Epi Question - Stops working at 9 cm?

Specialties Ob/Gyn

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My cousin just recently (1 1/2 months ago) had her first baby, and I'm 13 wks preg. w/ my first. She said something to me that I had not heard before, so I thought I would ask the experts.

She had an epi given at 4cm with wonderful, virtually pain-free results. She went to 10 rapidly, pushed for 2 1/2 hours and had a vag. delivery w/ no complications. She said that around 9 cm, the epi "stopped working" and one of her nurses told her that was norm.

My cousin went on to elaborate that it wasn't because they dialed down the meds, it was because it's just a fact that epi's stop being effective at 9cm.

Now, I'm just a nursing student, and I have zero experience in OB, but that's the first time I've ever heard that. I've heard of the epi's being turned off or dialed down so that the pt. could feel contractions and be more effective at pushing, but never that they just "stop working" at 9cm.

Is she experiencing birth amnesia? Making random stuff up to make herself feel better? Or is this a normal occurance. Just curious!

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Never heard that one before.

Maybe she meant that they reduced the dose, in order for her to feel the contractions.

Trust me, with my first birth my epidural was still working after the delivery and through the stitches....

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sometimes as labour progresses at 9 to fully as head desends you can get a pressure type pain which is difficult to get rid of even with an epidural may be this is what she was thinking of

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I am a nursing student and doula, my best guess would be that she was just feeling the pressure that comes with baby's descent. The urge to push can be very strong/uncomfortable. I can't think of a physiological response to the cervix being 9 cm that would cause the epidural to stop working.

Although you said it wasn't the case here, turning down the epidural can be tough on the mom, but it's really in her best interest to help her push effectively to avoid a c-section or instrumental delivery.

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Although you said it wasn't the case here, turning down the epidural can be tough on the mom, but it's really in her best interest to help her push effectively to avoid a c-section or instrumental delivery.

Well...my cousin said that wasn't the case. I'm not totally convinced of that. I'm wondering if she has pregnancy amnesia and "imagined" that part. (or maybe the nurse "lied" to keep her in good graced :lol2: J/K )

The comments about the head decending and the pressure sound like what she probably experienced. Good to know!

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When epidurals are placed, there is often a bolus of medication given when the epidural is placed. This provides very quick relief and often an initially dense block. After a an hour or so, the bolus wears off and the maintenance/pump dose is what the patient is then getting. At this point they will often feel the pressure of contractions, but not the intense pain that they often feel at that point in labor when not medicated.

Occasionally, patients move so quickly through labor that they may feel like their epidural is no longer working. We will even tell patients that if they feel like their epidural is not working any more, they need to ring out large and loud as it may indicate they are close to complete. I have also heard it explained that as the baby moves farther down in the pelvis, the epidural does not cover those nerves. Not sure exactly what that means or how that works.

We also do turn epidural pumps off during pushing to help women feel to push. The epidural usually takes about an hour to completely wear off, so they will gradually get the feeling needed to push without the pain. They usually deliver before the epidural has completely worn off.

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I've had two epis and they both worked *very well* all the way through. Probably too well. ;) Although I was able to push well, I was unable to use my legs for a couple of hours after each birth. I had to be cathed and pee in a bed pan both times. Oh well, I had really great births. I was able to feel pressure with the second birth, but never had any pain at all.

Just don't lie down flat on your side because there's a small chance the meds will go up instead of down. I had a bit of trouble breathing because of that, but as soon as I sat upright I was okay again within minutes.

I have heard that in some hospitals it is practice to turn off the epi close to pushing stage so the mother will push better. Just insist they don't do that if you don't want that to happen. Sorry to be too graphic, but a friend told me just to push like I was having a big BM, and it worked. lol! They both came out in about 4 pushes.

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I know this is a year and such later, but this happened to me...At 9 cm, I felt all the pain of the contractions and all the pressure...I was banging my head against the side of the hospital bed and trying to curl up into a ball...I could walk right after I got done being stitched up and they were pinching my legs and asking me if I could feel it after I swore the epidural wore off...

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Epidurals at analgesic doses (as opposed to anesthetic doses) typically don't work as well against the intense pressure sensation that occurs when the fetal head is on the pelvic floor (not the perineum). That could happen at 9 cm or earlier or later. It has nothing to do with dilation. Sometimes the dose is dialed back so that the mother can feel an intense urge to push, sometimes it's not necessary to do that.

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I had epi with my 2nd baby and it was great, however it traveled upward in the canal and I got a little too numb in the respiratory area. This was short lived and I felt great.

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Specializes in L&D, Antepartum, Postpartum, MB, Special.

I haven't found this to be true...some people do feel the pressure but that is a good thing. It makes pushing better. In my personal experience I did not feel anything with my epidural and only pushed 3 times with my first vag delivery (9lbs 7oz and intact perineum) and not at all with the 2nd vag delivery (8lbs 8oz and intact perineum).

ps my first two children were c/s and the second 2 were vbacs

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Specializes in L&D.

LOL it makes me wonder how I labored with No medication and delivered my big (over 10lb) infants!!

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