Do they turn off the epidural before delivery?

Specialties Ob/Gyn

Published

Specializes in Utilization Management.

I have questions. I hope you don't mind answering, but in order to grasp some of what's actually going on around me when people talk about their birth experiences nowadays, I hope you can indulge me and answer a few.

From what I hear, birth can pretty much be pain-free with an epidural. Is that true?

The epidural isn't given until Mom is how many cm?

I've heard that the epidural is turned off at a certain point. When do they turn it off? Why? Does it affect contractions or the baby or both?

What if delivery takes awhile--like hours? Does Mom have to push for hours without any pain control?

Are there any other options available for pain control besides an epidural or does Mom just have to go through it?

Thanks for answering. You don't know how many times I've wanted to interrupt coworkers with these questions, but I really don't want to spoil their stories.

Up Vote Up Vote ×
Specializes in NA, Stepdown, L&D, Trauma ICU, ER.

First off, no such thing as a 'pain free birth' If I could find the no-good-so-and-so that's been spreading that rumor, they'd get some quality ICU time :devil: Epidurals control/eliminate most of the pain, the sharpness of the contractions, but it's called labor for a reason, and it's gonna hurt a little bit. I love a good epidural, especially for long labors. Moms get comfortable enough to get much needed rest, the support person can go get some food, walk, etc. But, they don't always work. Women get so wrapped up in the idea of getting an epidural, being pain free, that when we can't get a good one (and it takes a lot for us to give up) they don't have any backup coping skills. They didn't attend childbirth classes, have no idea what methods they can use to get through the process. CRNA tries and can't get it in or gets a one sided block, calls the MD and then the anesthesiologist can't get it any better. Now what?

Even if the epidural works, I've seen moms progress out of it, if that makes sense? Make huge progress in a single contraction, and that's pain no epidural can control. There's intense pressure as the head comes down also, and most of the time we can't eliminate that pressure/burn as the baby crowns and delivers

Some docs won't let moms get an epidural until 4cm, others let her have it whenever she needs it (as long as she's actually in labor.) Research to support both positions (some say epidurals slow labor, others say it makes no difference) I've seen labor fizzle out after one, I've also seen moms go from 3cm to complete in an hour once they get comfortable and relax.

We turn them off if mom is too numb to push effectively (sometimes they aren't able to push at all) if moms BP has a huge drop we'll turn them off until anesthesia gives some neo to bump them up, and occasionally for a high block with mom c/o SOB or tingly fingers. If it's working the way it's supposed to, we leave them running until after delivery so any repairs can be done comfortably. If we turned it off for pushing and mom is starting to get uncomfortable we can have the CRNA bolus them or set the pump for a lower rate.

The options we have are IV meds-nubain Q2, until about 2 hours prior to delivery or epidurals. Occasionally anesthesia will do an interthecal, think shorter acting spinal, for fast progressing moms. They go in and work faster than epidurals. The OBs can do a pudendal block, but not many moms are excited about having lidocaine injected into the nerves in their who-who :uhoh21: Most OBs don't use them effectively either. Lido takes a few minutes to set up, but they usually don't do the block until they're ready to deliver.

Hope this info helps

Up Vote Up Vote ×
Specializes in Utilization Management.

Thanks! that's great! Any info is helpful at this point. I work with a lot of young people who seem to know a lot more than I do about the new ways of doing things.

(Bless their hearts, at least I don't have to worry about actually going through it anymore.)

Up Vote Up Vote ×
Specializes in NICU.
The OBs can do a pudendal block, but not many moms are excited about having lidocaine injected into the nerves in their who-who :uhoh21: Most OBs don't use them effectively either. Lido takes a few minutes to set up, but they usually don't do the block until they're ready to deliver.

Let me tell you, I'd have been excited about that!!! I had one of those epidurals that people probably refer to as "walking epidurals" - my torso was numb so I didn't feel contractions, but I could feel and move my legs without any problems. At first, I was very happy about this - one of the reasons I was afraid to get one in the first place was that I didn't want to be totally numb and paralyzed. I never told my doc or anesthesia this, so it's not like I influenced what type of epidural they gave me or what meds they put through it. So yeah, I was really thrilled and had a great time between the time the thing was placed (after my water broke when the contractions really hit hard and frequent, about 4cm) until I got to about 9 cm - then the pain started. My torso was still numb so the contractions were nothing. But the PRESSURE was horrible! By the time I was complete and able to start pushing, the pain was about a 9 on the 0-10 scale and it was all pressure in that area. Had they done some sort of a local block it might have helped me. I ended up with a c-section because the baby's head got stuck in my pelvis at a funny angle.

Honestly? I think the baby was going through those "cardinal movements" where it turns as the head descends into the pelvis, and I pushed too early because of all the pressure I felt and she got stuck.

Now, I get kind of upset when I talk to friends and they tell me that their epidurals worked so well that they felt NOTHING AT ALL even when complete and pushing. They felt NO PRESSURE. All I felt was pressure!!! I still don't really understand - did I get a different sort of epidural or did my body just react differently? It seems so unfair to me that they all laid there, playing cards, laughing, being told when to push, and watching in wonder as their babies painlessly slid from their bodies...meanwhile I was in complete agony! I even asked anesthesia to totally numb me and they said that even epidurals can't get rid of that feeling of pressure. I'm so confused! Thank goodness I had the sense to take childbirth classes with my husband. Had it not been for my focused Lamaze breathing, I'd have been screaming my head off for hours! (It wasn't until the pushing part - over an hour of it with no progress - that I just totally broke down and freaked out, but after being in labor for 24 hours already at that point, who could blame me???)

ANGIE - I know, not very helpful of me. But it's late, I've got a colicky baby, and I had to vent!!!

Up Vote Up Vote ×

Gompers, that was awesome. I think you hit the nail on the head w/that one. 24 hours! Geez.

Up Vote Up Vote ×
Specializes in NA, Stepdown, L&D, Trauma ICU, ER.

Now, I get kind of upset when I talk to friends and they tell me that their epidurals worked so well that they felt NOTHING AT ALL even when complete and pushing. They felt NO PRESSURE. All I felt was pressure!!! I still don't really understand - did I get a different sort of epidural or did my body just react differently? It seems so unfair to me that they all laid there, playing cards, laughing, being told when to push, and watching in wonder as their babies painlessly slid from their bodies...meanwhile I was in complete agony! I even asked anesthesia to totally numb me and they said that even epidurals can't get rid of that feeling of pressure. I'm so confused! Thank goodness I had the sense to take childbirth classes with my husband. Had it not been for my focused Lamaze breathing, I'd have been screaming my head off for hours! (It wasn't until the pushing part - over an hour of it with no progress - that I just totally broke down and freaked out, but after being in labor for 24 hours already at that point, who could blame me???)

Your friends are the exception to the rule, at least they would be at my hospital. Once in a blue moon the epidurals will eliminate the pressure feeling, but it's not the norm. Sometimes anesthesia can give another 'loading dose' that's heavy on the lidocaine if mom is really hurting. Sometimes it will take the edge of the pressure, but it doesn't usually do much more than make us feel like we're at least trying to help. Although we don't want the pressure to make you miserable, we do want you to feel some of it. The pressure helps direct the pushing, so moms can feel when and where to focus their energy.

Sounds like you had more narcotic than local in yours. I know each CRNA at our facility has their own 'formula' they use for the loading dose and the redoses depending on their preferences and how mom's progressing. Heavier local causes more numbness (and inability to move/push) while more narcotic with less local will help the pain without causing as much numbness.

Sorry yours wasn't as effective as your friends ((hugs))

Up Vote Up Vote ×
Specializes in LDRP.

From what I hear, birth can pretty much be pain-free with an epidural. Is that true?

well, no not really. it can be mostly pain free, but not completely. some people would like to think that they will be able to feel absolutely nothing

The epidural isn't given until Mom is how many cm?

dependson the doc, but around here, most will let you have it any time at all.

I've heard that the epidural is turned off at a certain point. When do they turn it off? Why? Does it affect contractions or the baby or both?

we turn them off at delivery and not before.

What if delivery takes awhile--like hours? Does Mom have to push for hours without any pain control?

see above answer

Are there any other options available for pain control besides an epidural or does Mom just have to go through it?

iv pain medicine (stadol/phenergan), pudendal block.

Up Vote Up Vote ×
Specializes in Utilization Management.
...

Now, I get kind of upset when I talk to friends and they tell me that their epidurals worked so well that they felt NOTHING AT ALL even when complete and pushing. They felt NO PRESSURE. All I felt was pressure!!! I still don't really understand - did I get a different sort of epidural or did my body just react differently? It seems so unfair to me that they all laid there, playing cards, laughing, being told when to push, and watching in wonder as their babies painlessly slid from their bodies...meanwhile I was in complete agony! I even asked anesthesia to totally numb me and they said that even epidurals can't get rid of that feeling of pressure. I'm so confused! Thank goodness I had the sense to take childbirth classes with my husband. Had it not been for my focused Lamaze breathing, I'd have been screaming my head off for hours! (It wasn't until the pushing part - over an hour of it with no progress - that I just totally broke down and freaked out, but after being in labor for 24 hours already at that point, who could blame me???)

ANGIE - I know, not very helpful of me. But it's late, I've got a colicky baby, and I had to vent!!!

Oh no, honey, you just go right ahead and vent!! I heard a similar story and that's why I asked. So many were saying "epidural = no pain" and then I heard a few others where the epidural did nothing and these poor girls had to just get through it without anything.

I didn't have any drugs for mine, but I had a very easy birth--nothing like what I've heard described. I think if I had to go through half of what you described, Gompers, I would've been begging for a C-section, for sure.

Hoping Baby's feeling better and that you can get some rest!! :icon_hug: :icon_hug:

Up Vote Up Vote ×
Specializes in Perinatal, Education.

You know, Gompers, your pressure probably had to do with how the baby was positioned in there--obviously not in a way it was going to come out lady partslly! I always warn my patient that their pain releif from their epidural can be effected by the position of the baby and how fast/when the baby starts their descent. Please don't tell yourself that you did anything to cause the c/s. Sounds like you have a healthy (and loud!) baby and that is terrific. Vent away!

Up Vote Up Vote ×

I'll only give you my personal experince as I can't say what others feel or do.

Baby #1 - Cervix softening gel, sent home, 12 hours later my water broke. 20 hours of labor, dilated to 9 and I finally consented to an epidural. It stopped everything. :o Pit started, waited for 3 hours to get to 10 (yep, from 9). Pushed for 1/2 hour and then when they asked what I was doing while pushing (I said I'm pushing - they said NOPE) they turned off the epidural. 2 1/2 more hours of pushing and baby was born.

Baby #2 - Pit induced labor of approximately 3 days. Can you believe after all that time when I finally needed the epi I had waited too long? Yep, delivered baby to doctor with no gloves, no gown, no nothing. :lol2: Well THEY were the ones who told me I could try squatting. How did I know how effective it was going to be?

Baby #3 - Induced labor 4 days early (actually in labor when I got there) for PUPPS. Boy THAT was worse than any darn delivery I've had. Anyway... about 4 hours after my water broke I was 4 (for about 3 hours). My doc finally talked me into an epi, relaxed, baby turned, delivered in about 5 minutes. They turned the epi off at my request (I know.... I must be some sort of saddist) as I was afraid I wouldn't be able to push.

In all of the deliveries I actually felt that the pain was much easier to handle once I felt the pressure and was able to push. The pudendal block sounds like heaven as that last little part was the worst for me. The burning had me trying to hold back just a bit. I also had very large headed children though so 3rd degree epsiotomies every time with an additional tear into the rectum the last time. :uhoh21: Even after all that I was talking about the next one while the doctor was stiching me up.

Having babies is one of the most beautiful things on earth. ;)

Up Vote Up Vote ×
Specializes in Peds.

I had 2 c-sections and always felt cheated. Call me crazy. First time my twins were footling breech and transverse (hence the c) and I had an epi. They were taken a couple weeks early d/t what they called toxemia back in the 80's. My other one was done because of the way the first one was done (vertical uterine incision) and d/t my cardiac status. Was given a spinal because I'd gone into labor a month early and though they'd tried to stop it all day, it didn't work. Unfortunately, my spinal stopped working mid-surgery and they had to put me out completely. Fortunately, this happened post-delivery so she wasn't affected by the gas.

Insofar as epi's, I have a friend who is a crna. Seems to me like he recently told me that they're (at least where he works) doing the epi's on PCA pumps?

Up Vote Up Vote ×
Specializes in LDRP.

Insofar as epi's, I have a friend who is a crna. Seems to me like he recently told me that they're (at least where he works) doing the epi's on PCA pumps?

we have them on CADD pumps (see attached picture-we use the one in the middle) and the epidural cassette looks like that thing onthe bottom of the grey pump but its bigger and very well labeled as to which epidural med it is. you use a key to get it on and off. the anesthesiologist (we dont use crna's) sets the rate (concentration is premixed), the amount of the demand dose,the number of allowed demand doses per hour and the time between demand doses.

then the happy little epidural is on its way, and if they have breakthru pain, we push the dose button, not hte patient. we dont change any settings, just dose button, stop button, and change cassette when necessary.

so its kinda like a pca in the sense that there are demand doses available.

wow, that was probably way more answer than you wree looking for

Up Vote Up Vote ×
+ Add a Comment