epidurals in small hospitals

bagladyrn, RN · Nov 8, 2002

I've worked in hospitals where epidurals were not offered. The women there were not necessarily "tougher". I think the difference was that they had not been brainwashed into believing that childbirth was impossible without an epidural. Maybe it's because the t.v. out on the res. doesn't carry "A Baby Story".(Can you tell I HATE that show?) The emphasis on epidurals is a relatively recent development, and I think overused as a result.

KaroSnowQueen, RN · Nov 12, 2002

Brainwashed? OH NO! Experience taught me! Tried natural with the first one, then some inj. drugs. Forget that!!!

An epidural was my friend for all three kids!!!!!

I had two kids in a metro hospital, no problem getting epidural. The other one in a very very rural backwoods hospital, my dr. was new and arranged for an epidural, I was the first woman in the county hospital history to have an epidural. Nurses hated it. I loved it!!!!!!!!!

Guess I started a trend, they are still doing them there, and that was twenty one years ago this month!

just1rn · Nov 21, 2002

I work in a hospital that deliveries 400-500/yr. RN's assist in administration. Never bolus or dose patient crna is responsible to dose or bolus pt. We are allowed to d/c catheter after delivery. We have to confirm a blue tip with another RN Hope this helps.

imenid37 · Nov 21, 2002

we do 600/yr. epid. on demand. no anesthesia in house after hrs. we must get ok for epid. by ob over the phone, then ob and anesthesia must be present for insertion. then they can both go home if pt. plodding along. usually ob stays in house at night post-epid. insertion. we do not pull cath or dose epid. nurses may only turn it off. pharmacy or nursing supv. can dec. the dose, but ob must be present when they do this. (pharmacy goes home too after 2300). we only have ob drs. as providers no cnm's or family dr's. our epid. rate is about 50%.

HazeK · Nov 21, 2002

Originally posted by SmilingBluEyes
We are IN NO WAY COVERED to set rates, administer boluses or do ANYTHING w/epidural drips except to turn them off. We DO remove the catheters and assess dermatomes. Anesthesia remains inhouse once the epidural is in til delivery occurs.

same in my 450/month hospital.

on some hospital areas, RNs w/ special training may check epidural placement and bolus for pain relief(duramorph, fentanyl), like the chemo/cancer areas, but not where TWO lives are at stake!

Having seen epi catheters migrate, I would NEVER dose thru the catheter!

The closest I get to "adjusting" an epidural is turning it off if the motor block gets too heavy!

Hugs

Haze

mother/babyRN, RN · Jan 8, 2003

We have to have current platelet counts, and the pt has to have had at least a liter of iv fluid....Usually have to be 4 0r 5 cms though some kind docs will allow those with ruptured membranes going on pit to have theirs earlier. We have to give alka gold per anesthesia, and be present during the epidural to assist and monitor. We have no LPNs, unfortunately, in delivery. We monitor BP and o2 sat q 3 min throughout the procedure, and the anesthesiologist is responsible for turning it on, though we set up the pump...They redose, and have to stay in house as long as one is running. They also give the ephedrine if the BP plummets..Although they say it isn't so, we have noticed a lot of pts have what we nurses call, the epidural dip soon after administration. After half and hour of the epidural on board, bps can go to q 15 minutes. We do not have walking epidurals, so of course straight cath every so often prior to delivery.

mark_LD_RN · Jan 9, 2003

we definitly see the epidural dip here, we don't do the walking epidural either. I wish anesthesia stayed in house here they place it wait 15 min or so then they are gone. we give the ephedra and other drugs as need,

usually insert foley if they are going to labor awhile verse repeated in/out cath

at your cervix · Jan 9, 2003

I just started working at a small hospital! Have I mentioned that it is brand new and I love it????? (yeah, I think that I have.) Anyway, we have one CRNA that is dedicated to our unit. He is on call pretty much 24-7. We just opened 2 weeks ago and so far we have done 18 deliveries so I can't really give you an accurate number of deliveries per year, but we call him for an epidural and he comes in and places the epidural and then stays in house until she delivers. It is great because he also attends deliveries if we have a bad strip to help with NRP if needed. When he is not on call we have one of the OR CRNA's on call.

obeyacts2 · Jan 18, 2003

Hi!!! Student here, I was wondering hoe many of your pts opt for the walking epidural? Do they have an easier birth because they can walk around? Second, if a pt has seriious back problems (Herniated disks) would that be an issue in receiveing an epidural?

Lauura

janetrnc · Jan 20, 2003

You need to get a copy of the AWHONN guidelines on epidural anesthesia PRONTO!!!! Nurses should NOT be rebolusing and injecting epidurals on laboring pts, bolusing and rate increases can be done POSTPARTUM. The guidelines from the Anesthesia organization also say they should be managed by anesthesist or CRNA. We only D/C and removed the catheters. We used to increase the rates and bolus on labor patients but after getting the guidelines, we refused to do it anymore. We do 400.yr.

janetrnc · Apr 21, 2003

Check your Awhonn guidelines on epidurals! The only time a nurse should redose an epidural is postpartum, NEVER on a laboring patient. Those standards are very clear. I am in a small hospital and we had this fight with anesthesia and we refused to do it when they didn't want to acknowledge the nurses standard of care.

TammyWilson808 · Apr 21, 2003

Our Family Birthing Unit does 400-600 births/year currently and epidurals are offered and anesthesia applies and RNs assist but we do not adjust rates, give boluses, etc. We do remove catheters once finished and turn them off when ordered to. I wish anesthesia would be in house until delivery but there are here on days and o/c at night with less than 10 mins. away time.

I wish I had the choice when I had my children ( first three are in their mid 20's). Giving these women the "choice" is what's important, in my opinion!