midwife refused pain relief

[liznay]

Please help as I'm seriously getting myself in a stew about this...
I'm due to give birth for the 2nd time at my local hospital. I'm under consultant care due to previous traumatic birth. He has said that I'm fine for community care from this point on (I'm due this Friday) and can have an epidural at 3cm this time if needed. (Didn't get one last time even though I asked 6 times)

However the issue I have is that the hospital seem to be seriously run off their feet at the moment. My friend gave birth there at the weekend. They had no delivery rooms available and so she gave birth in a side room behind a curtain because the midwife refused to examine her (hospital has a strict 4 hour policy on VE's) and said it was too early for G&A as she was only 3cm last time she was examined!!!

What are my rights if they try and do this to me? I was getting panicked about doing it without an epidural (even though I managed last time) but without even G&A, I think I might actually flip out completely.
Even if there is no piped G&A for a room, surely they should have got her a cannister? BTW the birth has been recorded as a near miss as midwife didn't spot she was about to give birth, so head of midwifery is looking into it.

I'm scared

An anaesthetist may not be immediately available but a caesarean is only around 45 minutes! To be honest, there is an equality issue here. Would excuses be allowed for why epidurals were not available if men had babies? Lol [grin}

i agree with getting the consultant to write something in your notes.

and you have to be insistent whenever you feel it's time. don't wait.

good luck.

The midwife at first refused to get DW an epidural at the birth of DS2. She was the senior midwife and I know full well she was trying to use DW so she could hit her 'target rate' of reducing the use of epidurals in the hospital.

She tried the fob off DW with answer that the anethetists were busy and I saw the look of fear in DW's eyes (she was in a lot of pain with DS2 back-to-back) and I walked over to the midwife and told her that DW was busy too and she needed pain relief. I made it clear in a calm strong voice that I was not going to back off.

The midwife flicked open DW's file and saw she was under the most senior obs/gynae consultant and magically the midwife suddenly couldn't do enough for DW. The epidural was in within 5 minutes. She nearly fell over when another consultant came to stitch DW up who was married to our friend from college who happened to senior consultant in anethsetics. She suddenly disappeared at that point.

Fact is that midwives try it on when a woman is on her own and/or doesnt demand what she is entitled to. Midwives like to wield power in the birthing suite but back down when consultants appear and hide when something goes wrong.

Get in touch with your obs/gynae consultant and make sure he/she writes a note on the front inside cover of your file as to what you want. If the midwife refuses then demand the consultant be contacted. Make sure your birth partner knows this. In the end midwives need to be reminded they are not doctors - they are nurses. Pain relief would never be refused in any other branch of medicine and to refuse it at a birth is barbaric.

I still feel very annoyed about it to this day.

Morebeta, your post is full of a lot of inaccurate and sweeping statements.

Just because you think one midwife was on a power trip you can not say all midwives do. Also midwives are not nurses. I'm no more a nurse than I am a hairdresser. Different jobs.

I've never needed to back down to a consultant. Nor have I ever hid when something has gone wrong. And it would make no difference to me which consultant a woman is under, I can't see it would make a difference to any midwife.

I did have a woman once where the consultant had written in her notes that she was to have an epidural. We didn't have enough midwives for her to have one as we were all looking after more than one woman. She kicked off. We rang her consultant and asked him if he'd like to come in and look after her so she could have an epidural. Funnily enough he wasn't very interested.

Viva - you may not think you are a nurse. You are certainly not a doctor.

Viva you say she 'kicked off' but can't you see it from her point of view? She had asked for an epidural, told she could have one and when she was in labour and vulnerable and unable to go elsewhere, she was upset. Can't you see why? Couldn't you have 'escalated' to get more on shift? And, there is no more requirement for a woman with an epidural to have someone with them than someone without and epidural. The guidelines just say that a woman in established labour should not be left alone.

More beta, I've never being under illusion that I'm a doctor.

Ushy, no I certainly can't escalate anything to get more staff in and the matron wouldn't as there isn't the money in the budget to pay them. There's no point blaming the individual staff on the labour ward for this. Blame the chief executives at the hospital, blame the govt and their spending cuts but please don't thump the midwife in the face and call her a fucking bitch.

Firstly, can I say thank you to everyone who has contributed to this thread, there is some good advice on here. I've e mailed my consultant today, hopefully he will reply tomorrow (and I won't go into labour tonight!)
For all the midwives that responded, thank you for your insight, it's nice to have another perspective. Aside from the epidural issue, no one has touched on the refusal of gas and air. This is a bit much isn't it? Has anyone heard of this before? This is the element that scared the living daylights out of me. I normally have 3 neurofen plus and a glass of wine just to have a bikini wax!!!

I'm printing this thread out and giving it to my DH as he was as overwhelmed last time and was fobbed off just as much as I was despite trying to get as much help for me as possible. Hopefully with the advice here we can go in to the labour ward educated, informed and insistent of what we want.

And nice guidelines can say whatever to be honest. I have to abide by my hospitals policies not nice guidelines. I can be sacked for not following a hospital policy and the policy states that a woman can only have an epidural if she can have one to one care. And to be honest I can see the reasons for that, an epidural can cause blood pressure problems, even respiratory problems. Fetal heart needs to be monitored as baby can be affected, well no point monitoring it if im not in the room 60% of the time. I wouldn't fancy trying to defend myself in court against that.

Refusing gas and air at 3cm shouldn't be happening.

If it's someone's first baby and they're 3cm I would advise them that they could have another 15 hours or so of labour ahead of them and that using the gas could be quite tiring. I'd talk to them about whether diamporhine might be a better option for early labour and save the gas for later. But if they still wanted the gas its their choice.

I wanted gas and air at 4cm and was told no, without an explanation. This was before I was a midwife. I was given pethidine instead. Then that wore off and I just assumed I wasn't allowed gas and air full stop so asked for an epidural instead. Still pisses me off. I think the midwife was probably right that pethidine was the better option at that stage but if she had explained this to me I'd have known that I could have had the gas and air later on.

I would be giving dh a notebook and ask him to keep a note of what happens when and who said what.

Fro example, requested epidural from midwife bb at xx time. Second request at xy time to midwife bc. This will help keep an eye on time scales becuse it is hard to remember the exact time and the name of who you asked if tensions are rising. And it will stop the fobbing off comments of "you only asked 10 mins ago" when it was 40 minutes.

If you had the time I think that having an IM to help stand up for you would be wonderful, allowing dh to give you support whilst IM deals with the HCP.

I would imagine that many dh/dps come away from this type of experience feeling thast they have totally let down their dws by not standing up to the HCPs and allowing their partners to be left in agony.

People generally only 'kick off' when their needs are ignored and they are not listened to or treated with respect. Sadly this happens all too often to patients in our wonderful NHS. Usually because there aren't enough staff to care properly for the patients

I vomited on G and A for the first 12 hours of my induced 26 hour labour with DS1 before I was given an epidural. After an emergency forceps delivery I was left left for 2 hours on my own after the birth without a wash, any food, water or pain relief. I then took myself for a wash as no help was forthcoming. I passed out on the floor of the hospital bathroom due to blood loss and dehydration and was found by the nursing staff. The excuse from the hospital was they were too overrun by emergencies to provide me with any care after the birth.

For DS2 despite my known reaction to Gand A they suggested G and A once more. I refused to let them set up a drip to induce me until they had put in an epidural. I didnt 'kick off' I simply said no. The midwives were'nt happy and did their best to bully me. but after a standoff that lasted about an hour I got an epidural and his birth was without incident. My H bought flasks of hot drinks and food so I got fed properly after the birth!!

Not surprisingly, after a couple of 'incidents' the unit was closed down the year after DS2 was born as it was deemed unsafe as it was so understaffed.

I think that many women choose to go to hospital to give birth because they believe, quite wrongly if this thread is to be believed, that they will get pain relief when asked for.

If they are not getting adequate and timely pain relief in hospital then perhaps many would re-think and choose to have home births where they stand much more chance of being able to cope with pain in secure and familiar surroundings?

with dd2 i asked for pethadine and mw fobbed me off, but i am glad she did, on my notes it said only gas and air, no pethadine etc, as i felt the pethadine contributed to my dd1 not bf, she read this and then fobbed me off during labour, and i am glad she did tbh.

After an EMCS last time I've requested an ELCS this time, a major reason being very bad management of my pain and not being taken seriously by the MW's at all with regards to how much pain I was in and how I was able to cope with it (not at all).
When I arrived on the labour ward in established labour I was shocked to be refused G&A until I'd been examined, which I then wasn't for ages. It felt barbaric that I was being refused even the basic pain relief for a second longer than necessary.
G&A did nothing, I had to wait over 4 hours for pethidine, then over 5 hours for an epidural, and wasn't beleived when I said I STILL had unbearable (constant not contractions) pain that I couldn't cope with and certainly couldn't push through. It was pure hell. The mw didn't take me seriously at all, and I hated her for that.
That was nothing to do with her being rushed off her feet, she was a sadistic bitch, and I will never forgive her for putting me through what she did.

*acatcalledfelix" I do hope that you have put in a complaint about your (lack) of care as I honestly believe that this is the only way to get things changed.

I remember reading on another thread how profoundly shocked a dp was that a woman(midwife) could stand by and do nothing to assist another woman in agony.

just reading these stories brings back my own anger at my births, and mw's being dismissive. perhaps dealing with labouring women all day hardens them.

op, remember that you're getting people clicking on your thread because it strikes a chord, so the viewpoints probably aren't a proportional representation.

be strong, and polite, and brief your partner to do the same. you DO have some control, and all i can say is that as soon as you feel you need an epi, ask for it and don't try and hold off until you really need it.

Good luck OP. I hope the consultant can help prepare a good birth plan. I had an induction with ds1 and did get g and a and an epidural in the end, I did have to wait a few hours though. My mum's advice (former MW) to me was to ask for one as soon as I felt I needed it because there was likely to be a long delay. I hope everything goes really well for you there are lots of positive birthing experiences as well

I won't get involved in the MW bashing here, but I laughed at moreBeta's comment to remind nurses and midwifes "You are not a Doctor".

That's right - know your place girls! Make sure you get the nice biscuits out for Dr's ward round. Oh, and don't you worry your pretty head about that ventilator or haema-filtration machine, you just look at the flashing lights.

Anyway, OP, It's probably worth contacting the Midwifery Matron ro voice your concerns. She will be able to speak to you over the phone, and you can just raise your worries, based on your previous experience and what happened to your friend.

If you find yourself in labour and being refused pain relief, get your birth partner to contact her again and at least you will be on her 'radar' so to speak.

Good luck, and hope your birth goes well.

my dh asked for a 2nd opinion after mw refused pain relief for dd1's birth. registrar arrived in 5 mins and discovered I was 10cm! I will never forgive the mw for ruining what could have been a fab birth by not checking how dilated i was and relying on a machine to measure contractions. the machine barely showed contractions this time for dtds 3w ago but the experienced mw felt my tummy and went by that rather than the trace.

basically, you have the right to ask for a 2nd opinion so use it if you have to, and get dh clued up on the plan. you can be firm without swearing etc.

I waited more than 24 hours for an epidural.
I didn't "kick off" but I definitely kept asking for it and didn't let up.
G&A was available from the very beginning and pethadine offered and given after about 15 hours. Midwives stayed with me 1:1 the whole time. Many horrible things happened during that birth, but I feel lucky to have had 1:1 care the whole time and I'm that this doesn't happen everywhere.

Also that people are refused G&A!
Agree that it is barbaric to refuse pain relief when requested during childbirth.

I want to balance out this thread a bit, as someone said before unfortunately most people who comment on here do so because they have also had a bad experience. I gave birth earlier this year at my local hospital and they were fantastic, I couldn't fault them. I demanded an epidural at 8cm, but then changed my mind back and forward about 6 times, eventually decided against it, but mw was very understanding and just said it was up to me but I was doing fantastic without it etc. G&A did nothing for me. I'm very surprised that your friend was allowed to stay without a delivery room free, we were told at antenatal classes and also at mw appointments that if no rooms free when in labour that I could be sent to another hospital (nearest is approx 45 mins drive away).

I understand why people are saying to demand pain relief if you want it, but as anyone who has ever worked with customers or members of the public will tell you, a screaming demanding customer makes you dig your heels in whereas if they are nice but firm about what they want you will move heaven and earth to help them, why should mw's be any different? Too often people in jobs like that come under threats of violence, or simply being spoken to like dirt on a shoe, why should they have to put up with it? And to the person who thinks it would be putting an unborn child at risk by refusing a labouring woman assistance, it would be the mum who is putting that child at risk, would you go to work and risk being assaulted? I work in a customer services environment and have frequently had to have customers removed from the branch despite genuinely wanting to help them due to their behaviour, 1 springs to mind who threatened to stab me in the stomach while I was heavily pregnant, in that situation should a midwife still offer to help?

Rockchick1984 You are right that a nice request is so much better but unfortunately I found 'nice' requests get ignored. We escalated from nice through nice reminders, through firm, through direct command, to finally threat of formal complaint. Sadly, I suspect very few people go in at the top end straight away and any 'kicking off' is a result of being ignored or dismissed.

quite right ushy.

i was very polite when asking for my epidural. perhaps that's why i never got one!!

I recently looked after a woman who was told she had to have a section and then had to wait for 2 hours without an epidural. It was hideous for her but the anaesthetists were genuinely trying to save the life of a woman who was already having an emergency section (they don't always take 45 minutes, this woman was in the theatre for about 4 hours) Thankfully the other woman was ok in the end but she had 2 anaesthetic consulatants, and 2 obstetric consultants in the theatre with her and it was felt that it was safer not to start my womans section in case she needed the same level of care (which was a real possibility for her due to her risk factors) She was very understanding about it but if she had kicked off and become violent as some suggest is a good idea, what would the point have been, there really wasn't anyone else to safely go ahead with her section.

To go back to the op, your consultant may write whatever he/she wants to in the notes, but he/she doesn't run the labour ward and if it isn't safe it won't be done. The thing about 4 hourly ve's certainly sounds dubious, I try to avoid them as much as possible for the sake of the womans comfort but sometimes in some situations (such as a very distressed woman requesting one) I would do one after an hour and I'm sure any midwife in any unit could do this if she wanted to. If you are unlucky enough to be denied g & a ask for a different midwife or to speak to the on call supervisor of midwives, I'm sure there would be a way around it. If you are distressed with contractions whatever your dilatation you would be really unlucky to be denied it, I certainly wouldn't if even after explanation to the woman she still wanted it.