Epidurals

SmilingBluEyes · Apr 20, 2005

Our doctors generally OK epidurals once mom is in active labor (regular, firm contractions that are changing the cervix) and she requests it. The emphasis is not on "how dilated" they are, but that they be actively laboring with cervical change. That is the criteria they use where I work.

housecat1216 · Apr 20, 2005

Hello
When do your doc's ok epidurals?
we have always made a big deal about waiting until the pt was in active labor and 4cm, however a 2docs so far have suggested the new thought is that is doesn't matter if the pt is 4cm or even contracting- just start the epidural then the Induction.
Any thoughts ?

There is a good thread on this topic in the Nurse Anesthetist section. It is entitled UCSF OB Anesthesia Meeting on pg 4 of the thread. I'll try to make a link, but I'm pretty new at this:

https://allnurses.com/forums/showthread.php?t=99466

USA987, MSN, RN, NP · Apr 20, 2005

Ours is on a doc by doc basis, but most of them are similar to Deb's. I have had several induction for true postdates (10+ days) where they know coming in that they are not leaving without a baby whether it comes via NSVD or c/section...and those docs will sometimes have us do the epidural prior to AROM or Pitocin.

SmilingBluEyes · Apr 20, 2005

Just a quick one: we had a patient w/a history of extreme prior sexual abuse who had an epidural before anyone checked or AROM'd her. It made all the difference, as she could not handle clinical people touching her there and feeling it. So they can be useful at any point, I suppose. It was early, but in her case, very warranted. It enabled her to procede through labor comfortably.

NurseforPreggers · Apr 21, 2005

Most of the doctors where I work require the woman to be 3-4 cms, however one doctor I know states that the only requirement to receive an epidural is pain.

JaneyW · Apr 21, 2005

Most of the doctors where I work require the woman to be 3-4 cms, however one doctor I know states that the only requirement to receive an epidural is pain.

Thankfully, I had a doc like that. I was only 2cm and intact when I got to the hospital at 6am to have my second. I was contracting but not hurting too much yet. We had to kind of strong arm the nurse into getting the epidural---I kind of understand now that I am a nurse--change of shift and only two and such. I gave birth at 10am. He was my only one that was a truly pain free labor but has made up for it by being my most painful child!!

babynurse61 · May 7, 2005

we have occasionally placed an epidural early due to borderline platlets in preeclamptics, to avoid waiting for labor to start and the possibility of the platlets going lower and not getting an epidural. This has worked well for us. The patients were very happy to have the epidural placed and then activated at the appropriate time.

Minou · May 9, 2005

At my hospital, we basically have epidural orders for active labor/4cm/when appropriate...so that leaves us room. of course some docs are pickier but since they're not there...we do them when we decide...some rns stick to the 4 cm...me personally, if they want it, they get it...and then I just crank my pit. I mean what's the point...you have this young primip at 2cm crawling out of her skin, pain meds don't do diddly, so you tell her : " but honey, you're only 2cm ? " Come on...It makes everything so much nicer for everyone ( pt, family and yes rn and staff ). What about giving that baby repeated doses of narcotics ? I also find that they do very well on epidurals, they don't stop progressing, and first thing you know you have a crown and the pt goes :" Really?....oh...good !" I've also often heard, especially about the very young pts : " but if she doesn't suffer, she'll be back here next year !" Possible but is that for us to judge ? So girls, make your days/nights easier, give your pts epidurals when they want them !

Well, that's my 2 cents

Minou

pebbles1977 · May 12, 2005

Wow, that's a great post to the CRNA site/article. I've always suspected that the epidurals did not slow down the labor. At least not always. I mean really, how could you know? How many times have you had a primip deliver in a few hours when she came in 4cm? Not often, but it happens. Just saying, everyone is different.

Now I haven't been in L&D long enough to make definite judgements, but I can say for my patients that I am glad that the majority of MDs/CNMs at my facility will write for an epidural when pain gets bad. I've never been through labor, but can appreciate the pain relief the pts feel from epidurals.

Not really a great point here, but just wanted to contribute!