‘I was screaming that I wanted my epidural, begging the staff over and over again’

Leigh Milner had one requirement for her upcoming birth: she wanted epidural pain relief. “I dreaded being in agony and knew I’d enjoy my pregnancy if I could avoid suffering during labour,” she says. “Following the advice from my National Childbirth Trust [NCT] course, I put my epidural request at the top of my birth plan in block capitals and bold type. Then I laminated it.”

Few birth plans make it out of the hospital bag, and Milner’s glossy manifesto was no exception. On February 1 2023, two weeks before her due date, Milner, 34, was rushed into hospital with high blood pressure and suspected pre-eclampsia. 

Pre-eclampsia is a serious condition that can be fatal to both mother and baby, so the hospital said Milner needed to be induced right away. “As the midwife prepared for me this, I asked for an epidural,” says Milner, who works as a news presenter for BBC Look East. “The midwife batted me off with a number of excuses, telling me I needed to be on the labour ward, it was too busy – there would be time to do it later.”

The midwife broke Milner’s waters, and her labour progressed with shocking speed. “The pain was immediately so brutal that I threw up on the way to the labour ward,” she says. “I was screaming that I wanted my epidural, begging the staff over and over again. They came up with all sorts of reasons to delay: that they needed to get the results of a blood test, and that certain forms had to be signed.” 

The gas and air machine on the unit was broken and Milner was offered only paracetamol. When a monitor indicated that the baby’s heart rate was dropping, Milner was prepped for a caesarean. She desperately wanted to avoid surgery, and steeled herself for one last push – to aid her delivery, she was given an episiotomy, or a surgical cut to the perineum. Milner had no pain relief apart from an injection of local anaesthetic that had no time to take effect. Theo was born safely, weighing 6lb 4oz, but Milner was traumatised.

“The whole thing was medieval,” she says.

Over the next few months, Milner suffered flashbacks and nightmares about the pain she experienced, to the extent she needed therapy. “I later had a meeting with the hospital, and they told me I should have been offered an epidural at the time I was induced,” she says. “They said there had been no need for this mysterious blood test. I’m 100 per cent certain I would not have suffered all this distress if I’d had an epidural.”

Pain-relief politics

The issue of pain relief in childbirth has always been political – and now it is entering the election race. In their manifesto, released this week, the Green Party remarked on the “escalation” of medical interventions, and their disapproval of such. “We will work to reduce the number of interventions in childbirth and change the culture of the NHS so that birth is treated as a normal and non-medical event,” they said.

According to guidance released in 2012, “natural” childbirth, as defined by the Royal College of Obstetricians and Gynaecologists includes births “without induction, without the use of instruments, not… caesarean sections, spinal or epidural anaesthetic before or during delivery”.

If the Green Party had their way, mothers-to-be like Milner would be even less likely to receive pain-relief.

This flies in the face of better news about the health consequences of epidurals. Last week, the issue was in the news again: a report published in the BMJ revealed that women who had epidurals during labour were a third less likely to develop life-threatening conditions such as sepsis or heart attacks after giving birth than those who did not.

An epidural is a type of local anaesthetic given into the lower back, which numbs the nerves that carry the pain impulses from the birth canal to the brain. “The idea is to numb the sensory nerves, which affect pain, but not the movement nerves that affect feeling,” says Dr Fiona Donald, the president of the Royal College of Anaesthetists. “The range of anaesthesia can vary: patients can vary from feeling nothing, to a sense of tightening when their contractions take place,” she says. A few hospitals offer “mobile epidurals” where the patient is free to move around. 

The procedure is safe, says Donald, though by its very nature, an epidural makes a birth more “medicalised”. “It has to be given by an anaesthetist, the patient needs to be in bed, attached to a drip and have one-to-one midwife care in case their blood-pressure dips too much,” she says. “The baby’s heart rate also needs to be monitored.”

There is a one in 10 risk of the anaesthetic “failing”, as well as a small risk of negative consequences such as a postdural puncture headache (which happens in around 1 per cent of births) and one-in-10,000 chance of permanent nerve damage.

Fiona Gibb is director of professional midwifery at the Royal College of Midwives. “Different areas operate under different guidelines, but epidurals are usually given when a woman is in established labour – having three contractions in the space of ten minutes – and her cervix is around 3 to 4cm dilated,” she says. “Epidurals are also often given before an induction.”

In certain scenarios, epidurals can be “contraindicated” – not performed because it may be harmful to the mother. “This can happen if the woman has certain pre-existing medical conditions such as low blood clotting levels, has cardiac instability, or has had spinal surgery,” says Gibb. “An epidural might also be contraindicated if the baby is descending quickly, or the woman is not able to lay still or sit upright.”

Otherwise, according to Gibb, all women should have the choice to have an epidural, “as long as the hospital can provide a safe, clinical environment”.

However, as Milner discovered, many labouring women find they do not have access to adequate pain relief. Statistics show that, despite the safety and effectiveness of the procedure, significantly fewer epidurals are given in the UK than in other Western nations.