Epidurals?

  1. I have noticed while watching births of different Tv shows, ex. Maternity Ward or a Baby's Story. Women are offered epidurals to control pain for vaginal births. I personally was never offered epidural as a alternative to manage pain during labor. I remember only Demerol IV given to control pain. I was not given a choice of any other alternative for pain. What is the criteria or protocol for receiving an epidural during labor? Or is it mainly the type of insurance coverage??
    •  
  2. 10 Comments

  3. by   fergus51
    It really depends on where you are. I have worked in hospitals where you only get an epidural for c-sections because there were not enough anesthesiologists to offer them on demand. Some insurance companies cover them, others don't. Our main medical criteria is the woman must be 3cm dilated with regular contractions, must have an IV put in and remain on continuous fetal monitoring.
  4. by   Nurse Shark
    I actually had an epidural when I had my son five years ago.. It was the best thing I ever did. I was aver two weeks past my due date(according to my OB) and he decided I should be induced. Well they started the Pitocen at 7am and by4pm I was in so much pain and I was only dilated 3cm. So the nurse just said "I'll call anesthesia for an epidural if you want me too" well of course I wanted her too!!!!I had my son a 5:10... It was great!! I personnally just could not relax and I fought every contraction..The epidural was not something I had planned on having but the nurse was so calm in offering it, it was like she was offering me a glass of water "Oh would you like an epidural with that contraction"
  5. by   SmilingBluEyes
    It's a VERY personal decision and one to made with INFORMED CONSENT...e.g. benefits and risks explained CLEARLY to you by your OB and Anesthesiology personnel. Some think it's the greatest thing since sliced bread; others have strong feelings against regional anesthesia. It's up to the laboring family as to how they prefer to manage pain and the best way to approach this is with good childbirth education and being an informed consumer. Personally, I got an epidural at 8cm with my son after 13 hours' of pitocin labor. It saved my sanity; I honestly think so. To each her own. Most major hospitals/birthing centers offer regional anesthesia (intrathecal, epidural, spinal (for csections) ) as options (among OTHERS) to manage labor pain.
  6. by   Dayray
    It depends on what hospital you go to . Some dont have the anesisia staff to handle the OR and L&D. I have never heard of insurance effecting weather or not you get an epidural and would be shocked if that had anything to do with it.

    I always ask my patients about their plans for pain control. some patients ask whats avilable or don't have a clue and thenI tell them about all the options but if they have specific plans I just talk with them about them and try to agree on a plan. As long as they are't in sever pain or having problems I just stick to the plan. Only if they are haveing a hard time copeing do I sugest other options. So it's possible your nurse felt you were doing okay and that an epidural was'nt really needed or wanted by you. The OB shows and Baby story make epidurals look like a no brainer and don't talk about the risks or the down sides to them.

    AsSmiling said pain controll is a very personal choice and as nurses we have to be carfule to provide information and guidance but not to make your decistions for you.
  7. by   nekhismom
    I had an epidural with my son nearly 2 years ago. That was before I started nursing school and before my L&D clinicals. At the time, I felt like I was informed of the risks of an epidural. After my nursing class, I couldn't disagree more!!! I plan to do natural childbirth with the next one, or at least use something else for pain management. I must admit, even though I wouldn't want another epidural, it was nice to sleep between contractions and to not feel much pain.
  8. by   moonshadeau
    Originally posted by Dayray
    I always ask my patients about their plans for pain control. some patients ask whats avilable or don't have a clue and thenI tell them about all the options but if they have specific plans I just talk with them about them and try to agree on a plan. As long as they are't in sever pain or having problems I just stick to the plan. Only if they are haveing a hard time copeing do I sugest other options. So it's possible your nurse felt you were doing okay and that an epidural was'nt really needed or wanted by you. The OB shows and Baby story make epidurals look like a no brainer and don't talk about the risks or the down sides to them.

    AsSmiling said pain controll is a very personal choice and as nurses we have to be carfule to provide information and guidance but not to make your decistions for you.
    I am glad that you are responsive to someone in pain. My first OB nurse was not interested in my needs at all.

    My water started leaking at 2345 and the contractions were coming very,very hard and strong. I got to the hospital at 0045 and was BEGGING the nurse for something to ease the 10/10 pain. I was 4+/100 when I got there and my water broke completely then.

    I Begged for 2+ hours for something for the pain. The response I got was "in a minute" every time. I tried to be understanding since I know how busy and how time can just fly by. At 0300, I asked why I hadn't gotten anything yet, not even an IV started. The response:
    "Because I haven't called the doctor yet to tell her you are here. I will when I get around to it."

    Needless to say, I was beyond livid! The response and the treatment were totally inappropriate.

    The rest of the story goes that I got some Fentanyl around 0330 and my epidural (intrathecal) at 0400. Started pushing at 0430 at C-section with delivery at 0646.

    Still torn on whether or not I should follow up on the nurse's behavior or forget it.
  9. by   SmilingBluEyes
    FOLLOW UP!!!!!
    For two reasons:

    One: for your own satisfaction that you did this.

    Two: the nurse involved was either VERY unaware of your needs and MUST be told so....

    or very incompetent and insensitive (this I more believe but I was NOT there, you were).

    They need to know your needs were NOT served well so this mistake is not made with other patients. At least SOMEone needs to be aware how you feel. Write a letter to the manager of the OB dept today and tell them your perception of what went down on that day and how you feel about it. Be honest and clear/concise.

    I work with this belief: THAT patient in that room could be my sister, mom, best friend. What would I do but give her my best? Well, my patient deserves NO less of me. I believe all nurses/doctors should practice this way. But alas, it's not utopia and we don't. There are times, especially when it's extremely busy, we tend to forget how much our attitudes and treatment of them affect our patients and their family members. Your post here is a great reminder to us all......

    I am sorry you were not treated as you should have been. Either some education is sorely needed for the nursing staff....OR counseling. Either way, you have the right and obligation to make your feelings known. Good luck to you, again I am sorry about this all. It was wrong. Take care now.
    Last edit by SmilingBluEyes on Aug 11, '03
  10. by   moonshadeau
    Thanks Deb for your reassurance. I wasn't sure if there was some reason why I was made to wait for so long when I was VERY vocal in asking for pain management. I sit on a nursing council with the hospital nursing administrator who will be asking me how the birth went. I think I will casually mention it to her and follow up with a letter.

    All I can say is that because of this I understand much better what a difference time is to a patient compared to a nurses' perception and that pain medication requests have definately moved up on my priorities list in patient care.
  11. by   SmilingBluEyes
    often, being patients is a HUGE revelation to us nurses as to what it's like on "the other side of the rail". let this experience teach you well. it will make you a better nurse. I have been known to drop EVERYTHING to give pain relief to patients, whether "my own" or not are ringing the call light. I figure they are asking for RELIEF and depending on US to give it--- they should not have to wait unless a dire emergency is going on. that prevents my going in there within 5 minutes. The people I work with are great that way. WE all cover each other's patients' requests for comfort. That is because we feel it's a priority and there is no "your" patient when it comes to making them comfortable if possible. Anyhow, Best wishes.
    Last edit by SmilingBluEyes on Aug 11, '03
  12. by   rdhdnrs
    OMG!! She was going to call the doc when she got around to it??? I agree with Blue Eyes, you must follow up. Especially if you sit on a nursing council at this hospital, because L&D has some serious medico-legal problems as long as this nurse is there. Legally, the doctor MUST be informed when a woman comes in in active labor!! How else can he or she be responsible for the care of the patient? There are so many issues here that they can't be addressed in this forum, but please be sure to follow this up.

close