Midwives are told to stop refusing epidurals in labour after government probe finds women in agony are missing out on pain relief despite asking for it

• Guidelines state women in labour should get an epidural if they ask
• This is usually within an hour, experts say, but it is never ‘too late’
• Minister Nadine Dorries is writing to midwives to remind them of guidelines  
• Epidural is a pain-relieving spinal injection given by an anaesthetist 

Midwives are to be told to stop refusing epidurals to women in labour after a government probe found that many are being denied pain relief despite asking for it.

Epidurals should be given to women if they want them, guidelines from the NHS watchdog says, usually within an hour.

But the inquiry by the Department of Health found that midwives and hospitals are breaching rules, meaning that mothers are forced to give birth in agony. 

Health minister Nadine Dorries has been prompted to write to all midwife heads and the directors of NHS trusts to remind them of guidelines.

Staff shortages have been blamed, while women have complained they were being told ‘it’s not called labour for nothing – it’s meant to be hard work’.

Clare Murphy, of the British Pregnancy Adivsory Service, said that women can ‘suffer profoundly’ when pain relief is treated as a ‘nice extra’.

And Maureen Treadwell of the Birth Trauma Association said that the failures of epidural services were ‘inhumane and discriminatory’.

Midwives are to be told to stop refusing epidurals to women in labour after a government investigation found that many are being denied pain relief despite asking for it

The government inquiry, which was reported by The Guardian, also found mothers-to-be are not being told that if they want to give birth at home, they will have to be transferred to hospital if they want an epidural.  

An epidural is a pain-relieving spinal injection which, while effective, is not risk-free. It must be given by an anaesthetist on duty. 

National Institute of Care Excellence (NICE) state women should be communicated with throughout labour about how they feel and if they need pain relief.

Women in labour can ask for epidurals at any time, including during the early stages of labour.  

Failing to make women aware of the possibility that pain relief can only be given in hospital – and not at a home birth – is a breach of the NICE guidelines. 

BPAS’s Ms Murphy said: ‘We have spoken with many women who have been so traumatised by their experience of childbirth that they are considering ending what would otherwise be wanted pregnancies.

WHAT IS AN EPIDURAL? 

An epidural is a pain-relieving injection which is often given to women in childbirth.

It is also given during and after some types of surgery.

They are given by an anaesthetist, who uses a needle to insert a fine plastic tube called an epidural catheter between the bones in your back.

The needle is then removed, leaving just the catheter in place.

Pain relief drugs are then given through the catheter and they take up to 30 minutes to have an effect.

While the epidural is in use, your chest, tummy and legs can feel numb, and your legs might not feel as strong as normal.

Once an epidural is stopped, the numbness can last for a few hours before the effects wear off.

While usually safe, there is a small risk of side effects.

These can include:

– low blood pressure, making you feel nauseous and lightheaded.

– temporary loss of bladder control

– itchy skin

– feeling sick

– headaches

– nerve damage

In rare cases, an epidural can also lead to permanent loss of feeling or movement in one or both legs.

Other very rare complications include fits; severe breathing difficulties and even death.

Source: NHS

‘Pain relief is sometimes treated as a “nice extra” rather than an integral part of maternity care, and women and their families can suffer profoundly as a result.

‘NICE guidance is explicit that women’s choices must be respected, including having access to an epidural early on in labour if that is what she requests.

‘Where this is not happening we need to understand why – staffing shortages may be an issue, but we also know women may experience gatekeeping by healthcare professionals and be told labour “is meant to be hard work”.’

She called on the Government to make sure that access to pain relief will feature in work to improve maternity care.

Ms Treadwell said that pain in childbirth had been ‘swept under the carpet’ for ‘too long’.

‘The psychological impact from the distress caused by horrific pain, which is what some women endure, inadequate epidural services and misinformation about risks is simply inexcusable.

‘It is both inhumane and discriminatory. Some of the accounts we hear are horrifying.

‘Failure to provide pain relief can leave women with post-traumatic stress disorder, fear of future birth and affect their relationship in the long term.’

A recent investigation by the Sunday Telegraph in January claimed that mothers are being denied epidurals because of a ‘cult of natural childbirth’ at some NHS Trusts.

NICE says healthcare professionals should think about how their own values and beliefs about childbirth and ensure their care supports the woman’s choice.  

The Sunday Telegraph investigation also identified six NHS trusts where women in labour pleading for pain relief were refused it.

Women were often told that they could only have an epidural when their cervix is dilated between 4cm and 6cm, Dr David Bogod, of the Royal College of Anaesthetists, said.

But it is ‘never too early and never too late’ for an epidural if a woman wants one, he added, and the national standard is ‘within 30 minutes to one hour of asking for it, except in exceptional circumstances’.

Previous data from NHS Digital also showed that the proportion of women in labour given pain medication such as epidurals had fallen from 67 per cent in the year 2008-09 to 61 per cent in 2018-19.

The Royal College of Midwives said anaesthetists were under pressure because of ‘stretched resources’ which they said meant that anaesthetists are ‘not always available’.

Chief executive Gill Walton said: ‘Every woman who wants an epidural should be given one if it is safe for her to do so.

‘NICE guidelines should be followed. Women should get pain relief when they ask.

‘They should be making choices about their pain relief armed with the information they need to make an informed choice, so they get the pain relief that is right for them.’

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