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?

"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"

In a publically funded healthcare system with finite resources, surely it would be unethical to offer free choice of treatment, unrelated to either cost or to clinical outcomes, in relation to childbirth or anything else.

Why should childbirth be the only area we shouldn't have to take healthcare costs or clinical outcomes into account when deciding on what treatments should be offere?

What about end of life care?

What about cancer care?

What about care for dementia sufferers?

At present women with an intense fear of childbirth should be offered counselling and the option of planned c/s. As should women who've had a previous c/s. That's as it should be.

But don't hold your breath for a policy change to electives on demand on the NHS - it ain't never going to happen.

Insomnia,

absolutely agree! This attitude smells miles of misogyny.

cliche. More about money than misogyny.

Spudulika,

I don't know, but I've always assumed that bringing a new person into this world is a little different than treating diseases. It's about keeping "the tribe" going, right? And if it's just a question of money, maybe there should be some kind of reform rather than trying to cut funds by not giving people enough pain relief, when they need it. Because this is something barbaric that shouldn't be tolarated in any civilised country. My husband got more painkillers for his big toe operation than people get on maternity wards in a week.

Siamo,

no. The misogyny lies in the fact how money is distributed. If the distributors weren't mostly men, more money would go to maternity services and less to treating alcoholics.

So is there no point in labour progression that prevents an epidural being administered?

I know anaethatist shortage is an issue that prevents this from happening on demand sometimes. But this also prevents some ELCS taking place as planned and delays EMCS does it not? If there is an emergency then that takes top priority. However if there is more than one emergency then surely it will delay the process of the other emergencies?

It is sad and but unless you have money to spend, there are no gurantees with any hospital procedures etc.

As for epidurals my ignorance still stands sorry. I thought there were other factors apart from staffing that prevented some epidurals being given, I have no idea why I thought that a certain stage in labour prevented it being effective and hence not given. This is why I never asked for one with either of mine as I arrived and was pushing in 15 minutes with my 1st and I arrived pushing with 2nd so I guessed it was too late.

a lot more money goes into maternity care than into treating alcoholics. And the alcoholics deserve treatment too, some will die without it. Will you die without an epidural?

Nope, Siamo, and I wouldn't have died if no-one had set my broken leg either. I could have had a really bad limp instead. NHSspeak - wot, not dying then? On yer bike! This isn't pragmatism; it's callousness.

As it happens I think there is a good chance I would have died without mine.

When dd got stuck I had numerous severe tears. As it was I lost a lot of blood and required a transfusion.

As it happened I was totally oblivious to what was going on and how serious it was so by blood pressure didn't rise. This combined with epidurals themselves lowering blood pressure meant that I didn't lose even more blood.

So YES I believe I would have died without mine. Not to mention the cost of therapy that has been saved as now I am only slightly traumatised by the experience and not inconsoleable (trying not to think of what would have happened if I was panicing and not letting the docs do what they had to to get dd out)

Siamo,

I'm sorry, but alcoholics are not people that I have any sympathy with whatsoever. On the other hand, I do with labouring women. I don't think these two can even be compared. Alcoholism shouldn't be supported by society by turning a blind eye on it and treating pub brawl wounds for free. On the other hand, mothers should get all the help necessary because it's them who are creating future for the country.

Wow.

Yet I'm callous?

Leaving this now, lifes too short for this.

Siamo,

just because we live with the idea that it is right to help everyone under every circumstance doesn't mean that it is really helpful to them or it is beneficial for the society. How are these alcoholics beneficial to the society? Yes, they should be helped, but only to a certain extent.
Anyway, maybe money could be also saved by changing the system a little too, so that there is more public control of where money actually go to.

Havent read the previous posts, but I thought it was common knowledge that having an epidural was not guaranteed.

lots of people aren't particularly beneficial to society, however making medical and care decisions based on that is barbaric. Why not just kill them all, that is how most genocides start after all.
Fucking hell, some people should get an epidural in the brain, it might improve you.

as far as I know there is no competition in funding for different areas of care, so you cannot blame the epidurals for lack of care for alcoholics! What else? Does children's care trump elderly care or cancer wins over cardiac disease?

But I also don't agree with alcoholics being non beneficial and thus not important - it's a similar argument to "having babies is a lifestyle choice so I don't want my taxes paying for it".

"I don't know, but I've always assumed that bringing a new person into this world is a little different than treating diseases. It's about keeping "the tribe" going, right?"

Of course. And it's important that women are treated with compassion and given safe care during labour.

And the current 'best practice' guidelines support women given pain relief when they ask for it.

I think Starlight's suggestion that there be a public record of the percentage of women whose request for an epidural is met be published for each hospital, alongside the average length of wait is a good idea. I always encourage women I talk to about labour to make sure that when they request an epidural in labour it's immediately written in their notes, especially if it's been indicated that they may have to wait for some time to get one.

You can already find out what percentage of women get the pain relief they've requested at every hospital here: here

It's interesting how much the figures vary, from 1 in 20 women not getting the pain relief they requested to nearly 1 in 5 at some hospitals. I think all women should be encouraged to access this site when they're deciding where they are going to have their baby, and then voting with their feet if they don't like what they see. (should add - I can't find out whether these figures refer to 'can't get the pain relief I need' or 'can't get the pain relief I requested' - quite an important distinction, as a fairly high proportion of women who have pethidine find it doesn't help with the pain. And of course 1 in 10 epidurals doesn't work fully or at all)

"And if it's just a question of money, maybe there should be some kind of reform rather than trying to cut funds by not giving people enough pain relief, when they need it".

People on this thread keep repeating this point, as though they have some evidence that epidurals are cynically and deliberately being withheld from individual labouring women by midwives or doctors because of hospital policies to save money. There is no evidence that this is the case. There is evidence that hospitals are currently suffering from midwife shortages and from an unprecedented increase in their workload caused by a high birth rate. Also unprecedented levels of intervention exacerbated by low staffing, but also linked to social changes (rising levels of obesity, high primary c/s rate, increasing age of first birth). This is inevitably going to impact on the availability of the services of obstetric anaesthetists on labour wards and therefore on women's ability to access regional pain relief in labour.

"Because this is something barbaric that shouldn't be tolarated in any civilised country. My husband got more painkillers for his big toe operation than people get on maternity wards in a week."

94% of women in the UK use pain relief of some sort or another in labour, but the majority don't request an epidural. Of course it's right that those women who request pain relief get it, and I don't think anyone is going to argue with that.

But focusing on it as the key issue when trying to address what's wrong with our system of maternity care? It's just one small part of a much bigger picture.

Metalelephant - it's not a thing of trying to balance out the budget across different arms of the NHS, but trying to agree some basic principles about expenditure. We have a system of evidence based care now and there surely has to be a rationale for paying for treatments, in terms of trying to obtain optimal health outcomes for the largest number of people? What other area of the NHS offers very expensive treatments for large sectors of the population where there is an alternative which is cheaper and associated with better physical and mental health outcomes?

Spudulika, I was referring to the earlier comment about the need for alcoholism treatment VS epidural costs and how one shouldn't negate or concern the other. It's usually a fake argument to call something superfluous because other areas could do with more money, they are incomparable aren't they?

I agree with you on needing more midwives - absolutely. I feel indebted to the lovely women ( and one man) that helped me with the birth of my son.
Besides, if lack of anaesthetists makes epidurals harder to get, we need one to one midwife care even more so that the labouring woman can have the support and advice that may help her cope with the pain.

Siamo,

hm, genocide starts with more funding for epidurals. Interesting leap. However, I still think that labouring women should really have priority over repeatedly admitted alcoholics, even though in an ideal world there would be funding for all.

Anyway, I'm and I've always been for public healthcare. However, when that public healthcare system fails to have enough funds for cancer patients or midwives and anaesthetists, than maybe we should start thinking about a change. I think that the OP's poor friend would be happy to pay for the epidural, if she could be guaranteed that. She was definately not happy with the b*tting. Many posters say that if you wish an epidural or ELCS than you should go private. But that is really very unfair, because these people have been also paying taxes like everybody else. So why should they have to pay the total for childbirth as opossed to zero on NHS, when they just want one thing done differently? Paying 500 for an epidural isn't the same like paying 10 000 for the total private care. Maybe NHS can actually profit from this.

"Besides, if lack of anaesthetists makes epidurals harder to get, we need one to one midwife care even more so that the labouring woman can have the support and advice that may help her cope with the pain"

So true, and midwives with the skills and the energy to support women undergoing long and difficult labours.

There is a view among midwives now that the widespread use of epidurals has left many midwives without the skills to help a woman who wants a drug-free birth, but is having a difficult time, basically because they never have the opportunity to put them into practice.

"Many posters say that if you wish an epidural or ELCS than you should go private."

With respect I think there has been ONE person on this thread who's suggested that epidurals should be paid for privately. And the thread is 7 pages long.

The argument about requesting an elective c/s on the NHS is different because it's not just a matter of upfront cost. At present 27% of births in the NHS are surgical and the system is at breaking point. There simply aren't the staff - the midwives, the obstetricians, the anaesthetists, the operating theatres, the postnatal beds to cope with an overnight surge in the number of planned c/s, as there would be if c/s on demand were given the green light in the NHS tomorrow.

Spudulika,

but if you want to have epidural guaranteed, you still have to go private. Because NHS just tell women bunch of lies instead, just like the OP's friend.

"Because NHS just tell women bunch of lies instead, just like the OP's friend"

The NHS isn't a person or a single body. The NHS employs about 1.5 million people in the UK. All individuals.

There is no official or unofficial policy to lie to women about the availability of epidurals.

I haven't gone back through the whole thread but I don't remember the OP saying that her friend was ever told that she was guaranteed to have access to an epidural in labour. In which case she wasn't lied to.

Raluca, for what it's worth, in my personal experience giving birth on the NHS is not faultless but they really took good care of me and my baby, overcame risk and delivered my son healthy and happy.

Also, the prenatal care I received both then and now is great, I get mixed care so see both midwifes and doctors, all the extra planned scans we need, emergency scans for suspected oligohydramnios (reduced liquor) and much more.

And it's all free! I feel really grateful to the NHS, and I'm only writing this because often you only get to hear the horror stories and miss the good stuff.

Where I know things lack is postnataly, with few midwifes and nurses taking care of oversubscribed wards and little breastfeeding support, but this is something we need to ask and campaign for.

Again, I'm not belittling your worries, just giving my positive own story.

"I did get one last time on demand - but it meant being induced for no real medical reason"

You opted to be induced because you wanted an epidural?

Epidurals are not available to women who aren't being induced?

Which hospital?

Metal,

yes, I agree that care can be very good on NHS, however, it is pot luck and it shouldn't be that way. You should be able to get standard care and not end up stuck in maternal ward for 24 hrs with no one around. This is even worse than giving birth in the street surrounded by strangers because the staff are professionals, they should be available and give you proper care and listen to you. It's their job. And that's why you actually go to a hospital. You don't go there to be ignored and mistreated.

Raluca, ofcourse I agree.