"Unable to receive my choice of pain relief in labour"

I gave birth last week to a baby girl after coming in for a planned induction. This was my 2nd baby and I had discussed at length my desire to have better pain relief management in comparison to my first labour.

Remi-fentanyl was promoted as an option (and I remember this from my 1st pregnancy as well) and I had included this in my birth plan. Analgesia choices during the initial surges in induction bay were appropriately discussed with me and my husband by the midwives, allowing us to make an informed decision about taking paracetamol, moving to Entonox and then remi-fentanyl once in established labour in the delivery suite.

Once there though, I had cannulas inserted and then was told that the doctor/consultant wasn't available to prescribe the analgesia, as they were in theatre, so had to continue on Entonox alone to deliver my baby.

What is the point of promoting remi-fentanyl to women as an analgesic option, if it cannot be prescribed or made available in a timely manner?

This was one of the most important aspects of my labour that I wanted to improve upon this time around; I felt gutted and somewhat vulnerable that in that moment, a medical professional wasn't able to provide me with the analgesia that had been actively encouraged by the service as being my choice to receive. I had also come in as a planned induction, so there was time to get this prescribed once I had arrived and during the time I was monitored before going into labour.

If feel a review of the way that remi-fentanyl is made available and how/who is able to prescribe it should be done. It can't simply be left to a consultant; what happens for women who present overnight or after 5pm when a consultant isn't there? What grade of doctor can prescribe it? Can the process be streamlined or made more efficient with PCA type labels from pharmacy that can be placed into the prescription chart and then filled in by a doctor? And even to consider having the appropriate analgesia prescribed as per someone's birth plan, which we are all encouraged to make for our own empowerment and our own decision making?.

As all acute maternity services are now at Antrim, and I know this has made the unit busier, I strongly suggest that you ensure you are meeting the needs of the women you are providing a service to and not put them under a false illusion of what they could receive.