Need updated info on epidurals

  1. I used to work OB/GYN in the 70's - 80's and I'm sure things have changed quite a bit. My daughter is due in 3 weeks. When do doctors usually allow the epidurals? I know it used to be 4-5 cm. Also the CRNA would stay close by to redose the epidural as needed. Aren't they now put on a pump? What is the drug used?
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  2. 4 Comments

  3. by   SmilingBluEyes
    Where I am, once active labor has ensued, the patient gets her epidural when she requests it. The cervical dilation is of little consequence in this context. If she is being induced, or her cervix is changing, and she is a full admit for labor, she gets it when she wants it. IF labor stalls, we start/titrate pitocin to keep things going.

    Also where I am, generally, once the patient has her epidural and she is stable, the MDA goes home or to the sleep room on his/her beeper. (during night shift). ON dayshift, they are always downstairs in the OR, anyhow. Either way, they are there in a flash, should we need them.

    CONGRATULATIONS to you, Dutchgirl and best wishes for a healthy, joyous birth experience for your daughter and family.
  4. by   SmilingBluEyes
    I forgot to say, The drugs our MDAs generally use are a quick intrathecal shot of local anesthetic (marcaine/bupivicaine) for fast pain relief (within minutes of placement)---- followed up by the administration of a mix of fentanyl and more local in a bag on a pump for pain management for the duration of labor. Our MDAs set up a PCEA system, so if the patient begins to feel pain, she can self-administer a bolus of medication for relief. If this does not work, the MDA comes in, assesses the situation, and re-boluses her with more medication as needed. With the advent of PCEA use however, this is rare anymore. Usually they are very comfy right until they are delivered and recovered.

    Hope this helps.
  5. by   obosoon
    Ditto from above except ours are usually continuous epidurals. Although we have the capabilities of a PCEA system, we seldom use them in OB. The anesthesiologist/CRNA will usually start with a bolus then attach the continuous solution.
    Good Luck!
  6. by   SmilingBluEyes
    ours are continuous too. But if they fail to work, the patient has the option to self-bolus via the PCEA system.

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