If you want to see a laboring woman go ape sh*t crazy, keep her waiting a very long time, or do not give her a longed for epidural.  Yes there are many, many, many women who deliver in hospitals who want, really they demand, on having an epidural during labor.  In fact, the majority of women request epidurals.  Yet occasionally, this demand is not met.  These women may be in labor for hours before they get some smack in their spine, or they may never get it at all.  Let me explain.

Anyone who has worked in OB long enough has come across those days when the meconium is hitting the fan.  Women lined up in the lobby.   Women laboring in a triage room.  Women delivering vaginally in the OR because all the L&D beds are taken.  There may be a crash C-Section, where the woman is being put under general anesthesia, or there may be a woman hemorrhaging and being rushed to the operating room.  During these crazy days, there are still your average run of the mill women in labor who need, want, demand, an epidural, and a woman in labor is anything but patient.  Yet hospital staff must triage, or prioritize our care.  For an anesthesiologist, when other patients lives our on the line, inserting an epidural is low on the priority list.  An epidural is essentially an elective procedure.  You don’t have to have one, and you are not guaranteed of getting one.  Do you think the patients know that?  Uhm,  no.

Whenever I lead my unit’s birthing tours, invariably the subject of pain relief comes up.  “How long will it take to get my epidural?” (number 1 question).  “If I want a natural childbirth, can I change my mind and get an epidural?” “Do you validate parking?”  (Parking rates can be really painful in the city).  I always recommend to all my birthing tour moms to take a natural childbirth class, even if they want an epidural the minute they are in labor.  I do not recommend these classes based on any philosophical or scientific belief that natural childbirth is superior, but on  a realistic knowledge that you are not guaranteed an epidural.  Let me say it again,  YOU ARE NOT GUARANTEED AN EPIDURAL.  Those are tough words to hear when you have your heart set on an epidural.  I tell those moms to take a class on natural methods of pain relief, because you can not predict how your birth will go.  Having some alternative methods of pain relief, like the jacuzzi tubs we have in every labor room (I call them the aqua epidurals), or using imagery,or hypnobirthing, or whatever, will give you back a sense of control over the pain.  I have no idea how many of these moms take my advice.  My guess is not many.

For those moms who demand epidurals and do not get one, it can be a very painful experience for the mom, her family, the staff, and the CEO of the hospital.  A lot of these women feel betrayed and punished for not getting one. We will often receive complaint letters from moms who were denied an epidural, for whatever reason. The feelings of being punished is exacerbated when staff respond to the woman’s complaints with “Well, you should not have come to the hospital so early.” or “Well, you should not have come to the hospital so late.” or “Well, you should not have come to the hospital.” Word of advice, blaming the patient for their health care outcomes is never helpful.

I am in no means criticizing these women for feeling betrayed or punished by the hospital for not getting an epidural.  If we are advertising and promoting a pain free delivery, well, we are basically lying to them.  A pain free delivery is never a guarantee, even with an epidural.  All options for delivery need to be explained to women, before they enter the hospital in labor.  It may be a conversation they do not want to hear or believe, like an epidural is not guaranteed, but it is an honest conversation.

*BTW, we do validate parking.*

RR