Can I be denied an epidural?

[dino98]

I'm currently 39+7 but a couple days ago I was having regular (every 2 minutes) contractions that were quite uncomfortable, so I went to hospital at around 2am. My baby's heart rate was monitored as well as the contractions I was having for around 25 minutes.
Then a midwife came to check how dilated I was, due to events in my past I was very uncomfortable of the idea of a vaginal examination. I reluctantly agreed but told her to stop almost immediately as it was too much to cope with.
She then told me to "grow up and be an adult about it" and at this point I was crying and just wanted to go home.
I went home and luckily my contractions have slowed down now so I don't think I'll be giving birth too soon but now I'm scared to go back to hospital when the time does come in case she's there again.
I am terrified of the pain of childbirth and know I definitely want an epidural but will I be denied one if I refuse to have a vaginal examination? Even if I'm in a lot of pain?

I’m not sure but I would make a complaint about how you were spoken to.

You will not be denied an epidural but they need to check it is givenat the right time (an examination may be needed) and there may not be an anaesthetist available (in which case you can’t have it)... a birth does not always go to plan. Have you previously discussed the anxiety around examinations with your midwife? Maybe you can call her and have a plan?

I needed a spinal block for a caesarean and had to wait over an hour due to there being no anaesthetist available. If they don't have the staff, I'm afraid it is possible.

Staffing aside there may be medical reasons why it’s not possible.

You can refuse an vaginal examination at any time during labour many women do but with a epidural you cannot feel anything. You will not know when you’re transitioning or when you are fully dilated. So you do rely on midwives More than your body. Do you will need to have some ve’s but you can talk to them about your issues and agree maybe only one every x hour or something.

I would complain about how you were spoken to.

If you refuse to be examined then how can they know how far along you are in order to give an epidural? You don’t want one too early in case you’re not in proper labour and too late when you’re close to transition.

I’m not really sure what you want here. If you’re adamant on no vaginal exams (and that’s your right) you’ll need to rely on your body to tell you what’s happening.

What did your midwife say when you discussed it with them?

IME they don't refuse one, but instead delay it for so long that it is 'too late'. Have you tried gas and air? I found it helped me cope with vaginal examinations, particularly when I had to have a lengthy one after my second child, when I was bleeding heavily. They were concerned that I might have placenta retained so there was no choice but to check thoroughly.

Have you told your midwife about your problems with vaginal exams? With issues like this, I found writing it at the top of my birth plan and getting my husband to show it to everyone whenever possible, helped to be treated more compassionately. Some midwives have much better people skills than others, if you've been able to explain your issues a bit, then they might be able to allocate you a kinder midwife (which is not necessarily the more experienced or highly qualified).

You can ask for an epidural straight away and then have all examinations afterwards when you can't feel them? I understand not wanting examinations, I hate them too but they are needed to assess how far along you are. And yes definitely make a complaint

Is this the first time you’ve addressed the subject? It’s a little late in the day and surely should have been discussed as part of your birth plan?

The midwife should not have spoken to you like that, I would complain.

Surely the safety of your baby is the most important thing? How do you expect them to know what is going on without an examination?

You can be denied an epidural if there isn't the staff to perform one or on medical grounds.

There was another thread about a woman complaining about her vaginal examination during labour earlier, is this a common thing to refuse or just coincidental? I always just thought vaginal examination was an unavoidable part of giving birth.

Might be a bit late but have you thought of requesting a c section? No vaginal examination required and is quite often requested by women with difficult personal reasons.

I would say that epidurals could go hand in hand with VE (and catheters). If you dont want one then I suspect you need to not - with me because I didnt at 10cm my body started to naturally push.

Epidurals stop that so it will be harder to monitor if you refuse. Im surprised a csection has not come up if you discussed it

The question is what level do you not like - unless you have an unassisted birth a certain amount of examination will have to happen (although hands up so to speak are not needed)

I don't know if you would be denied one for refusing an examination but when I got to hospital I was in labour and was 7cm dilated when I was examined and I was refused an epidural as the midwife told me you can only have one of you are 5cm or less.

I ended up having one anyway as I had to go to theatre as she got stuck in the birth canal.

I’m shocked at the way you were spoken to. :-(

Can you call the hospital and ask for an appointment with a senior midwife to discuss this issue and come up with a care plan for labour? While you’re there tell her how you were spoken to. She’ll be mortified I imagine.

I would be complaining about the way you were spoken to. Also you can usually ask for gas and air for vaginal examinations if you need it

midwifethinking.com/2015/05/02/vaginal-examinations-a-symptom-of-a-cervix-centric-birth-culture/amp/

Good article about the issue of vaginal examinations in birth, what they’re for and their limits.

I had the guy trying to put mine in...3 times. He gave up when my waters went and ds was born in 2 pushes a few minutes later. So even if you get an epidural it might not actually work... but you know what its not that bad without.

That’s a horrible way to be spoken to. I will say I’ve had two babies and never had a vaginal examination. Although I didn’t have an epidural either, you could start with saying no to examinations and see if that made you feel any better?

To a previous poster, safety is not improved by vaginal examination, as a rule - they carry their own risks!

“However, there is no evidence that routine VEs in labour improve outcomes for mothers or babies. A Cochrane Review (2013) concluded that: “We identified no convincing evidence to support, or reject, the use of routine vaginal examinations in labour…”

Do you have anything in your past that's upsetting you?

You're having a baby, they come out of your birth canal/your vagina and essentially to see what's going on they do need access and that's via the vagina. They're not trying to hurt/humiliate or damage to, they're trying to help. I don't think comments like grownup help but I can see a midwife getting the jump that at the brink of birth someone's not even child suffered they'll need access to your baby's body or cervix to get your child out without damage to the child

I hope you can get over this, it's embarrassing, yes, but that's just because we don't shownourselves off down there essentially it's got a job to do for us and we get an amazing baby out of the deal ... think of it like that .... honestly though your baby's welfare may necessitate a vaginal exam - but that's just fine, it's skin and bone down there

I think most anaesthetists would be very reluctant to put an epidural in a woman who may or may not actually be in labour. They aren't totally risk-free interventions, and can't stay in forever, so if you had a stop-start labour or long latent phase, they could be exposing you to those risks unnecessarily.

Some midwives seem to come up with arbitrary numbers of cm dilated which you are allowed to be and have an epidural but most anaesthetists are quite happy as long as you're in established labour but delivery isn't imminent (because they take time to set up and get working so if delivery is going to be within an hour or so there would be little benefit from it). But they do need to know that there is a delivery coming!

The examinations only tell them how far you are now, not how fast you will progress. They don't tell you how fast you ARE progressing unless it's done by the same midwife every time.

I refused all but one, and the one they did do was entirely pointless as dc already had his head past my cervix. I could have told them that if they'd asked.

Complain about that midwife as soon as you feel able and make sure your birth partner knows who she is so they can send her away if she tries to come in. You are entitled to reject the midwife the send and ask for a different one. Make sure birth partner does that as you will be busy.

I would also stick it on the front cover of my notes that she is not to come near you.

You may not be able to get an epidural if you don't consent to an exam, but you may not need one. I am the biggest wuss with pain and cry if I stub my toe, I had dc with only a tens machine and then a pool and he was back to back for most of the labour. You might surprise yourself how well you cope.

Brief birthing partner now about plans, and if you do want the epidural then ensure they know it's up to them to make as much fuss as possible until they agree.

I was refused one as I was too far dilated, and then ended up having one anyway a couple of hours later when I was already pushing, so it was only in effect for the last 10 minutes or so. It did mean that I was completely unaware of the midwives dealing with the after birth and stitching me up while I cuddled ds though.
As a side note, they may need to look up there for reasons other than a ve. I had a monitor on my bump throughout due to complications but it got to a point when they needed to attach a monitor to his head instead, which obviously meant them working through my vagina.

My closest friends son turned part way through labour, and if she had continued pushing, she might have broken his neck. Something told her to stop pushing, and a midwife determined the position using VE.

I think you need to address your anxiety about this issue as a VE might become inevitable.