"Anaesthesia. I had my second ..."

What could be improved

Anaesthesia.

I had my second child at UCLH. All aspects of patient care except one were excellent and I am very grateful to have had my baby there. My feedback concerns the anaesthesia service.

I presented at UCLH for induced delivery at full-term with a history of uncomplicated pregnancies and a previous rapid, uncomplicated and standard delivery after induction, and a birth plan that clearly documented my wish to have an epidural as soon as medically indicated and to minimize the pain of the delivery. I had thoroughly researched the risks of epidural and scrutinized and rejected each of the common moral and scientific arguments valuing the experience of pain in childbirth as somehow special. I also understood pretty well, I think, when an epidural can be administered with minimal risks to mother and baby and when it cannot be.

The progress of my labour after induction was rapid and uncomplicated, just as my first labour had been. However, the experience could not have been more different. I was in serious pain from 6pm. The white knuckle agony started at 10.30pm, the pain so great that one cannot keep one’s clothes on and cannot stop running. Up to just before 1am, and despite my increasingly urgent requests for pain relief, the midwife kept on reiterating "an epidural can slow down labour". While this is true, I believe that at that point, medical protocols allowed the use of epidural, and the risk of epidural to me or the fetus was extremely low: at least, sufficiently low for me to be able give informed consent to an epidural. The epidural arrived at 1am, but failed; my husband told me that the anaesthetist told him that I had no coverage in the crucial places, so to speak. There was no plan B. I delivered at 2.10pm. No comment.

I was left with the impression that UCLH has double standards: excruciating pain that is preventable with a minimum of risk is prevented outside the labour ward but allowed and even welcomed within it.

Anything else?

midwife smiling, encouraging and ignoring me as I screamed for the anaesthetist.) Furthermore, one is prohibited from taking small risks that, in other areas of the hospital one can give one's informed consent to assuming.

When I delivered, the midwife declared proudly that I would be able to walk off the delivery table, which would have been impossible with a strong, functional epidural. I did appreciate being able to walk off the delivery table and the feeling that I could have walked home. However, I would have stayed four months in bed to avoid the experience of childbirth, assuming that I could have had my laptop. Once the epidural was indicated, the trade-off between risks and benefits should have been mine to make. The midwife also seemed to assume that, once I had the baby, I would forget about the pain and think that it had been worth it. Perhaps this is a common reaction, but it was not mine, and my anger interfered with my bonding with my baby. I was waking up early from anger long after my baby was sleeping through the night.

I was also surprised that the combined spinal-epidural procedure, available in the labour ward at the major Boston hospital at which I had my first child, was not available outside the operating theatre in UCLH. I assume this means that women with very quick labours, or women for whom the epidural fails, will be unable to have significant pain relief, as epidurals take half an hour to work. It was also surprising that I received the pudendal block (a local anaesthetic), not at delivery, but for the stitching, which I assume is far less painful than delivery. Perhaps there is relevant information of which I am ignorant, but I would be forgiven for not knowing it because it was not disclosed to me.

Of course, I am grateful for the fact that the midwife gave me a safe delivery. However, a year on, I continue to be disturbed by her unjustified usurpation of my decision regarding anaesthesia.