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

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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?

If labour was that much agony that women couldn't go through it without pain releief the human race would have died out centuries ago.

It's painful but not agony - it is not something that will not go away - as soon as you have the baby normally you are not in any great deal of pain - had a really bad tear with DS and going to the loo after for weeks was more agony than actually giving birth.

Breaking your leg or popping out your shoulder is bloody agony giving birth is something that we are made to do and it is only advances in medicaine that make women able to go through it without feeling pain - I always think of the woman who gave birth in a tree and then was picked u by a helicopter during the flooding (Bangladesh or the carribean) if she can do that I can sure as hell give birth ina nice dry warm hospital with my husband holding my hand.

It might be agony, but an epidural is not essential. Thats a fact. You might really really want one and it would be great if anyone who did got one, but it is not essential.
I heard a woman complaining once about not getting one, the main reason being there was a big emergency in the hospital with many casualties and surgeries. She actually thought she should have got priority over people getting life saving surgery because "I was there first".

I never expected to have one. Knew it wasn't an option with DD1 as it was a MLU i gave birth in, I knew that if labour got complicated or needed pain relief about pethadine then i would have to be transferred. With DD2 she was back to back and from 11-14 hours into labour i was stuck at 7 cm. They got the anesthesiest to come and give me an epidural because i was crying in so much pain, and there was a strong chance of needing emergency section due to distress that DD2 was in. I never expected it but i was really relieved to be offered it.

Sorry that your mate had a traumatic experience, nobody deserves that. But What ^^ tabulahrasa said. Nothing (at all) is guaranteed in childbirth (or pregancy for that matter). I thought everybody had figured that out by the end, should be esp. obvious so someone who's already had 2 DC.

The majority of women who labour in the uk do it without an epidural. In most cases this is because they haven't requested one. Hence 'most women don't need an epidural'.

For what it's worth - I found labour agonising. I
didn't request an epidural.

SPUD - that's obviously because you are a better woman/mother than the rest of us then

The problem with the system is that the drugs exist to create a pain free birth, but certain elements in society ( lack of funds/strange hospital policies/uncaring mysogynistic mumsnetters) feel compelled to prevent women's access to them. I find the attitude of 'well, I found it painful but I did it, so therefore you can too' - utterly repellent.

The drugs exist, the resources do not, that is where the problem lies - but that's not the woman's fault or some symptom of her naivety!

'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.'

Actually, we're not well-built to go through and withstand childbirth due to bipedal locomation/smaller pelvis having a greater advantage from an evolutionary standpoint. That's why, in places with no adequate maternity level, about 10% of women (more in some places) die having a child.

The UK has one of the worst rates of maternal death and stillbirth in the Western world.

Hope people who say, 'It's agonising, but I got through it, so should everyone,' never have to live in a place where you hear the screams of women who eventually go on to die trying to give birth. What an ignorant, mean-spirited, compassionless comment.

Liznay - that's a nasty comment.

I had my own good reasons for not wanting an epidural, as do other mothers who choose to go without.

That's grand, spud, good for you. But it's ignorant to assume that because you didn't want one, no one really does or should.

I got through labour and delivery without one, too. Thankfully I had straightforward deliveries. I might have felt differently if I had certain conditions or was induced.

no, it wasn't nasty. What else were you trying to convey by saying that you found it agonising (but didn't feel the need to request an epidural) - if it was not some superiority over those that did.

Lachesis - high maternal and neonatal mortality rates don't have anything to do with lack of epidurals.

They're generally to do with poverty, lack of antenatal care and lack of midwifery care in labour. Most mothers who die in places like Congo today would be saved by proper midwifery care in childbirth.

We had a very low maternal death rate in the UK in the 1950's when epidurals weren't available and the c/s rate was 2%.

What I was trying to say was there's more to needing an epidural than just the amount of pain you experience.

Where have I said nobody else should need or want an epidural because I didn't?

They are totally missing the point spud, I wouldn't worry about those who can do it with one so fecking obvious. Your comment was both logical and factual, some people just have to make everything so emotive.

"Uncaring misogynistic mumsnetters"? Really, thats how you want to come across? Up to you I suppose.

Individual pain thresholds. Are not for others to judge. If a woman can ask for a home birth (to be attended by 2 midwives) why cant a woman ask for decent pain relief?

On a side issue why does there need to be 1 on 1 midwife care for the duration of an epidural. My midwife barely even looked at me in between doctor examinations (until 2nd stage and then I figure its mostly 1 on1 care if you are epiduraled up or not)

I begged for an epidural for over 6 hours. I suffered PND and went to seen the supervisory of midwives who assured me that the policy had been changed and no woman will now have to wait more than an hour from asking even if that means transfering to another hospital.

I don't know whether to believe her or not but it sounded better.

How is it obvious that pain relief is not available????
After 26 hours of painful labour I was offered pethidine. I was not told there was a chance it would not work and was very upset when it didn't. I'm not sure how true to life the situation portrayed in 'One Born Every Minute USA' is. It was stated that 9/10 women opt for epidural and the general attitude seemed to be if you want it; have it. In my experience, the attitude to pain relief in labour was you should try to do without and at every step I was discouraged and told to get on with it. I still feel very emotional about my experience - even after 4 years.

My labour was way more painful than when I had appendicitis, and with appendicitis I was offered very strong pain relief. Just because it's labour doesn't mean not offering appropriate ( ie until the pain is bearable or gone for the individual) pain relief is acceptable. Just because women in history had no pain relief in labour, doesn't mean its acceptable for pain relief not to be given now. People used to have amputations without pain relief too, but doesn't happen today.
Med Students are taught that all pain is on a scale of 1-10, with labour being 12. Just because you were lucky enough not to have an agonizing birth, doesn't mean you experience was typical.

"If a woman can ask for a home birth (to be attended by 2 midwives) why cant a woman ask for decent pain relief?"

She can ask. And she usually gets it.

If she doesn't it's often because of a shortage of midwives to provide one to one care, the same reason why women are sometimes told they can't have a homebirth. BTW - the second midwife at a homebirth is usually only in attendance for an hour or so - just for the birth of the baby.

"On a side issue why does there need to be 1 on 1 midwife care for the duration of an epidural."

Because having an epidural means your labour becomes high risk. Your blood pressure and the baby's heart rate need constant monitoring.

"My midwife barely even looked at me in between doctor examinations (until 2nd stage and then I figure its mostly 1 on1 care if you are epiduraled up or not)"

That's shit care.

"and no woman will now have to wait more than an hour from asking even if that means transfering to another hospital."

That's really interesting Starlight. I'd be fascinated to know how often transfers actually happen in this sort of instance.

"I'm not sure how true to life the situation portrayed in 'One Born Every Minute USA' is. It was stated that 9/10 women opt for epidural and the general attitude seemed to be if you want it; have it."

I think most women in the US system have highly managed births. Hospitals probably have loads of spare capacity - unlike the NHS which is pretty much functioning at full capacity all the time. That's probably why the health care spend per head is so much higher in the US. And of course, if you're paying for it at the point of use, you get whatever you want.

Scarlett - the bottom line is that midwives should listen to mothers. The RCM has fingered this as one of the most important facets of good midwifery practice. It's horrible to feel that someone has their own agenda and your feelings are not on it.

Not receiving enough pain relief can also lead to PTSD, but maybe that's not possible, just cause you were lucky enough not to experience it,too?

"Just because it's labour doesn't mean not offering appropriate ( ie until the pain is bearable or gone for the individual) pain relief is acceptable. Just because women in history had no pain relief in labour, doesn't mean its acceptable for pain relief not to be given now."

The key difference between amputation and childbirth is that many women don't want to use pain relief. And they don't WANT to be offered it. I didn't and I know plenty of people who feel this way.

That's not to say that women shouldn't be listened to when they request pain relief.

"Not receiving enough pain relief can also lead to PTSD, but maybe that's not possible, just cause you were lucky enough not to experience it,too?"

Are you addressing this comment to anyone in particular?