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?

metalelephant,

you are right. This conversation is going in circles as usual, but I'm happy that spidulika admitted that there are indeed midwives who are not so ideal as she is always trying to paint them.

"It's an operation that carries many risks, and you needn't assume that your body cannot cope with VB."

I know it's an operation, I've been through two abdominal operations already and I know what it's about. However, even women who didn't have the same kind of experience might choose ELCS, if they compare the risks and advantages.
Also, I can assume a lot of things about my body because I'm the one who has been using it for a lot of years. I'm the one who decides whether to see a doctor or not, when I don't feel right and I'm the one who decides to follow or not follow his or her advice. I don't know who else could be able to feel what I feel or able to asses my capabilities better except for some kind of god entity.

"I used to think that CS would be easier and safer than VB, till my sister nearly died during her second one, because the doctor accidentally ruptured a vessel and all Ida sudden she started bleeding profusely."

Well, this is your sister's experience. My friends and family's experience is quite the opposite. All the people who had CS were happy and all the people who didn't ended up with some kind of an ugly problem.

"If one has tokophobia, a breech baby, a previous traumatic birth, a bad tear or any other factor that would make VB dangerous for either mum or baby, then CS is a great option."

I disagree, in this day and age, CS is becoming an equal option.

"But a fear or aversion of midwives, honestly, that's a bit extreme..."

Yes, I have a great aversion to all people who try to patronise other adult people and treat them like five year olds, whatever their job is.

Spudulika,

"It'll be midwives who'll be caring for you for afterwards......"

That might be right, but their role is really not that important afterwards. They don't get to decide about much.

"Most births are OK, and most women are well and happy afterwards. I think the odds are quite good for women trying for a normal birth."

As you can see from this thread, this is not entirely true and you might not even get the right stats to prove that most women are happy because there's a great conspiration of silence about birth trauma.

"And of course there's always the chance of having a really fantastic experience of labour, the psychological benefits of which can last a lifetime. I wouldn't pass that chance up for the greater certainty of a straightforward c/s."

Psychological benefits of torture? Maybe if you do martial arts or aspire to be a secret agent, than it can be kind of an exercise for you. Otherwise I don't see any benefits in withstanding hours and hours of pain. There's nothing good about pain, nothing beneficial. I wouldn't pass up the certainty of being damaged for certainty of having things under control with the help of science.

But this is all OT, this thread is about epidurals, which are being withheld. btw. this is a favourite pro VB argument "But you can have an epidural and feel nothing!" Apparently not in many, many cases.

Raluca - I have never said or implied that all midwives provide ideal care. I have said - based on current research - that midwifery care seems to be associated with better clinical and psychological outcomes than obstetric care for low risk mothers. I am quite open to the view that midwives - like other hps - are not always as good as they ought to be. Particularly at the moment when they are experiencing very very difficult working conditions because of our high birth rate and unprecedented levels of intervention in birth, both of which make good practice a challenge in situations of inadequate staffing.

Re: the odds on having a good birth - you can't take the stories on this thread as evidence that a high proportion of women are having terrible birth experiences. It's not really going to be representative of the views of the general population is it?

You need to step outside of the bubble of your own experience. There is research into women's satisfaction with birth and that shows that the most important factor is the outcome for the baby and the quality of the care. Not whether the mum had interventions or not, not how much pain she experienced, but how much she was listened to and her own health and that of her baby after the birth.

Re: not being able to understand the idea of a happy and fulfilling birth experience - yes, I can see it might be hard for you to imagine. And that this failure of imagination will play a big part in shaping your birth choices.

Would want to add - surgery is done by human beings, and human beings can and do make mistakes......

Spudulika,

"And that this failure of imagination will play a big part in shaping your birth choices."

You are right. I've experienced quite a lot of pain in the course of my life and the only lesson it tought me was to avoid getting into situations that might cause it as much as possible. I really NEVER enjoyed it and never felt it's good for anything. I can't imagine any situation where pain could be beneficial for me. None.
However, other people might have other attitudes towards pain or they simply want to try how they cope. And that's OK, it's their life and their decision. But they shouldn't try and persuade others that pain is good in some way. For them it might be, for others it isn't.

Haven't read thread sorry can't get my brain to engage today.

I have very little knowledge of epidurals during labour, so forgive my ignorance.

Under what circumstances is it too late to have an epidural? I know it sometimes comes down to staffing and needing an anaethatist and one not always being available. But are there factors in labour progression that prevent one being given?

"I really NEVER enjoyed it and never felt it's good for anything."

Can't say I enjoy being in pain either. But because the pain of labour is a) transitory and b) episodic c) not a sign that there is anything wrong with your body, I personally found it bearable. Particularly as it prefigured what I hoped would (and was) be the most amazing moment of my life: meeting my babies. And whatever people say about 'there are no rewards for going without pain relief', many of us find there are benefits - emotional, clinical and physiological.

"But they shouldn't try and persuade others that pain is good in some way".

If it's socially acceptable for people to try to persuade others that the pain of labour is generally unbearable and traumatising, and that going without pain relief is masochistic and pointless, then I think it's fair to argue the opposite: that many women find the pain of labour bearable and find that going without pain relief has significant benefits for them.

I think there's room for the expression of both views don't you? Though I do that as well as referring to our own birth experiences, we acknowledge what the research tells us about women's feelings about birth in general, as it helps set our own feelings and births in context.

Meta 'and you needn't assume that your body cannot cope with VB'

Ruluka is not saying her body can't cope with a VB, she is saying she doesn't trust the midwives to allow her body to cope with a VB. It is very different.

I agree with her tbh.

'there's a difference between a midwife being unkind and lacking in compassion, and being actually incompetent and dangerous'

Well actually I disagree. Unkindness and lacking in compassion IS potentially dangerous to a labouring woman and usually ends in less than optimal intervention which could have been unnecessary and may well lead to a c/s anyway, and possibly PND/PTSD.

Spudulika,

yes, we can agree to disagree and that's all right for me. My problem is that whenever anyone comes with a question regarding something not in the VB or natural childbirth (no pain relief) camp, she always gets a lot of answers arguing for these camps, but not really the answers she is interested in. Besides, the arguments get a little repetitive.

Starlight,
yes, I don't trust midwives very much, but I don't trust my body very much either. It's always been like this with me, so I don't have a reason to believe that somehow my body will magicaly do what I want it to do, just because I do some breathing exercises. So both VB routes with or without pain relief are a definite NO for me. However, other women can have other, but also very valid reasons for the same decision.

'I don't have a reason to believe that somehow my body will magicaly do what I want it to do'

No I don't expect you do. Our maternity culture is filled with language and stories and policies that are based on the fallibility of the woman's body.

failure to progress, incompetent cervix, poor maternal effort etc etc etc.

It's all bollox but perfectly acceptable terminology it would seem.

FWIW, I have faith in your body, but your mind needs to work with it and if it ain't there, it ain't there. Without it your body is likely to malfunction thus proving all the failure to progress nonsense. Quite frankly you probably ARE better off with a c/s in your situation.

LOL, I suppose what I am saying is that I don't have any faith in your mind -

Starlight,

well, my mind is never there for my body. My body usually does all sorts of things that I don't want it to do, like spraining ankles while walking on perfectly straight and flat pavements and giving me migrains etc. I never ran as fast as others or did any sport well. And as I said, it's always been like this, so I don't expect it to change in my mid adult years. And it's funny for me that others always try to persuade me otherwise, as if they were able to make that magic change happen. This fact has nothing to do with any medical language.

Let me add, that on the other hand I have great faith in my mind which has been proven right many times.

"Without it your body is likely to malfunction thus proving all the failure to progress nonsense. Quite frankly you probably ARE better off with a c/s in your situation."

Research shows a small increase in emergency c/s rates for mothers with tokophobia who labour. But most go on to have normal births, which doesn't support the hypothesis that if you think you can't labour, you won't progress.

Raluca, I don't mean to sound patronising one way or another, I guess I have felt more belittled by doctors than midwifes - after all I have met far less midwifes than , say, GPs.
You're right that it's a matter of trust, and you will have to trust at least the person that performs the CS, and to a degree your body to cope with that.

I must say that I was a lot more scared before having my son than I am now, expecting my second. Simply because it's no longer the great unknown. I try to be as fearless as possible, so that I can hope to cope with whatever happens.

And I'm in no way anti CS, the only reason I mentioned my sister's story is because I guess it's the what happens to our family and friends that forms our opinions the strongest. And I also come from a country where a great number of women opt to go private and emcs seem almost the norm. What seems to make a difference is that the doctor gets paid more and finishes the job in minutes rather than hours. So, if the (first) baby is not out quickly, a cs is the norm, whereas I think that in the uk you're given more time and are not rushed to the operating table.

Having said all that, I will welcome having a CS if a problem arises, though if they suggest I need high forceps I will simply run away. No way am I accepting that...

Spidulika,

research also shows that women with tokophobia who are forced to have a VB either go for a late term abortion or suffer PTSD in majority of cases. Is this the desired outcome, then?

And also, I don't have tokophobia. I'm just old enough to know myself really well.

I expect you'll progress eventually yes. Baby can't stay in permenantly if positioned correctly, but c/s rate alone don't show the actual damage to mother and baby. Perhaps the c/s ones were the ones with the least post-natal 'damage'.

metalelephant,

the simple morale that we can take out of all the stories and opinions that people should be listened to what ever birth choice they make, not patronised, bullied or forced by lack of funding into something they even hate to imagine.

Can we have a link Raluca to the research showing poor outcomes for women with tokophobia 'in the MAJORITY of cases'?

But yes - you are right, that women with tocophobia who are not given the choice of mode of birth often do go on to have terminations and PTSD. But a proportion of women who've had counselling for tocophobia do opt to try for a vaginal birth, and of those women, it seems as though most have normal deliveries.

"I'm just old enough to know myself really well"

I thought I knew myself really well, but I had no idea how I was going to experience labour. Every woman experiences it differently. Thought I'd be that woman in the corner, confidently squatting and pushing a baby out with no pain relief. Actually I was the one weeping, clinging on to the midwife and begging for help. Had pethide. Had epidural.

Next baby I gave birth to without pain relief, but was never a confident labourer. Always went through needing lots of comfort and support from my midwife.

So women do surprise themselves. Even those - like me, who have babies as mature adults and go through a lot of soul searching and reading before labour.

I do think there is this pretense that women should be able to make an informed decision.

Because if the decision is to have a c/section then they are simply refused one as not being informed enough.

Raluca, absolutely yes

IMO - we pay the taxes to fund the NHS. We should get an epidural if we want one. There's no other time when if you are in agony in hospital, you won't get pain relief. If we all just accept this, it will continue. Get her to complain.

I think women should be able to have an epidural or other pain relief if they want it unless there are clear medical reasons for not adminstering it. It shouldn't be a case of there not being enough staff or lack of other resources. I mean these days you're lucky if you can get into the first hospital you try when in labour. It shouldn't be left to pot luck as to whether you get good care or have the resources available you were expecting.

Imagine if a man had to have an op on his genitalia and they said "Ooops, sorry we've run out of pain relief today" or "I'm afraid there just aren't enough anaesthetists around at the moment".

But hey, it's only wimmin's stuff. It's only giving birth. Not that important.

I think that there should be published statistics on the number of women that ask for epidurals, and the number of times they ask.

I think it is THIS figure that should be monitored and a target for reducing.

This will ensure that a. the care and support is of a high standard and the women is listened to, and their is no risk of her asking for an epidural due to neglect, and b. when one is asked for it is given quick smart.

thats not reality though is it, and wishes aren't horses. If you want your own private needleman you'll have to pay privately, because the free care you get can't possibly guarantee that there will always be enough room or enough anaesthatists. Most women who want them get them, and most women get a room at the inn.

Of course its bloody important. However you need realism, not idealism.

Spudulika,

this is a very well-known research.

bjp.rcpsych.org/content/176/1/83.abstract
Pregnant women with tokophobia who were refused their choice of delivery method suffered higher rates of psychological morbidity than those who achieved their desired delivery method.

"I thought I knew myself really well, but I had no idea how I was going to experience labour. .......
So women do surprise themselves. Even those - like me, who have babies as mature adults and go through a lot of soul searching and reading before labour."

But YOU chose the method. It was YOU who decided to take that course. Not someone else.

Star,
"I do think there is this pretense that women should be able to make an informed decision.
Because if the decision is to have a c/section then they are simply refused one as not being informed enough."

Exactly! But this goes not only for the medical profession, but also public. Even here all the people who decide for ELCS are presumably "not informed enough."