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?

Surely women research labour and birth before the event?

If they did then they would know and understand that sometimes epidurals are not available. They just are't, not because someone is lying to them but because the ae not the resources.

I'm afraid if someone is then surprised they couldn't get one on demand it's their fault for having unrealistic expectations.

I forsee with the masive cuts in maternity care epidurals, along with one-to-one midwifery care, breastfeeding support, antenatal care, postnatal care and every other aspect of pregnancy, birth and beyond will be less and less available.

As far as I can see the problem described by the OP wasn't that her friend was deliberately deprived of pain relief, it was that she wasn't in the right place to access this service because there was no room available on the labour ward.

OP - can you clear this up for me pls? Was your friend admitted to the labour ward? How many hours was she on the labour ward?

"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)."

I've just looked the figures up.

The assisted delivery rate in Canada (all regions 2010) is 13.9% of all deliveries. in some regions it was as high as 17%.

In England it was 12.4 and 13% in Scotland. So not higher.

I think it also needs to be acknowledged that PTSD isn't usually linked to labour pain alone, but is usually about much more than just this: fear of death and injury to yourself and your baby, feeling uncared for and out of control, and VERY often - with substandard care (which is what you're getting if you're requesting an epidural and being ignored or treated with disdain).

I don't know why there is so much masochism among women with regard to the pain of childbirth. I'm also not sure why medical staff are so keen to fob women off and lie about what pain relief they need. Some women will in fact need an epidural e.g. because they require a Caesarean, forceps delivery, are having a very long labour that's not progressing so it's not true to say that no-one needs one. Even without medical necessity, different people have different responses to pain as well.

I haven't been through labour yet (due in 1 month) but I can imagine that for some women, being in intense pain will only slow their labour down and complicate the birth as they react with fear. Obviously there are breathing techniques to manage this etc but if that's not working, why not just administer as much pain relief as possible to ease distress? There's no need to be masochists about it. Denying women pain relief does seem like some kind of fetish with certain women and medical professionals.

As for people saying that childbirth is 'natural' and telling tales about some woman who gave birth in a tree , that's all well and good but the reality is that the first established medical anaesthetic, chloroform, was developed precisely for women in labour by James Young Simpson. If it's so natural and manageable, why did doctors prioritise it as a target for pain relief before any other medical experience?

Denying women pain relief does seem like some kind of fetish with certain women and medical professionals. - Bollocks.

why did doctors prioritise it as a target for pain relief before any other medical experience? - Because they were victorian men.

I haven't read this whole thread but wanted to say...

I had consultant care throughout my pregnancy, was induced with syntocinon, had one to one midwife care the whole time and was still refused an epidural even though it ended in a forceps delivery.

There are some VERY bitter women on here. How you can be happy that another woman suffered unnecessarily during ther brth of her child is beyond me. I'm amazed by the vitriol from some women here.

(Apologies for wrong stats, copied from a MNetter on another thread that'll teach me!)

I was told I definately wouldn't get one. DS born abroad and they simply do not give them. Don't give gas and air for labour, just delivery.

I did however have an epidural 19 minutes before DS was born by ECS. So personally the fact I got one wasn't positive as was due to extreme complications.

When I had DS (a low risk birth) I specifically went to the labour ward, not the birthing centre as I knew I may want an epidural, and that to get one I would need to be on the LW. If I wasn't, and there wasn't a room available for me to be transferred to, that would be that.

I did have one eventually, but had to wait about four hours for an anaethatist to be free. That was after having to wait about the same amount of time for pethidine as there wasn't a doctor available to sign it off, and being refused gas and air for a long time after arriving at the hospital as there was noone to check I was in established labour .

Once I'd had the epidural (and being induced so the contractions where stronger), the pain didn't go away and I was in complete agony (constantly, not contractions), but the MW wouldn't believe me and basically told me to get on with it. Eventually, after two hours of stalemate where I was in too much pain to do anything, never mind push a baby out, they finally relented and got a doctor in. Turned out DS was back to back. Ended up with a spinal block and EMCS.

Oh and at no point did I have 1:1 MW care.

I'm due again in October, and one of the reason I'm going for an ELCS, is because I do not trust the maternity service to respond to my needs, listen to me, take me seriously, BELIEVE me when I say I'm in too much pain to cope. Is that right????

I don't really care that having a baby is the most natural thing in the world, or that many women don't need an epidural. Bully for those who can sail through it, or who can tolerate feeling like they are being torn in half for 24 hours. How anyone can say that labour is not agony is, frankly, mad. We live in an age where we do not have to tolerate that agony if should we choose not to. Now I'm not naive enough to think that a doc is ready to jump as soon as a woman says they need an epi, but if a woman feels strongly enough to want one, then it needs to be very clearly explained what the possible problems / implications may be.

For the OP, what I don't understand is that if your friend had made it clear from the start, why did she end up in the MLU?

stop assigning emotion to other people, its both insulting and tedious. And suggests a lack of emotional maturity on your part, particularly when you are wrong. I didn't have any trauma, and the PND was a different child. And thats not at all what I said anyway.

And stop infantilising women, buy making campaigns out of nothing. There are real problems with maternity services, that need addressing. Not bothering your arse to even ask about what pain relief options are available is not worthy of a complaint form, let alone a MN campaign.

Most women DO ask. In fact they ask obsessively ime.

The fact is though that the people delivering the information are NOT the people in the maternity units and labour wards or on duty that night.

One of the reasons for my PTS was down to being set up to fail. I researched like mad, and questioned like mad, and always took well over my allocated 'slot' at maternity appointments to make sure I understood that situation.

I attended active birth classes run by the hospital I attended. They told me all about giving birth upright and moving around and we practised them.

How on earth could I have known that on the day they would deny my pain, refuse to let me off the bed, fail to diagnose a back to back, pretend that an epidural was on its way for 6 hours and then insist that I gave birth on my back due to medical reasons (which incidently, according to my notes did not exists)?.

THAT is reality and has nothing to do with poor research skills.

Pamplemousse you are right that the issue here is not that an epidural wasn't available on request. My friend was fully aware that she may have a quick labour and not get one or that an anaesthetist would not be immediately available. Her issue ia that she was labouring for hours and I suppose it never occured to her she would have to go through a long labour and still not recieve one. Barleycorn you hit the nail on the head about her feeling out of control and unlistened to.

Why would it be obvious to people that they might not get an epidural? A lot of women do lots of research about labour, others less so and all sources of information will vary greatly in quality. People don't know what they don't know and it isn't obvious to everyone that epidurals aren't always available or that they have to ask if they are. Thats my whole point really, that the situation should be explained to women. I don't think its fair to blame women for being naive and not knowing.

I believe she was admitted to the MLU because she is essentially low risk and labour ward was full and at that time. She was deemed to be in early labour but she refused to go home so remained on the MLU. During the whole time she was in labour a room on the CLU did not become available. (I suppose the high risk women take priority). I think she got to the hospital at 2.30am and had they baby at about 8pm.

It's as disrespectful and wrong-headed to describe women's wish not to have pain relief as as 'masochistic' or a 'fetish' as it is to describe the wish to have an epidural as 'weak' or 'wimpish'.

"During the whole time she was in labour a room on the CLU did not become available"

In other words, she wasn't refused an epidural. There just wasn't room for her on the ward where epidurals are available.

"How anyone can say that labour is not agony is, frankly, mad."

Can you not accept that there is a RANGE of experience when it comes to childbirth? Some women don't find labour that painful. Really!

Anyway - not surprised you don't want to risk having the sort of poor care you had first time around and want to do things differently with next baby. No wonder your labour was unbearable.

I also had poor care in my first birth which led to a cascade of interventions. I opted for private midwifery care with my second dc and had a homebirth. Hideously painful (he was 11lbs and got stuck on the way out - ouch!), but a good birth all in all.

Would want to add, that when you're getting really brilliant care from a very good midwife who you have a relationship of trust with, and who's totally focused on you - it can change the experience of the labour in a very profound way. My third labour was longer and more painful than my first (both back to back babies, both over 9lbs), but I found I was able to bear the pain with my third much better and was able to forgo an epidural. I think the reduction in FEAR you get from having good care is very important when it comes to coping with pain.

I agree with mosy of your post Spud but what's the difference between being refused an epidural and requesting one and not receiving one because of lack of resources? They amount to the same thing- not getting an epidural!

Lost

Whoops!

Depends how often the labour ward is turning away women because it's reached capacity.

The NHS is almost always operating at capacity - which is why it's so efficient in terms of funding. At the moment birth rates are so high in some areas that occasionally hospitals find themselves turning women away. It happens all the time with birth centres attached to hospitals. Women who had their heart set on a waterbirth or low tech birth in a midwife led unit are directed towards the labour ward because the birth centre is full, or all the midwives from the birth centre have been sent to work on the labour ward.

I have yet to hear anyone complaining that it's inhumane to deny women access to a birth pool or restrict their right to a active birth in a low tech unit, even though, like epidurals, this is what some women need in order to find birth bearable.

I think to answer the OP first that it was a communication breakdown or assumption that went wrong. I had an epidural with DD but knew that if the ward was busy etc I would have to wait/get on with it - didn't like it but understood.

However the comments on this thread about PTSD make me very sad and angry especially if this hasn't been suffered by the poster. It is not just for people who go to war as was stated, it's a reaction to any traumatic event. My birth ended up being traumatic with an epidural, it was agony and I tore incredibly badly and seriously. No one has the right to state that birth or labour doesn't cause PTSD - it does. Fact. People are being cruel and ignorant in this thread - I have never had mental issues previous to this episode and genuinely hope I never do again. Labour was awful and painful but the PTSD came close to destroying me. If you have never experienced it then you don't have the right to tell someone it doesn't exist in certain circumstances. Nasty nasty women.

I think the fact that NHS antenatal classes are being cut out of existence in many areas will contribute to more women being unprepared for the realities of childbirth, especially when it comes to understanding the pain relief options available to them.

The four criteria (to actually be in labour, being in a safe place, having an anaesthetist available and a MW to monitor you) are in fact really obvious. Epidurals are medical interventions with attendant risks, which need to be carefully managed. The problem was that nobody pointed out to the OPs friend in advance that her birth plan ("epidural") would not be available in the MLU.

The nhs classes in my area were worse than useless. Infact they perpetuated the idea that giving birth was fine, it wouldn't hurt that much, nobody would need an epidural, or a cs and you would be fit for discharge within 4 hrs. I asked how likely a 4 hour discharge was and the midwife replied very likely it happens all the time. I would love to go back and ask her what she actually meant by 'very likely' as I am yet to meet a person who gave birth in that hospital who had a 4 hr discharge!

I would be more than happy if the money from those classes were diverted to give better facilities and more available staff on labour wards.

The only indication of pain levels given in the class was the following exchange:

Mum to be : so if I need an epesiotomy do they give you a local anaesthetic?

Midwife : No but it is ok we will cut with a contraction so you will barely notice.

Wide eyed dad to be: fuck me you mean this is gonna hurt so bad she wont NOTICE you cutting her bits!!!!!!!

Midwife (who now admits she has not had children herself as yet) suddenly looks very pale as if she has just realised that labour might actually hurt a bit more than she has previously given credit for......

Hi, OP, just wanted to say that I agree wiht you absolutely and in every wya, and some of the horrible posts here had me pounding the walls.

Last year I broke every bone in my lower leg - tibia, filbula and big ankle break. It hurt about as much as the contractions you get to about 3 cm, but they were plying me with pain relief. My leg was utterly hideously distorted and I was in the OR for 3 hours, and the pain was NOTHING compared to childbirth. I could have withstood it for days without so much as a paracetamol.

So could everyone urging everyone else not to be wussy please shut up? Some labour is easy, others are hard and horrible, but most people I know say the pain was much worse than they expected. If you gave birth and it wasn't agony, lucky you. Not true for everyone, though.

I'd also add that of course anaesthetists COST MORE than aromatherapists. So of course hospitals supply a scant minimum of them. The NHS budget cutters have formed a bit of an Unholy League with the Happy Birth people, because both are low-budget.

Let's not kid ourselves. We are not being given a choice here. If what you choose happens to correlate with a low-budget, midwife-led birth that won't leads to a lawsuit, then you are allowed to 'choose' it. Or if there happens to be a real doc available, then you can 'choose' an epidural. If not, not.

It's also interesting to note that unlike in the US or Australia it's impossilbe to get health insurance cover for birth or antenatal - well, you can, but it raises the premiums to four figures a month.

Sieg - very very good point! I would happily pay a REASONABLE health insurance premium if it gave me more choice, knowledge and control. Unfortunately I could not justify the cost of a private birth on the offchance it might not all go according to plan.

'Let's not kid ourselves. We are not being given a choice here. If what you choose happens to correlate with a low-budget, midwife-led birth that won't leads to a lawsuit, then you are allowed to 'choose' it. Or if there happens to be a real doc available, then you can 'choose' an epidural. If not, not.'

No, I'm sorry. I agree with your general gist, but a midwife-led, active waterbirth type birth is highly sold but rarely given too.

What we are taught is this:

MLU, active waterbirths are best for you and baby and highly achievable and available as it is the lowest cost and most efficient. If however, you feel you are not able to cope with this then most hospitals have epidurals available if you ask, but be prepared for a wait of up to 20mins or so so make sure you ask early.

What is delivered is some kind of inbetween service, with the ideals and aspirations of the former but with such loose interpretation that the latter is required but refused.