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?

Well maybe they should have pulled someone out of surgery so she could have one

Did I want an epidural with my first? No. I read lots and was quite adamant but when it came to it I NEEDED an epidural with my first. I didn't get one. Did I manage without? NO. I did NOT manage. I relive that birth, the pain and the torchure frequently.

Amazingly with an almighty amount of counselling and a hundred written promises from the hospital staff, not to mention hours and hours of extra meetings with them an written correspondence, I had a second baby.

Was I in agony? YES. Did I want an epidural? NO. Did I NEED an epidural? NO. The pain was quite overwhelming at times but I didn't even ask fir Gas and air despite having G&A, Meptid and and epidural on standby.

You absolutely cannot compare two births or use one birth experience to set policy whether that is to insist on epidurals or refuse them.

Should someone in surgery wait an extra 30 mins so a suffering woman can get pain relief, - well yes, if not an emergency I believe they should. Should we have a system where those kinds of balances have to be weighed up by people based on their opinions rather than established protocol supported and properly funded - no.

Yes but that wasn't the case. The woman requested pain relief and it wasn't provided.

The comment about the PTSD was directed at all the posters on the thread who seem to think that a) epidurals aren't necessary and b) labour isn't agony, just because it wasn't the case for their individual birth.

Why should someone get adequate pain relief for passing a stone through their urethea, but not a baby through their cervix?

"Why should someone get adequate pain relief for passing a stone through their urethea, but not a baby through their cervix?"

Pain relief IS usually available, and there's no policy in UK hospitals of denying it to women when requested. If women aren't getting pain relief when they request it, then it's down to a) poor practice on the part of midwives and/or b) insufficient staffing levels.

I honestly think most, perhaps all, people on here strongly agree with the view that there should be more midwives and more anaesthetist cover in uk maternity units.

Whether everyone would agree that CURRENT resources should be directed away from current areas of expenditure within maternity services to ensure easier access to pain relief for everyone is another matter.

I think most of us prioritise safety of mum and baby above everything and wouldn't resources directed away from anything which might impact on this.

By the way - I get frustrated with comparisons between illness/injury and labour. I've never come across anyone who's rejected pain relief for surgery or severe injury. But plenty of women go through painful labours and don't request or want pain relief. Either they're stupid, or there's more to the decision to have pain relief than the degree of pain alone.

This thread has some extremely ignorant comments!
Labour is agony for some people and not so for others. I was firmly in the agony camp.
How dare somebody tell me that I don't NEED an epidural??? I'll decide that thanks.
If you were lucky enough to feel you didn't need an epidural then I'm delighted for you but for some people it is the only way to get through it.
There are many reasons why you might not be able to have one, I don't think that's right but unfortunately thet is the way it is.

spudulike you are talking a lot of sense to me.

I was in labour for well over 2 days and was discouraged from having any pain relief for the first 24 hours. Having a baby was the best thing that ever happened; being in labour and the general hospital attitude of 'get on with it loads of women have a EMCS' afterwards was the worst experience of my life.

MadameCastafiore - different people have different levels of pain from childbirth, and other injuries. You say 'breaking your leg or popping your shoulder is agony' but different people see that differently, for example, DH used to be a professional rugby player, he's continued to play the rest of a game when braking his collar bone in the first half. Some people would be in pieces with that injury, but some people (like DH) don't find that intolerable levels of pain.

I accept that you shouldn't expect to get an epidural the second you ask for one, but the OP's friend continued to labour for hours, if they don't have the room/staffing for hours, the hospital has a serious problem and should have transferred her somewhere they did have adequate staffing levels/turned away other woman arriving until they had a reasonable number of labouring woman to staff.

Also, why did they need to give her 1 to 1 midwife care with an epidural? I had an epidural when i had DS and I was left alone with DH for most of the night, just being checked on for less than 5 minutes once an hour.

Bit the issue in this case was that epidural wasn't available on request

PTSD because you don't get an epidural?

FFS. Its a bit more complicated than that.

Labour fucking hurts. Some more than others. But almost nobody actually needs an epidural. If you disagree, look up the word need in a dictionary. If you want one, you should get one, but in real life, shit happens.

With my second child, I had an instrumental delivery with gas an air. I needed loads of stitches, which of course needed local anaesthtic. Due to a cock up, I didn't get any. I got over it, I'm still alive. I'm not whining about it.

Siamo -

I'm sorry you had a bad experience. You clearly are not over it. Telling other women they have to endure excruciating pain because you had to does not make anything better.

I think what happened to the OP's friend was a breakdown in communication.
Surely if all she'd had written in her birth plan, for her 3rd baby, was 'epidural', then that in itself should have excluded her from the MLU.

If they they weren't going to take that seriously it should have been explained by the MW weeks earlier.

I know the consultant unit was full but if she was high risk and thus unsuitable for the MLU, they'd have found a room for her somehow, even if it meant a transfer.

I don't think this is about how much pain different people can take, this is about preparation. If the OP's friend thought there was a chance in hell she wasn't going to get her chosen method of pain relief, I'm sure she would have made different birth preparations, whether that be hypnobirthing/reading that Birth Skills book or going privately. She must have felt that everything was completely out of her control, which is frightening, and of course makes any pain worse.

Some of the responses on this thread stink of "I had a natural birth and think any woman who doesn't is clearly inferior in some way."

1. The woman, reasonably, based her preparation for this birth on her experience of 2 previous births.

1. Just because the pain of labour is for a finite period (sometimes spanning days) it does not mean that once the pain has stopped, the damage cause by suffering it will go away.

1. Everyone labours differently. If you managed on nothing but aromatherapy and whale music for 48 hours then great for you. Expecting all women to follow the same plan as you is unrealistic and arguably unempathetic.

1. People don't die from toothache but are rarely refused/denied pain relief due to unavailable staff members/cost etc. The culture of denying a woman an epidural by using delaying tactics is not a global phenomenon. Take Canada for instance, more epidurals on average and interestingly, less births involving intervention (query the role of stress and exhaustion in the intervention rates in the UK).

The attitude from some respondents which imply this was the woman's own fault and nothing more than to be expected does nothing to advance woman having the best labours they possibly can - which should be in all of our interests.

With both my births I had just gas and air - both were too quick to have had an epidural, and I didn't need one. Other women have different experiences and so will need different pain control. However - the NHS has fixed resources so an epidural will not be available on all occasions - women should be informed of this.

Oh - and you can't compare an epidural to pain relief for a toothache - the resources required for an epidural are considerably more than those required for a few painkillers.

Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event. Being in great pain and feeling out of control of the situation could easily trigger this, especially if you keep asking for help and don't get it.
Siamo, you don't need to feel like you do. Have you fully processed what happened to you?

Yes thanks. PTSD is what people caught up in wars and terrorists events and such often get. Not sure "I didn't know I might not get an epidural" is quite enough to trigger it, in the absence of other factors.

I didn't say other women should endure anything. I also never said it was excruciating either, but thanks for telling me how I feel.

All the comparison to other conditions that people wouldn't have to wait for pain relief for is a nonsense and only shows the naivety of the person saying it - pain relief for dislocated shoulders, kidney stones, even post-op amputations would be very high levels of morphine which you cannot have while labouring due to the risk to the baby.

Also morphine doesn't strictly stop the pain as such - it just makes you so high you don't really care by dulling pain receptors and rewarding pleasure receptors. You also don't need to be monitored as closely after receiving morphine, nor does it require specialist administration - quite often patients can administer their own morphine.

The equivalent to morphine is pethadine, not an epidural which (unless you get a bitch of a midwife) should be available pretty much on request.

It would be great if more resources could be made available, but even if every labour ward had two dedicated anaesthetists there would still be women who didn't get an epidural when they wanted one - because the anaesthetists could be in EMCS's or administering epi's to another women (they can take up to an hour to site) and by the time the anaesthetist is available the requester could be too far into labour, or there may not be enough midwives available or beds on the consultant unit because they've had an influx of genuinely high risk women come in.

Besides, if more resources were available for maternity services, I'd (personally) much rather it went on midwives.

I do however, agree that it should be made clearer to women that a epidural may not be a possibility - that is to do with better ante-natal education - my community midwife didn't mention it but the ante-natal classes at my hospital made it very clear. However, as not everyone goes to hospital ante-natal and not all are as good as mine were, the focus on any campaign should be the improvement of community based ante-natal care where these issues should be made clear.

At the end of the day the only way to guarantee and epidural if you really want one is to go private.

I had counselling after my birth trauma and it helped me enormously. Just sayin'

Just to clarify - I meant the pethadine should be available on request not the epidural.

Good for you, glad it helped. Not all of us need counselling for normal life events though.

seems im not alone

I didn't get an epidural with my first baby despite begging for hours. gave birth then had retained placenta. they put me on a syntocinon drip to start contractions again which were immediate agony, was still refused an epidural, this was after giving birth remember when i should have been getting to know my son.

instead was writhing in agony for 2 hours until a theatre was available so they could give me a spinal block and remove the placenta.

I had counselling whilst pregnant with dd and was diagnosed with PTSD.

So don't be so judgemental SiamoFottuti you haven't got a fucking clue what you're talking about.

(and you do sound as though you still have issues surrounding the birth of your child tbh)

Why are folk assuming siamo still has issues with the birth of her child?? People can go through a painful labour with complications without it causing emotional trauma later on??

NanBullen _ I thought a spinal block was the same as an epidural??

siamo, you referred recently on a thread in AIBU that you had 'crippling PND' after the birth of one of your DCs.

I'm very sorry you experienced that.

Consider how you would feel if someone dismissed your crippling feelings of depression - and denied they even existed - and told you to get over it, and that having a baby was a normal life event, so you should just stop being so weak and self indulgent. That depression was only something suffered by women who'd been the victim of famine and war etc.

Now come back to your own views on birth trauma, and PTSD.

There's an irony there, and a very sad one.