After nearly 12 hours of labour with her first child, Samantha Burgess reached a point where she knew she could no longer cope with the pain.
Up since 3am, she'd spent all day dealing with intense contractions brought on by medication given to induce labour.
She told hospital staff she wanted an epidural, an injection of anaesthetic used to block pain from labour contractions.
It was the third time she'd asked for pain relief over the course of the day.
But each time her requests for help were met with resistance.
The first time, her midwife said it was too early and suggested a bath to help with the pain instead.
The second time they'd unsuccessfully tried using nitrous oxide gas.
The third request was also met with pushback.
"[The midwife] sort of just looked a bit put off like, 'No, I don't want to give it to you.'"
Samantha's midwife then did an internal exam. Halfway through Samantha said she told the midwife to stop because it hurt, but the exam continued.
"I remember I screamed to say, 'Take your hand out of me. I want the epidural now.'
"She kept her hand inside me. I just felt violated."
At that point, the midwife said it was too late for an epidural because the labour had progressed too far.
When Samantha insisted, the midwife went in search of an anaesthetist and didn't return for 40 minutes.
"I felt like she was doing that because she didn't want me to have the epidural," Samantha said.
Delays for epidurals common
Samantha's story is one of dozens the ABC received as part of its Birth Project, which heard from nearly 4,000 women around the country about their experience having a baby.
Women who contacted the ABC reported having pain relief, including epidurals to numb the lower body, delayed or denied.
Many said they felt some midwives deliberately delayed requests or did not give them access to the full suite of pain relief options available, leaving them traumatised.
This conflicts with advice from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, which states women should be informed ahead of time, and in a timely manner, of pain relief options.
Globally, Australia's epidural-spinal rate sits in the mid-range at 46 per cent, far lower than France at 85 per cent but higher than the United Kingdom at 31 per cent.
Nicole Sheridan, chair of the Australian and New Zealand College of Anaesthetists Obstetric Anaesthesia Special Interest Group, said access to pain relief was a basic human right.
Myths preventing epidural use are 'prevalent'
Dr Sheridan said myths about epidurals pervaded maternity wards, where staff were keen to keep medical interventions to a minimum.
"The common ones I hear is you're more likely to need a caesarean section, which isn't true," she said.
"With advancing epidural medicine techniques we're using more and more dilute local anaesthetic solutions and we're delivering it in a different way."
She said pain was highly individual, and anatomy, pelvic size or the positioning of the baby could influence a woman's discomfort.
Psychological factors or even a history of chronic pain could heighten a person's experience of pain.
"Everyone's labour is different," she said.
Dr Sheridan said it was a myth that the procedure prevented pushing, with the current doses of anaesthetic only blunting sensory nerves and leaving motor nerves usually unaffected.
Another myth, she said, was there became a point where it was too late to administer an epidural, although it could take some time to set up and get consent.
She said best practice was to deliver an epidural within half an hour of a request — but in reality, waiting for blood test results and dealing with other patient priorities could lead to delays.
"It's all about education. I'm sure some of these myths are playing on some patients' minds but with good antenatal education we can hopefully dispel some of these myths."
'We're failing women'
Hannah Dahlen, a midwife and academic at the University of Western Sydney, said pain during labour had a physiological function including setting off a series of responses in the body including endorphins, which in normal circumstances should help.
"They release a natural opioid-like substance, which gives the woman a feeling of dealing with her pain, but also a timelessness, an ability to be able to manage that pain," she said.
"Pain is a very natural part of childbirth."
Professor Dahlen surveyed more than 6,000 Australian women about their birth experiences between 2016 and 2021.
She found approaches to pain were a common complaint, with more than 170 women wanting more pain medications next time.
"We're failing women," she said.
Loading...Data shows about 80 per cent of women who give birth each year in Australia receive some form of pain relief.
The majority use gas (101,642), the next most common is lower body numbing using an epidural or spinal block (90,384), followed by opioids (20,314) — some women have more than one.
The remainder — about 39,000 — have no pain relief at all, but the figures don't indicate whether that's by their own choice or not.
Professor Dahlen said staff shortages could be an issue because women who have epidurals need more intense nursing, including regular blood pressure and baby checks.
"Where you have short staffing, where you have midwives in the room very rarely, (they're) running in, running out — we know that women get more distressed and have more negative experiences of their birth."
Trauma continues after birth
About seven hours after she first requested help, Samantha Burgess ultimately received an epidural.
But she said her experience left her traumatised and she developed post-partum depression and rage.
She complained to supervisors at Maitland Hospital in regional NSW and said the facility sent two administrators to her bedside at night.
"I felt like I was getting ganged up on," she said.
"They just made me feel stupid, like I was complaining for no reason. I was just in tears the whole time."
The hospital later gave Samantha a full apology, but the new mum said she could never have the experience of her first child again.
"It feels like I lost a part of myself when I gave birth," she said.
A spokesperson for Maitland Hospital acknowledged the distress caused to Samantha from her experience of care.
"We also logged this formally as a complaint so the matter could be investigated, and feedback could be provided to improve care," the spokesperson said.
NSW Health said it was actively learning about experiences of maternity care and had consulted with more than 18,000 members of the public and clinicians about issues.
The NSW Parliament is also holding a birth trauma inquiry.
"NSW Health recognises the need for individualised care that is responsive to women's unique needs and achieves the health outcomes that matter to them," a spokesperson said.
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2024-03-18 18:40:21Z
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