I will try to keep this as brief as possible... I'm a nursing student who recently gave birth. I've have two other children so I'm no rookie, but there were several things about this birth that concerned me, so I got my medical records and fhr strip, and now I have some serious questions/concerns that keep eating at me. I would SO appreciate some experience/feedback, I want to know if there's any cause for concern and if my care was appropriate while I was in labor.
I have two concerns... biggest one is hypotension. After epidural placement, had some hypotension that passed after 20 minutes, not too worried about that episode. A few hours later, I requested a top-up. Right before the CRNA arrived, nurse put me on my back to check cervix, BP dropped to 104/37, then 106/42, now CRNA comes in and gives me more meds, BPs continue to be low, 98/55, 106/37. This went on for a total of 30 mins from start to nurse coming in and hanging new IV bag. Pressures immediately went up to 120/45, 112/44, then right back down to 108/45, 94/55, then not read again until 20 minutes later at 105/38. Twenty minutes after that last reading, the nurse came in and gave me an IV bolus, BP isn't read again until an hour later, 112/72. I was never given ephedrine and response time was 30-40 minutes with these ongoing pressures. I'm wondering if I should be concerned about my baby having some hypoxia due to these blood pressures. My normal pressure was 120/70. During this time period, my IUPC came out, so contractions weren't picking up, but my baby began to have some shallow decels, cant tell if early or late due to no contractions to compare. Variability decreases but stays 6bpm (moderate), and accelerations decrease and are almost absent for about an hour. Then, she comes on and off the monitor, the tracings I can see in between have moderate and some minimal variability, but this is after BP is resolved. It continues for quite a while. One more episode after this, nurse puts me on my back for 4 mins straight to check cervix, bp plummets to 120/37, and stays low for 20 mins or so.
After this 2-hour-long episode, someone else came in the room and suggested checking me for ketones. They didn't tell me why. I was fasting according to hospital rules, and they knew I'd been there for 13 hours at this point. Why did they check me for ketones? Do all laboring women who are NPO develop ketones, and what is the protocol for checking for them and administering dextrose? Mine came back large and they gave me dextrose.
So... was care appropriate? Should I be scared? Why weren't they worried? And is it ok to put patients in supine position after epidural? I thought that was a big no-no, how dangerous is this?
I would appreciate some feedback so much. I just want to know what happened, know if I should be worried.
Thank you so much everyone for the info and advice. It has helped tremendously. I am still having a hard time with worries and what-ifs, and am extremely disappointed with the care I received. Reaction time and monitoring was just not there for a few hours when it should have been. But, it helps a lot to be better-informed
Specializes in Nurse Leader specializing in Labor & Delivery.
Good luck to you as you process things. A bad birth experience can be so horrible, and a lot of people don't appreciate that it can affect you for YEARS. My last birth was, in my opinion, mismanaged (my provider, who was also my friend, knew of my desire to be as low-maintenance and hands-off as possible, and instead went too far in the opposite direction and didn't intervene when appropriate), and as a result, I delivered at 36 weeks and my baby spent a week on a vent in the NICU. It took over a year to fully process the birth experience and even longer to fully heal.
Consider enlisting the help of a counselor who specializes in childbirth trauma if you feel it's affecting your mood or bonding with your infant. Be well!
I can understand the feeling of wondering and questioning and mourning the loss of the birth experience you'd hoped for. I am itching to get my hands on my medical record from my own. It took me a good 18 months to be able to tell my birth story without ending up in a ball of tears. Thankfully my son is fine, but I often wonder if the crash c-section was truly necessary, and how one intervention led to another. It took attending a few births that were similar in many ways to my own to help me really process everything, but I would really like to see what my son's strips looked like, and how my vitals were.
That said, I agree that the findings you've mentioned are normal, and that if the BP was concerning, it would have shown up on the strips. It sounds like your little one tolerated it all well, thankfully. If that's the case, most HCPs will try to avoid unnecessary interventions (not all).
I also agree about the nursing student curse of knowing enough to be nervous, but not enough to know if you really need to be! It's a sucky place to be! :) One takeaway (there's always room to take something away from these experiences) is to communicate with your patients, especially when you can see they are anxious. Honest communication and reassurance when it's warranted can go a long way.
Specializes in Nurse Leader specializing in Labor & Delivery.
The fact that this is so normal for American women makes me
Epidurals come with risks, including hypotension and decreased placental perfusion. The hypotension was probably caused by the epidural. Yeah, epidurals come with risks, which is one of the reasons why I did not have medication with any of my births, but I think it's a valid choice for a woman to want an epidural. I don't think a woman should be made to feel guilty about that, particularly since there was no adverse outcome.
I meant having negative, meddlesome birth experiences and having to process them later. Your reaction to my non-mention of epidurals is interesting.
Epidurals can have their place, judiciously used, but they are massively overused in this country. Like EFM, pitocin, surgical and instrumental interventions, IV hydration.......
Specializes in Nurse Leader specializing in Labor & Delivery.
I guess I'm having a hard time understanding what you mean by "overused" in the context of an analgesic. It's not like it's something that providers are foisting upon women. A woman chooses an epidural. I don't see how anyone can make a judgment call on whether it's overused if it's something a woman feels like she needs or even wants.
Ha ha, I remember very clearly during my first birth, every time the nurse entered my room asking, "Do you want your epidural yet?" Plus, how many women are provided honestly all the risks of epidural before they consent? I know the anesthesiologist lied straight to my face when I asked him a question, but not until later after I became more educated.
There is plenty of research showing that person to person support reduces the need for pharmaceutical pain relief during birth. Reducing epidural use reduces the number of mothers and babies facing their risks. I think the American birth system sucks because we'd rather put women in non-physiological positions on beds and hook them up to machines, both to monitor them and provide pain relief, than introduce a modicum of humanity back into it and help women birth in the healthiest way (physically and spiritually/emotionally) with the fewest possible risks.
That's what upsets me more than anything about the epidural - I asked about risks at every one of my births, I had no idea until now that low bp/poor perfusion was a risk, never heard of it or experienced it until now.
I would really appreciate some input about the ketones... I understand with NPO policy that some ketones would be expected, but I had large ketones (>80 mg/dl)... does that mean I was in a state of acidosis? Do ketones get that high in non-diabetic fasting states? I have tried to read everything I can about ketones. Seems that they're very harmful at levels seen in ketoacidosis, but can someone go into ketoacidosis without being diabetic? What are the risks? When are providers supposed to check for ketones in a laboring woman?
Specializes in Nurse Leader specializing in Labor & Delivery.
No idea about ketones - you should not have been NPO. At very least with an epidural, you should have been able to take in liquids, including juice, popsicles, broth, etc. Ketosis and ketoacidosis are not the same.
I guess I'm having a hard time understanding what you mean by "overused" in the context of an analgesic. It's not like it's something that providers are foisting upon women. A woman chooses an epidural. I don't see how anyone can make a judgment call on whether it's overused if it's something a woman feels like she needs or even wants.
Sorry, I totally remember the anesthesiologist coming into my room every other hour asking if I was ready for my epidural and clearly remember him being annoyed at the fact that I didn't. Then I also remember the "it took you long enough" attitude I got when I finally conceded.
If it were standard in America to provide alternative means if pain relief, (massage, TENS unit, gas & air , etc) and providers and nurses not mention epidurals, you'd probably see the use of epidurals take a dive)
Red Kryptonite, you should move by me and help me open a birth center! I feel like I could write all your posts.
And to the OP I think you need to process your birth. It wasn't until I attended doula training when my daughter was 2 that I did some major healing. And then the healing was completed with a successful HBAC with a supportive CNM, where all the decisions were mine to make and I only ever received evidence based care.
Specializes in Nurse Leader specializing in Labor & Delivery.
Wow, our CRNAa have way too much work to do to have time actively trying to drum up business! Maybe I'm lucky to have only worked in facilities where natural childbirth was encouraged and supported.
RachelScurlock
9 Posts
Thank you so much everyone for the info and advice. It has helped tremendously. I am still having a hard time with worries and what-ifs, and am extremely disappointed with the care I received. Reaction time and monitoring was just not there for a few hours when it should have been. But, it helps a lot to be better-informed