Delivering fetal demises

[sharonx]

Our anesthesiologists are refusing to do epidurals on mothers delivering a stillborn. They think that other meds are appropriate and enough because at this point we don't have to worry about harm to the baby. We think pain management would be so much better with an epidural. We cannot seem to find any research on this topic. I cannot believe that this is standard procedure. What is everyone else out there doing for these patients and if anyone has research articles, that would be so helpful to defend our case for these moms.

[chare]

This thread seems to have gone off-topic...

[...]

Yes, it has. My apologies to the OP for participating in the derailment.

(Strikes colors and withdraws from the field of battle)

[Rnrmom]

I'm sad to hear this. I delivered my son stillborn 5 days after his due date. it is the only time I ever had an epidural when giving birth. It was recommended so that I would not have as much physical pain as I went through so much other pain. The care that I had during/after his birth is what has propelled me to become a nurse myself. I hope that you can find some research or some information that can help them see the value in allowing an epidural. Also, why can't it be the patient's choice? I find it odd that they are just saying "no."

[quazar]

Okay, what is the physiologic/medical reason they are giving for NOT giving a CLE? See, that's the sticker with me. In my mind, you don't need studies to back up why they SHOULD give women epidurals, THEY need to be the ones providing the data here to support their refusal to place an epidural. Let me frame it differently for you: sick, compromised MEN who have need for regional analgesia and anesthesia are able to get epidurals, yet a woman who must deliver a dead baby cannot, because WHY, exactly? Unless she has some physiologic process or anatomic difference, e.g. a clotting disorder, HELLP, Harrington rods, severe scoliosis, that makes her an unsafe candidate for a CLE, these docs are just blowing smoke. They are demanding that patients suffer and they don't have the evidence to back it up. No. No ma'am. YOU don't need evidence here, THEY do.

This whole thing stinks of rank misogyny and I would be dragging it all the way to the top, and very much touting the "customer service" angle of this as well as the JCAHO/CMS emphasis on pain control in order to get the attention of the right people.

[klone, MSN, RN]

Speak it, Quazar!! I totally agree, particularly your last paragraph on how it should be addressed, because clearly "Because it's the right thing to do" doesn't hold weight with them. You need to speak their language (or at least, the language of administration that has the power to make the final decision).

[sharonx]

We are struggling with this as you can understand living on both this sides of this. I am so sorry for your loss. I have sent stories like yours to our nurse manager that I have found, hoping that we can use them to demonstrate how important relieving the physical pain during these times really is. And it starts with them and we need them to understand this. Yes it is frustrating and we need to advocate for our patients. Won't give up till the mission is accomplished! Thank you for sharing.

[sharonx]

This is our intention for the next physician meeting with administration. So what I was able to gather were many stories from women who have gone through this first hand. Hoping that all women will be given the choice for themselves. Will continue till we are heard!!

[WKShadowNP, DNP, APRN]

I'm sad to hear this. I delivered my son stillborn 5 days after his due date. it is the only time I ever had an epidural when giving birth. It was recommended so that I would not have as much physical pain as I went through so much other pain. The care that I had during/after his birth is what has propelled me to become a nurse myself. I hope that you can find some research or some information that can help them see the value in allowing an epidural. Also, why can't it be the patient's choice? I find it odd that they are just saying "no."

i

I am immensely sorry for your loss and grateful for the fact your terrible situation was mitigated with compassionate pain control.

I had an early miscarriage and the pain of that was far worse than my subsequent full term (and blessedly healthy) deliveries.

[shortstuff31117]

We absolutely offer an epidural to anyone with a demise. It's still labor!!! We actually encourage it so that they don't have the physical pain on top of everything else. I can't believe these doctors...what evidence do they need for pain control?? It's despicable what they're doing...

[sharonx]

We feel the same way and we are bringing this up the chain. Thanks for your post!!!!

[bagladyrn, RN]

If you are willing and able to face a pissed off anesthesiologist you could do what I did with one who refused to even come in for any epidural a until the pt. was at least 8 cms.

I called him and when he refused I stated "let me make sure I have this right - I am charting that I have informed you of the patient's pain level and her request for an epidural. I am charting that you are refusing to perform the procedure. Is that correct Doctor?"

He was there in 5 minutes, steaming, but my patient got what she needed.

They do NOT want anything like that to be discoverable in a chart.

[quazar]

If you are willing and able to face a pissed off anesthesiologist you could do what I did with one who refused to even come in for any epidural a until the pt. was at least 8 cms.

I called him and when he refused I stated "let me make sure I have this right - I am charting that I have informed you of the patient's pain level and her request for an epidural. I am charting that you are refusing to perform the procedure. Is that correct Doctor?"

He was there in 5 minutes, steaming, but my patient got what she needed.

They do NOT want anything like that to be discoverable in a chart.

I want to high 5 you through the screen. You are awesome.

[ragingmomster, BSN, MSN, RN]

Some of our anesthesiologists will refuse to place an epidural in the case of IUFD deliveries. Because they anesthesia group is a private contractor they don't have to listen to hospital or obstetrical suggestions. In the case of PCA versus epidural pain management, the risk of epidural or combined spinal epidural to mom is greater. The 'ologisists that decline to place an epidural use the reason that an epidural is preferred method when of pain management when harm to the fetus is part of the decision process. Due to the dearth of RTCs and EBP data on the topic, please consider involving your office of patient and family experience folks. Pulling together a concerned group of mothers who have been though the process may provide enough data (heart string tugging) to move some of your 'ologists toward the "light". Improving patient satisfaction scores can sometimes have an impact. Good luck.