Epidural placement as a "spectator sport"

Suebee6 · Jul 19, 2006

I think the statement that birth is not a spectator sport is true beyond words. I also strongly agree that there should be limits to the number of people present for epidural placement. I am one-hundred percent behind staff advocating for patients and limiting visitors when necessary.
However, having worked extensively as a Doula I always found the request to sit or leave during placement a little odd (These requests only popped up when I moved to the East coast). Keep in mind that I was never a private Doula, but always directly employed by the hospitals where I attended births.
I felt that it was my job to keep moms comfortable and calm during placement so that they would focus on their RN and MDA. If I could keep them calm the medical staff could do what they needed to do expediently and safely. Sometimes the RN was going to do a much better job than I could manage keeping a particular Mom calm and then I knew it was time to back off. But 99.9% I felt it was my job to provide a continous presence to Mom and support the staff as well. Maybe I am an odd bird, but other Doulas may feel the same way. So if a Doula is working as an appropriate (no personal agenda, good relationship with pt) advocate/support person your institution may discuss allowing them to stay during epidural placements. Just a gentle suggestion.

I would have no problem with that at all. Now a dad going "oooh ...wow. look at THAT needle' doesnt sit real well with me. :uhoh3: I also tell them ahead of time...and mostly they do okay and just leave. This dad just seemed to want to be a pain about it. He was leaving for Iraq in a few weeks and didnt want to miss a single minute was his reasoning..well he only missed 6 1/2 minutes total time for the placement, and I wanted to ask if he goes with her in the bathroom with her every day too cause that surely takes her longer than 6 1/2 minutes. :angryfire

Marie_LPN, RN, LPN, RN · Jul 19, 2006

Are we the only ones that do this..ask the support person to leave?

It's our policy to not have spouse or family in the room for the epidural.

Gabie Baby · Jul 19, 2006

I would have no problem with that at all. Now a dad going "oooh ...wow. look at THAT needle' doesnt sit real well with me. I also tell them ahead of time...and mostly they do okay and just leave. This dad just seemed to want to be a pain about it. He was leaving for Iraq in a few weeks and didnt want to miss a single minute was his reasoning..well he only missed 6 1/2 minutes total time for the placement, and I wanted to ask if he goes with her in the bathroom with her every day too cause that surely takes her longer than 6 1/2 minutes. :angryfire

The bathroom query, of course, would have been out of line.

Why did you let him make YOU feel like crap? You should have told him to talk to the doctor about it and let him know you understood his feelings and you're sorry but the policy is such and such because fathers have, in the past, commented on the long needle or fainted and died. Usually, if you tell the reason for policies, people are more accepting. I know I see red when someone tells me "It's our policy" but can't explain why and it is something that I don't comprehend and which strikes me as unreasonable.

fergus51 · Jul 20, 2006

I don't approve of policies like this as a rule. Epidural placement can be scary for a woman and if she is comforted by having her support person in the room, I think it's callous to insist they leave for no reason. I don't have any problem with making them sit in a place where they can't see the actual insertion.

Suebee6 · Jul 20, 2006

The bathroom query, of course, would have been out of line.
Why did you let him make YOU feel like crap? You should have told him to talk to the doctor about it and let him know you understood his feelings and you're sorry but the policy is such and such because fathers have, in the past, commented on the long needle or fainted and died. Usually, if you tell the reason for policies, people are more accepting. I know I see red when someone tells me "It's our policy" but can't explain why and it is something that I don't comprehend and which strikes me as unreasonable.

Actually, I did explain. Not the died part beacuse that didn't happen at our facility, but I did explain before he even got upset why we ask them to leave, before I simply said "it is policy" because I do agree with both of you, I dont like to hear that as a fact either with no backing. I always tell the story of the EMT we had that hit the floor, how it is different when you are watching your wife ..etc. The doc was saying "it is how I can best take care of your wife". I really think he was just looking to argue, and that kind of personality rubs me the wrong way. Plus the fact he was cussing at me ( not threatening, just cussing) His wife never said a word, never asked if he could stay, never once. Had 3 epidurals before, she wasnt scared (his first baby though).

anyway...jsut wondering if anyone else had this policy.

ANd of course i would have been out of line to say the bathroom comment :lol2: That is why i came HERE to vent and not there.

MS._Jen_RN, ASN, RN · Jul 20, 2006

As a nursing student, who had seen far worse things, I came VERY close to passing out while watching an epidural insertion. I would probably be OK now, but something about it that day. . . I would, were I an L&D RN, at the very least expect that it be policy that the support person not be able to see what was happening.

~Jen

HeartsOpenWide, RN · Jul 20, 2006

What about the dad who was holding his wife during the placement, passed out, cracked his head open and died. Wife sued the hospital. I think I heard that one on here. However, IF I have my baby in a hospital I want my husband there for everything. Why not let dad sit on the floor and watch from a distance?

fergus51 · Jul 20, 2006

I think it's an overreaction to ban all fathers from the room over one freak accident.

joyrochelle · Jul 20, 2006

actually thats what we had them do too- sit. but we cleared the room of all other people. i think it makes sense.

BabyRN2Be · Jul 20, 2006

We have the same policy at the hospital where I work as a doula. Although the staff are (for the most part) accepting of doulas, we have to leave the room, too although we are sort of working for the hospital and not the patient.

Since we've worked hard to keep our doula program strong, I don't go against this policy. Everyone must leave, spouse, boyfriend, other support people, etc. must leave the room. Only the MD/CRNA and the nurse are allowed to stay.

As stated above, we've had some dads hit the floor and then you add yet another persooon

SmilingBluEyes · Jul 20, 2006

Our MDAs allow the primary support person to stay in the room during placement. I think that is a reasonable and prudent thing to do.

And there is no being a "spectator" about it. The person stands or sits in front of the patient, who is sitting on the side of her bed. He/she can't see anything being done in the back of the patient during the procedure.

There need NOT be a room full of people during this procedure, but one person that the woman trusts, why NOT? It will likely keep her anxiety level down and foster trust on the part of the support person, as well. Seems a good deal to me.

babyktchr, BSN, RN · Jul 20, 2006

We have one doc who wont even argue. He just walks out, says "let me know when you want your wife to have the epidural"...

I actually kinda like this response. Our anesthesia department PREFERS no support people in the room but at times will allow one person to be in the room but totally in front of the patient. I find, no matter where they are positioned, even the greatest of stomachs falter and boom, the support person goes down. I gauge my 'booting' of support people based on the patient and her level of 'out of control-ness'. If I feel she needs someone other than me there, I keep one around...if not..they all go. Its just too darn much.

My question is.....what happened to the SUPPORT in SUPPORT person???? They are there to eat, and talk and irritate all those involved. They whine about the temperature of the room, they eat in front of the patient, they run in and out of the room constantly. Where is the support of the poor patient? I think it is a shame that folks can't look beyond their own agendas and really support the laboring patient. Just the other day I had a patient who had a miserable prodromal labor (all night and only 3cms) and was exhausted. We got her an epidural (unattended by the SUPPORT people). When they came back I stopped them and kindly explained that I wanted her to sleep now that she was comfortable. As soon as they went in the room, they woke her up to ask her if her pain was gone and then proceeded to tell her when she was having a contraction. ARGH!!!!!!! WHY WHY WHY. I pulled the FOB aside and advised him if he couldn't control the mothers, then I would have to ask them to leave. The moms ended up going for breakfast and left the two exhausted ones to sleep. Hoooooray!!!!