Feeling traumatised by not getting the pain relief i asked for, anyone else

[Naty1]

Had dc2 friday, and been feeling upset about not getting the epidural i asked for (3hrs before delivery)
I had it clearly on birth plan.
I asked for it then said pethidine while waiting and ended up with g&a too.
Mw went off to request epi and said its a busy night theyll be there when they can.
I clearly couldnt cope with what i had and remember begging. Saying i want it now.
I just shut down and willed the contractions to stop.
Was saying the baby was stuck (as dc1 was )
But i think what has triggered my anger/ upset is reading my birth notes. My birth plan isnt there and on the computerized printout as its not a question- no mention of my requests or why it wasnt done.
It feels like they want people to be too late for pain relief.so keen to send home, refusal to check dilation.
Not caring how it feel afterwards to be ignored, patronised 'havent you done well with no pain relief.'
I did have epi with dc1 back to back, stuck at 2cm, sytocin, failed ventuose and forceps, episiotomy.
But i think the issues were more to do with being back to back.
It just annoys me the illusion of choice but if your choice isnt natural you are being judged. Made to go on a bit longer until its suddenly too late.

Madwoman are you taking the piss or are you actually that stupid? It's just that if you're joking, I don't want to post a line by line rebuttal of everything that was wrong with that post. You do sound like you might be parodying some of the worst sort of NCB fetishists and I've been known to miss the joke before, you see.

And healthy babies mean nothing really, it's too low a bar.

It sure is, if the mother is fucked up. I draw a bar at healthy mother, healthy baby as a standard we should aim for as a low bar.

If you think that the acceptable level of care is below that then I question your sanity. Any where we don't achieve this in western society we should be questioning and reviewing what happened and giving adequate support both to ensure its not something that has gone wrong and could have been prevented, to improve future care and to ensure the wellbeing of the woman concern rather than merely throwing her back out in the street and saying "well your baby is healthy what are you complaining about you ungrateful woman, belt up and get on with it".

Because that's what you are suggesting is acceptable and should be regarded as the standard of care we should be happy with.

Not my understanding of too posh to push. That would be concern about lack pelvic muscles for sex after, or how it would look etc.
and anyway who are you to judge how people choose to deal with their concerns/fears/valid worries.
And anyway we keep being told - apparently CS is difficult/dangerous/painful so actually chosing natural birth is the easy option.

Im so sorry to hear of so many other similar experiences. Especially the not being assisted to shower, but it doesnt really surprise me. Even without disability people could be giddy/low blood sugar/ exhausted having lost blood. So have seen where people said they passed out in the shower.
I dont know if i already said the community mw said they do take out birth notes, so i would have to request them.
I think it could only help if you could review your experience. As it is not many new mums would feel like pursuing a complaint (you are busy enough as it is)
Also i dont know that i want a complaint on my records.
But on the other hand i do want this culture to stop.
I dont take too much offense to madwoman as with the internet i cant see what experience he/she has. Could be a man/mw/never had kids/had a CS/ or just had easy labours.

I mean if everyone were the same there would be no intervention, forceps/ventouse/CS as we would all be popping them out.
On my side of the family this is the only intervention free birth so 1 /6
1 natural
1 b2b forceps/ventouse
2 CS (1 breech, 1 placenta previa)
1 breech forceps, 1 b2b forceps

I do find it sad that instead of empathising, comsidering the thread title, there are posters arguing. But again really enforcing my opinion that some people have agendas re pain relief availability. My body (should be) my choice.

My point about wanting it NOW was clearly in relation to being misunderstood/not heard comments.
If you felt they were doing their best/believed the excuses then i probably wouldnt have been saying that.but anyway, was the bit where i was in agony missed, i think a lot of people would be feeling PO about being in pain for no reason
I appreciate what people are saying about length of emergency operations etc. its the knowing its been purposely withheld from others that makes me suspicious.

Even if an epidural is being delayed due to an emergency what is lacking, it seems to me based on the stories I've seen on here, is basic communication skills and empathy. There is no excuse for that. Overworked or not.

Of course not all midwives are like that but those of you arguing the toss can't simply dismiss the accounts of women like the OP as fantasy/whinging/entitlement. Jesus. Childbirth must be the only thing where it's deemed acceptable to let someone spend literally hours and hours in agony. That's fine as long as their baby is ok. No matter about the mother being in a fit mental and physical state to look after it.

I too am shocked by some of the dismissive attitudes to the OP's completely valid and understandable feelings and concerns from some posters on this thread.
[Flowers] for you, Naty.

I wish I was shocked.

I just think such posters are nasty pieces of work who never step out of their own little bubbles.

If madwoman is a midwife we are all in trouble.

I had a brilliant midwife who got me an epidural for horrible back to back labour within 15 minutes, she managed to get the anaesthetise in quickly just before a planned c section was to take place. I have mixed views on them, it contributed I am sure to a long 2nd phase needing ventouse and then shoulder dystocia but I could not have carried on for hours in that state, no break between contractions, G&a did literally nothing.

the assessment midwife on the other hand (before I was admitted) was clearly trying to delay me and trying to get me into the birth pool etc. I and DH had to be very firm that I did not want to go to the home from home section and wanted the hard stuff asap

I do think there is something wrong in the availability of anaesthetists. It took 3 hours for me to get pain relief in one of the largest maternity units in the UK, when I was top of the priority list (as I was told several times). What would have happened if I had needed an EMCS, if there really was no one else available?

I also find it hard to believe that this would happen in any other scenario. If someone in A&E was screaming in pain and begging for pain relief, they would be seen in less than 3 hours. Why doesn't that work in maternity units?

I'm not shocked either. As OP correctly points out, some posters have vast agendas when it comes to pain relief availability for women in labour nobody is fooled by the name changes.

Some of them hide behind a cost argument, then scurry away when it's pointed out that ELCS would become the cheapest way to give birth were it the default mode. Others throw in barbed asides about safety, as if we've even ascertained whether ELCS is safer than VB on average, let alone in every case. I'm surprised we've got this far without anyone grossly exaggerating the state of research about microbiome, actually. Not to mention that more ELCSs would also make them even safer as we'd get better at dealing with the possible complications. The last tactic, then, is to try and portray labouring women in agony as selfish for wanting pain relief, because the anaesthetist might be dealing with an emergency. When of course, as bearsinmotion points out, the question we ought to be asking is why we accept a state of affairs that makes this happen routinely. There is no other medical specialism in which so many people would just shrug their shoulders at people being left in agony for hours because of resource constraints. Which is not to say that this never happens, simply that there aren't so many people queueing up to justify it and berate the victims.

Quite simply, a surprising number of people have a lot invested in the idea that unmedicated vaginal birth is the desirable goal for most women, rather than something that some women want to undergo and should be assisted in doing so if at all possible. Sometimes they're invested in it for financial reasons, other times emotional, other times because of a fundamental misunderstanding of evolution. But they must be questioned. Always.

Naty, I'm sorry about what happened to you. It shouldn't have happened.

As a midwife can I say that personally I have no interest in denying women pain relief. Firstly im there as the woman's advocate. Secondly on a selfish note Id much rather spend my shift looking after a woman with an epidural rather then looking after someone who is screaming for pain relief.

I hardly ever see situations where women don't get an epidural. It happens very, very occassionally. I can think of less than ten times in my ten year career where a woman ive been caring for hasn't been able to get an epidural. Once or twice that's been due to the anaesthetist not been available. More often it's due to there not been enough midwives available to provide the one to one care needed. An emergency on labour ward can take hours, it isn't just an emergency section. The anaesthetist is a major team member at bad post partum haemorrhage among other things. Ive known a woman with a bad pph be in theatre for six hours before now.

OP says she laboured during the night so it's even harder during the night if not impossible to call on extra staff. I should imagine in most hospitals epidurals not been given due to lack of anaesthetists is so rare that no hospital would employ an extra one 365 days a year just in case, not if its only an issue a couple of times a year. Obviously if you're the unfortunate person who is affected I understand that isn't much comfort.

Lastly the computerised printout of your birth is a very basic summary and doesn't go into much detail about anything. The midwife would have been handwriting much more detailed intrapartum notes and Id have thought would have documented more stuff about what happened in there. You can ask for a debrief where you go through your notes with a senior midwife. I would certainly write to the Head of Midwifery at your hospital telling her what happened. I would always encourage people to put stuff like this in writing because if it is an issue for that hospital then the more ammunition the HOM has to put together a business case for more funding/staffing the better.

I'm sure I'm not the only one who'd never suspect you of deliberately denying pain relief viva. Nothing you've ever said on here suggests you have that type of attitude.

Yes I think you're right. There does seem to be a relatively small window of time during which you can take your place in the queue for pain relief - and there are times when that does seem to be influenced by funding more than anything else. It's become a cliche that there are no medals for how you give birth but unfortunately it doesn't feel like many midwives are aware of this.

In a sense, we're set up for disappointment. Women are told to draw up a 'birth plan' and encouraged to believe we're in charge of our own bodies and our own labours. Like a consumer paying for a product, we tell the NHS what we want, just as if we were in a shop. And though we're made well aware that the birth plan may go out of the window if there's a medical problem, it perhaps isn't emphasised enough that limitless pain relief cannot be given to everyone at any given time. So even if it's on your birth plan, you can only have it if it's 'in stock' when your window of opportunity comes up. Perhaps medical staff should also be a bit more honest that 'waiting a while to see how things go' decreases that window of time. And we as women should be more realistic about what it is that NHS doctors do; they are there to provide adequate care within a budget. If they don't stay within the budget, the care will no longer be adequate. So their treatment of one individual is not just about that individual, but also relates to the overall number of pennies in the jar.

My problem with insufficient pain relief is not only that there is a moral basis for it being available when the patient wants it. It's the long-term consequences, not least the emotional strain that a woman can feel about not having being 'good' or 'strong' enough to bear the pain. If she cracks, panics, feels she can't push as a result of pain, medical staff are obliged to do whatever it takes to get her to push. (I witnessed this a few weeks ago.) Those voices, heard at such an emotionally charged and vulnerable time, may linger for a long time and come to mean, 'They thought I didn't do well enough/I'm not good at labour/I wasn't strong enough to do the right thing for my baby so I don't deserve her'. Sometimes the chain of events leading up to those feelings is unavoidable...and sometimes I wonder.

Perhaps we need more recognition that childbirth is about more than just 'getting the baby out'.

farfallarocks Are you saying that the epidural was somehow linked to the shoulder dystocia?

I have a condition that causes severe, chronic pain. As well as usual consultants, I am under the care of a pain management consultant/clinic. I never realised that pain management was a specialism or that so many options existed. Their baseline is to make me absolutely as pain free as is humanly possible. I cannot praise them enough.

The contrast between the care I have received for this condition and the care I received during all my births is eye opening. I am asked my opinion on what I need, I am offered whatever it will take to make pain manageable, If I present at hospital now crying in pain, (I'm embarrassed to say I have shrieked during a particularly bad incident), I am immediately medicated with whatever it takes, usually morphine straightway. Yet when I presented like that in birth, I was offered a fucking paracetamol.

Why is it acceptable to leave someone in pain if they are giving birth? We wouldn't accept it after a car accident, broken bones, cancer treatment etc, so why is the pain management for something which is probably the most pain women will ever be in, so poor?

Purple: I have thought about this and completely agree. I think some of the difficulty arises from the idea (and truth, I guess) that birth is natural, as it's something females have gone through since beginning of time. The fact that in the past women had little or no pain relief and still often pulled through fine (although often with the help of a very experienced midwife of sorts), disregards all the women (and babies) who greatly suffered, and were damaged or killed in labour. It was a very risky business. It was painful, as it is now. Labouring women may have been more prepared, rehearsed and supported, so could have possibly had lower levels of pain, but pain they had, and still have. "Natural" is no reason to deny women (who want/need it) pain relief we now have available, especially knowing the consequences a truly bad birth experience can cause. All sorts other things are "natural" too, and have been around forever, such as extremely painful diseases and accidents - often all people had to hand was prayer, alcohol and herbs, but nowadays nobody would deem it ethical to deny adequate pain relief in these cases.

Some very interesting comments.
I think the mw stayed with me once i had the pethidine, but i guess may have had to leave if someone else had come in.
I asked mw today, all they really said was do you feel you recovered quicker this time without it? And that they had had people with bladder problems from the catheter.
And it was a quick labour.

Ive been reading a few birth stories recently and it seems unusual for a b2b baby to be born without intervention (so you may be better with the epi for the instrumental deliver if needed)
I thought shoulder distocia was more about it being a large baby?

Very much agree that the psychological impact of not receiving requested pain relief is under estimated. In my case it wasn't that I wasn't good / strong enough, it was the fact that I felt (and still feel) that if this had been DC1's birth DC2 would never have existed, despite DC1's birth being much more traumatic on paper. And that in the midst of all that pain I wished I hadn't had him, and I can't get over the guilt I feel for that.

notanotherword the research I have done and the debriefing I have had suggests that a few things can contribute to dystocia. A large baby is one but 50% of cases happen with a normal size baby. A prolonged 2nd stage and instrumental delivery as well as being on your back (which you are by the time you are in theatre) all increase the risk. Epidurals do cause an increase in instrumental birth and a prolonged 2nd stage so I do wonder if the outcome would have been different had I been more mobile etc.

Having said that there is no way I could have coped with hours of back to back labour and I was very grateful for that epidural when all the intervention started (manual turning, ventouse, huge episiotomy, various manoeuvres to get DD out, I felt nothing). Thankfully DD was born crying and well which is not always the case with dystocia. It has left me in a real muddle about how to proceed this time!

Thanks for this info farafell. Glad you have your little one safely with you . My baby son (I'm not his birth mother though) had an almost identical birth and didn't breathe for a number of minutes. Longest minutes in the world for us. He was a very big baby.Three weeks on he is huge.

With regard to instrumental deliveries, it is not a simple causal link between epidural and instruments. Difficult labour leads often to epidural and that leads to instruments, because of the epidural instruments are easier to use (already numb) so could be more likely than another method. It is a very complex relationship and the NHS often vastly over simplify.