epidurals

Specialties Ob/Gyn

Published

Are you required to keep a patient in bed for a specific amount of time after delivery when a patient has an epidural? We have a new anesthesiologist who wants us to keep our patients in bed for 3 hours after delivery with an epidural. I can't even imagine. I want to do a lit search and see what I can come up with as far as standards go, but wanted to see what everyone else is doing.

Thanks!!!

Specializes in Community, OB, Nursery.
And we definitely give epidurals with the idea of 100% removal of pain. No doubt about that.

No cut-back on the rate or anything so mom can push?

I'm not working L&D right now, so I can't say for sure. But our unit is one small unit, and I sit there with the L&D nurses all night (when there is time to sit) and I take their pts 2 hours after birth, and I'm thinking there can't be that much cutting back. I mean, if I've got a mom 2 hours post partum who still can't feel her legs, I'm thinking that we are giving "good" pain relief. I know that many moms sleep through their labor after the epidural, and since I've been there we've had a couple of "ooops, that strip looks terrible;" only to have the nurse go in to check and baby is +4.

I suspect it greatly depends upon the doc and the nurse.

Specializes in Nurse Anesthetist.

After receiving an epidural for labor, it is usually enough relief for the pt to finally get some rest and therefore sleep. I am all for "laboring down" meaning once the pt is 10 cm, allow their body, contractions and gravity to push the baby naturally out. But studies have found that epidurals that are too strong/dense of a block, their can be serious blood pressure drops and therefore poor perfusion to the baby. Also, you have the problem of not being able to push. Also, the reason you had "oops, that strip looks terrible" is the baby isnt getting the perfusion/oxygenation that it needs. Once that strip looks bad, the baby has already taken a little hit.

I don't know about other hospital's epidural policy, but in my primary location we try to give the mother the most natural birth as possible. Pain relief not absence of the inconvenience of birth.

I think that you and I do not work in the same hospital, and maybe not in the same decade.

I'd come and work in your hospital (or at one of the several other of the more progressive ones I see mentioned here--encourage natural birth? Attend VBACs? No well-baby nursery?) if I didn't have such deep roots in my little town here.

I guess I'll just have to keep plugging away to change the things that need changed, and enjoy and celebrate the things that our facility does well. I certainly have learned a lot on these boards.

Specializes in Community, OB, Nursery.

I love our well-baby nursery, but I wish we didn't have one. I wish well moms kept their well babies with them. And most of them do - the other night, out of 32 babies on the floor, we only had 5 babies in the nursery. So it's not as bad as it could be.

But back to epidurals...if you've consistently got moms who can't feel their legs at all two hours PP, those are some dense epidurals, or high doses or something. It's pretty common for me to get a mom 1hour PP who's got one leg asleep or is still a little wobbly but not completely dead bilaterally. Wow.

On our unit the moms have no choice but to keep the infant with them. It is a "birthing center" and one RN is the L&D, nursery and postpartum nurse. The PT labors and stays in same room. We have more midwives the MD's and having the dad "catch" the infant is not unheard of... nor is allowing the infant to crawl to the breast! We also circulate and scrub in all our c-sections. It is a lot different than the other place I work where we have seperate nursery, L+D, postpartum, PACU and OR units and staff. I guess I have more on "my plate" at the birthing center. At both facilities the PT's get up as soon as they can bear weight.

+ Add a Comment