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?

They can refuse you an epidural but only for a medical reason such as you are too dilated/close to the stage where you have to push, when you ask for one. They cant just refuse you an epidural because they dont think its for the best... if theres time to give you one and you ask for one then they do have to give you one.
You may have to wait for the person to come and do it though because sometimes they can be busy. I had to wait half an hour for mine after asking.

You CAN however refuse all internal exams at any point if you want to and how that midwife/nurse spoke to you was disgusting and I would complain.

and btw I also refused internal examinations before my epidural. I had had it written into my birth plan by my midwife before hand. Due to traumatic experiences in the past I did not want any internal exams that I could feel. Everyone was very considerate about this.

They only really need to do them when you are in full labour.

You can refuse examinations, however I don't know if this will stop you getting an epidural as I think you have to be a certain way along before they will give it. I would also say that epidural do depend on whether someone is available at the time. In some case examinations can be necessary, I had to have a monitor attached to my dd due to her heart rate dropping. I would speak to your midwife about this asap.

I won’t add to why you may need a VE during labour as that’s well covered on here, but you are aware that if you give birth naturally you WILL need one post birth to check for tears which is far more painful I found?

Please also be aware that there may be a medical reason for no epidural. I got the needle in but no drug as my blood pressure had dropped far too low.
You won't be 'denied' one, instead you'll will get the pain relief that's the right medical choice at the time.

Your fear sounds more mental than physical, perhaps you can work on strategies to be calm in labour

I definitely think you need to address your issues before giving birth.

They will only give you an epidural if your 5cm or less, they can only do this through a vagina examination. Many reasons they might need to do one, positioning of baby and so on.

Her telling you to grow up was uncalled for but she doesnt know your issues.
If you felt this way, you could/should havr asked for a c-section and they would habe given you one.

Also you can request to have another midwife! I did with first DC as the first one I got was rude and I didn't feel comfortable with her. DH had a quiet word with one of the other midwives and she did a direct swap and that was it. Didn't see the rude one again (and I was there in labour for 2 days!!) honestly it was a well worth the 30 second conversation, we didn't even have to justify ourselves.

Make a complaint now before you go in-they will treat you extra well when you do come in again that way

Without a vaginal examination my son would've died. I get you're anxiety but u HAVE to put your child first and tough it out

AFAIK you need to be dilated to a certain point before you can have an epidural so they will need to do an internal examination to check first.

Not ok for her to speak you that way. Please complain! You are free to refuse any and all procedures or interventions. I found it helpful to consider whether the midwife was able to justify the proposed course of action in terms of benefits to me or the baby or whether it was simply something protocol. For example, on arriving at the labour ward, clearly in established labour, I did not consent to a vaginal examination, the reason for which was to give information to the midwife. At that time, I had all the information I needed. A little while later, feeling unable to cope (in retrospect going through transition) and it was suggested to me that I might be ready to push, I consented. It turned out I was at 10cm. You don't have to do anything you don't want to, and you should remember that the priorities are yours and the baby's wellbeing - not the expectations of health care professionals. Having said that, as pp suggest, if you're set on an epidural, it might be part and parcel thereof.

It’s not true that you need to be 5cm or less to have an epidural.

You simply need to be in established labour. Which means a vaginal examination to determine that.

You don’t have to consent to vaginal examinations.

Op is due in 3 days, I'm not sure how she would be able to get over this issue in such a short amount of time. Perhaps it might have been better to address earlier in pregnancy but it's pretty much too late now.

Purple line might be a good way of confirming labour progress now I think about it.

Cherry-the midwife speaking to her like that was uncalled for. No need for the ‘but’.

It is not true that you have to have internal examinations in order to have babies. Prior to labour, during or after.

You can have them, you will be offered them, there are many situations in which they might be a useful diagnostic tool which might help the people caring for you and they can talk to you about the risks and benefits at that time but it is absolutely, totally YOUR choice. End.

why are people saying that you have to have internal examinations?? I know that you dont, because I requested that I didnt have any until id had my epidural in and that is what happened. So you certainly dont need one to put an epidural in. They could tell from how far apart my contractions were whether i was in established labour or not.

You really CAN refuse all internal examinations and they do have to ask for your consent every time. Not doing so is terrible practice.

I hate it when people say all that matters is a healthy baby. No it fucking isn't. Op is a living breathing human. She is important. What she wants to happen to her body is her choice.

Op I'm sorry u were spoken to like that I honestly would complain.
You absolutely do NOT have to have a ve in order to have an epidural I've had 2 epidurals the 1st I didn't have a ve cos that's wot I requested the 2nd I did have a ve but only cos I wouldn't of had my epidural at that stage if I didn't (my contractions were only 20 mins apart but on 've found I was 6cm dilated), however I was offered gas & air to help with my anxiety which I gladly had, the mw got me good and high before she did it and I didn't realise she had done it until she said.
With my 4th baby I had to have 4 ve cos my dd was not happy and I had to be induced via having my waters broke (took 2 attempts), then a heart monitor and finally her head got stuck on my cervix so the mw had to give a helping hand but again I was offered gas and air. I didn't have it written in my notes but I made sure to tell the mws that I didn't want ves unless absolutely nessaccary but could I have g&a if the time came for 1. None of the mws I encountered had a problem with this so I urge u to say just wot u have here... that something happened and u are not comfortable having ves but could u have g&a if it becomes needed, or at least write a short note if ur not comfortable verbalising it.
gd luck
xx

If you have an underlying infection of any kind they won't do one.

Can be flagged by a high temp,
My baby did a poo en route and my temp shot up, I was very lucky to get one and stayed in 4 days after

Just to add my epidural for DS1 was given when I was 6cms, was missited (sp?) and then given again when I was 7cms so I would guess any claims of no epidural if you're over 5cms is a department or midwife level rather than a medical one.

@mutiny absolutely. my local hospitals policy was u had to be a minimum of 4cm and maximum of 7cm dilated to get an epidural.
x

Epidural is not a risk free procedure. A 10cms long 5mm bore needle is shoved into your lower back until it reaches a "zone of suction". The distance from success zone to disaster zone is 5mm or less. The most common complication is what is called "post dural puncture headache", which can be debilitating for weeks. I am sore many on the midwives in the forum would have seen other complications like infection, abscess, bleed into brain etc.

I assume that you are not primi from your question. Epidural not offered for doing internal examination, it is for relieving labour pain. The minimum criteria for siting an epidural catheter is either onset of regular uterine contraction OR 4cms dilated cervix, which cannot be predicted by any other method, other than doing an internal.

If you do not do-operate with your midwife for an internal examination, she can refuse to summon the labour ward anaesthetist or she may summon him too late. If, on internal examination, the cervix is found to be dilated more than 8cms, midwife can refuse epidural because you are "nearly there" and it takes 30minutes from the time you decide to go with epidural to appreciate any real benefit from it.

There are also other factors. Even for an expert in epidural, he needs a labouring mother to keep still for at least 3 minutes. If she can't, the anaesthetists can refuse epidural in her own best interest.

Epidural is only a pain relieving procedure and if there is anything more sinister happening (eg. foetal distress, emergency caesarean), then they take priority over your pain relief procedure because you have alternate means for pain relief.

Hope it all makes sense.

@OssumMummy1 are we to presume from your post that you are a midwife? If so, you would appear to be firmly in that same domineering, patronising camp as the midwife who distressed the OP.

What is your aim on posting on this thread? The OP hasn't asked about the risks of epidural. And if she had, you have chosen the most extraordinary way to explain them - use the scary-sounding jargon when that suits best, and then completely non-medical terms like "shoved into your back". And you are actually wrong. Epidural is for the relief of pain. The job of an anasthetist is to manage the patient's pain. If the patient requests to see an anaesthetist, because the patient is in severe pain, then you would be skirting very close, if not beyond, the boundaries of your practice to refuse it. Informed consent for a VE includes not being coerced, and coercion includes the threat of withholding access to pain relief. Do you realise what you are saying? That you would refuse to allow the OP, a patient in the hospital, be referred at her request to the anaesthetist, when she is clearly in severe pain, unless you, to use your own preferred term, "shove your fingers" into her vagina. Are you sure that you could defend that in court? You would, of course, have given the full gory details of the risks of VE (infection, etc) to the OP, in the most frightening language, naturally, before seeking consent? As well of course as the full range of risks of vagibal birth - emphasising the worst ones and giving no indication as to how rare they are? Or does this only apply to "interventions" that you as a midwife cannot perform?

And please explain why you are trying to tell the OP in your last paragraph that she might undergo a Caesarian section without pain relief, or less effective pain relief?

It is disgusting how women's pain gets dismissed and ignored and goes untreated. Patronising paternalistic midwives who seem to believe that every woman should have a vaginal delivery without effective pain relief, and who block women's access to the skilled qualified doctors whose job it is to manage their pain, horrify me. I really hope OP that you meet with more understanding compassionate treatment and that your consent is respected.

I think you should discuss your concerns with your midwife and agree a plan that can go in your birth plan. Although do bear in mind that plans don't always work out.

From personal experience I had a successful epidural with my first and I literally couldn't feel anything. I had no idea when to push and found it very stressful. I kept watching the machine to see when my contractions were to work it out. I was so worried that I was doing it wrong and was delaying the birth (it did). I had an epidural with my second and it didn't work. They kept telling me it had but it didn't remotely feel like my first. With my first I felt no pain at all (once I'd had the epidural obvs) and with my second it was excruciating pain that completely debilitated me to the point that I was vomiting, couldn't hear anyone and physically couldn't move. What I'm saying is don't get hung up on having an epidural, they don't always work.

But do come up with a plan and do discuss it with your midwife. Also make a complaint against the one who spoke to you in such an appalling manner.