Moms who want to feel absolutely NO pain

[HappyNurse2005]

This is another thing I didn't realize was as common as it is-people who want to feel zip in the way of pain. granted, most women who want epidurals do say that they want to wait until the pain is unbearable, or at least hurts somewhat.

I've had a few now that wanted the epidural BEFORE they had any pain, so they wouldn't have any pain at all. Had a pit induction today. her family was encouraging her to get the epidural before we started the pit. she wanted it asap. So technically, she wasn't even really laboring.

here the doc has to give the okay for the epidural. (female)resident says she's not in any pain, i think she should wait. i was trying to get an answer from her as to when she could get it. (ps-pt is 41 weeks, g1, 2cm). she then told me to ask the other resident b/c she didnt know.

so i asked the (male) resident and the (male) attending. they said go for it, but be more aggressive with her pit. actually, the male attending said "if i was going to get pit, i'd want an epidural. if i was in labor, i'd want one asap".

so, are women allowed to get their epidurals as soon as they want them, even if not in pain? or do htey have a centimeter amount they have to get to first?

(my personal opinion is that they should be able to have it whenever they want it, if there is no medical reason to wait. of course, i also make sure they know that though it won't hurt, you can't eliminate the pressure. )

[CNM/NDstudent]

I had drug free with pit experiences with 3 of my 4 and the fourth one came so fast I didn't have time to blink let alone get pit or drugs.

But here is my two cents: I think that women should be able to make informed decisions because a lot of them don't realize some of the side effects and complications that come with an epidural. My best friend didn't know a lot with her first and after we talked she agreed to let me help her labor naturally and she made it 8 1/2 cm but her bp sky rocketed and she had to get an epidural to lower her bp and she was actually upset that she had to get one. I think that if women have the right support they can get further along before they need an epidural. Even though I personally chose not to have any drugs with my children, I don't expect my patients to do the same. However, I try to give them sufficient information on all the choices they have to make during childbirth and many have told me they never knew a lot of the information and they are glad they can now make an informed choice on their own and that is more empowering than anything else.

Good luck to all you soon to be mommies and be glad you are informed and can make the choice that is best for you and your needs.

[oneillk1]

OP, I am with you. Pitocin is like being beaten with a bat. If I were to wait until I was 3cm to get my epidural, I would have been in agony for 12 hours.

Why should a pt have to feel pain, not matter what the cause?

There's pain and there's pain... I have seen people who have screamed blue murder when the IV goes in, and then there's others who walk into the OR for a caesar, have been labouring for quite a few hours with no pain relief on board and they still smile and say hello to you. Some people are just scared of any kind of discomfort.

I think some people are just far too precious and doctors pander to it a bit... well from my experience some doctors do.

I have also seen more caesarean sections than I can remember that is for a failure to progress... mum has early epidural... ends up with a caesar. Probably at least 70% of the failure to progresses that I have seen (hey this isn't official stats or anything) already have the epidural. Just an observation.

Also, I really lose a lot of respect for doctors (surgeons and anaesthetists) who will do a caesar for purely social reasons, especially those who do them under GA. (I am not talking about where it is medically indicated - just mother's preference)

[inanna]

our order states they should be at least 4 cm and in a good labor pattern. alot is left up to our discretion, though, if pt is progressing fast, a multip, has a iufd, then they will probably get their epidural sooner. also, if they have ROM, then, we usually let them get their epidural, if they want it. 10 yrs ago, when i had my daughter, our hospital only did intrathecals, i remember i was 2 cm and dying!!! i was told i wasn't dilated enough, and by the time i was, the doctor told me that i was progressing too fast, and i probably wouldn't have time for anesthesia to get there to do it (anesthesia is not necessarily in the hospital, they take call), or i could have a shot of iv med, which i could have right then. so of course i took the iv med, which btw, didn't help at all! so, if there is ever a next time, i will have my epidural when i walk thru the door, i don't care how far dilated i am!

[dawngloves, BSN, RN]

There's pain and there's pain... I have seen people who have screamed blue murder when the IV goes in, and then there's others who walk into the OR for a caesar, have been labouring for quite a few hours with no pain relief on board and they still smile and say hello to you. Some people are just scared of any kind of discomfort.

I think some people are just far too precious and doctors pander to it a bit... well from my experience some doctors do.

I have also seen more caesarean sections than I can remember that is for a failure to progress... mum has early epidural... ends up with a caesar. Probably at least 70% of the failure to progresses that I have seen (hey this isn't official stats or anything) already have the epidural. Just an observation.

Also, I really lose a lot of respect for doctors (surgeons and anaesthetists) who will do a caesar for purely social reasons, especially those who do them under GA. (I am not talking about where it is medically indicated - just mother's preference)

Yes, everyone expereinces pain differently.That's why we asses it and not guess it. I do not scream if my pain is a 10, others do.If someone is in pain, you intervene.

[kalayaan]

i was in the assessment room, arrived at hospital in 7cm pain. i wasnt screaming, just quietly clucthing my belly in pain. beside me was a 2cm mama screaming for an epidural. the good nurse told her no, that she could even go home, and that she should behave like the 7cm lady beside her. whew.

as soon as they asked me if i wanted one, i said, yes! a few hours later i saw that i could wiggle my toes. afraid of any more pain i asked for another shot. haha.

btw, my male anesthesiologist was pretty rude when i was given my first shot. he kept telling me i should stop grunting and keep still. @#? like i wish he got pregnant and have a baby through his ....

to this day i am so thankful for the nurse that was with me during that episode. she was truly so comforting. yay to ob nurses!

[OB_or_NICU_hopeful]

i was in the assessment room, arrived at hospital in 7cm pain. i wasnt screaming, just quietly clucthing my belly in pain. beside me was a 2cm mama screaming for an epidural. the good nurse told her no, that she could even go home, and that she should behave like the 7cm lady beside her. whew.......

Someone actually said this??

[MD1211]

I'm thinking the nurse who said to behave like the 7 cm woman is NOT a good nurse. Everyone experiences pain differently. She would have been better by shutting her mouth and giving the 2 cm woman some meds.

[kalayaan]

Someone actually said this??

oh yes. but sorry for the confusion, i had 2 nurses in my story.

the nurse that told the 2cm mommy to stop complaining was good to me but pretty stern with the one beside me. and they werent communicating well bec the pt didnt know how to speak/understand english. the other nurse was the oh-hail-the-great-one that soothed me through my epidural. this happened 5 years ago.

[nursing06]

Everyone has a different pain tolerance level (even without adding pit to the equation). As long as there are no other health concerns and you have the fluid bolus on board to prevent the drop in blood pressure with the eipdural....I don't understand why it should matter when the pt gets it. Does pain somehow bring about a healthier situation for the mother and baby?

[May_baby]

The timing of epidurals is an interesting question.

There is some discussion about the potential for increased length of labor with early epidurals.

A long labor may = vacuum, forceps, or c-section for "failure to progress"

Vacuum/Forceps = Higher incidence of maternal and infant birth injury and morbidity.

C-section = Higher risk of maternal and infant injury and morbidity.

[RNsoon!]

Interesting

[SmilingBluEyes]

I don't know if it's the epidural timing in and of itself that raises the risk of these problems so much as the resulting need for the woman to stay in bed, thus not moving about much, that does. Natural labor lends itself well to correcting some malpresentations like OP, for example, in that a woman can walk, rock, and squat to correct the problem.

Also, pushing is much more effective when a woman can FEEL WHERE to push and when--and can do it in a position that is not on her back with feet stuck in stirrups. The epidural itself is not as much the problem and the immobility it creates may be , IMO.

Sometimes, experienced practioners can overcome these problems if there is time, by moving women about in bed often, from position to position, and assisting with pushing in other positions than lithotomy. But again, that takes skill and/or experience and lots of dedicated time to do, something that many nurses may be short on.