relief in other medical settings is that they know that the pain will subside after giving birth, so if they hold off then the demand will go away. This isn't the same for the majority of other medical settings - it takes quite a while for pain to go away if you have broken your leg.

Ffs maybe labour wasn't agony for you madam but it was for me. It was hell thewhole way thru. And no all I had was gas and air which did fuck all. Thats possibly the stupidest sweeping statement I've ever seen.