Moms who want to feel absolutely NO pain - page 3

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... Read More

  1. by   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!
  2. by   dawngloves
    Quote from oneillk1
    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.
  3. by   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!
  4. by   OB_or_NICU_hopeful
    Quote from 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.......
    Someone actually said this??
  5. by   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.
  6. by   kalayaan
    Quote from OB_or_NICU_hopeful
    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.
  7. by   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?
  8. by   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.
  9. by   RNsoon!
    Interesting
  10. by   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.
    Last edit by SmilingBluEyes on Oct 21, '06
  11. by   NurseNora
    When I have a patient requesting an epidural before labor starts, I tell them that there is a certain amount of discomfort associated with the epidural itself. The tingling numbness is very annoying to some women; there is some pressure felt even with well working epidurals, enough pressure to be painful; being unable to move her legs freely is often disturbing. I have found that women find the epidural discomforts much less irritating if they have had some discomfort from the labor first.

    Pitocin given for induction of labor usually does not cause immediate painful contractions. It's not like flipping the "On" switch. The woman can sit in a rocking chair, on the birthing ball, or stand and pace at the bedside while the induction is started. By not keeping her in bed, focused on feeling the tiniest bit of uterine activity, I can usually get a woman up to 4 cm before she feels uncomfortable enough to want the epidural she came in wanting immediatly.
  12. by   SmilingBluEyes
    My mind keeps going back to the need for nurses (and doctors too!) to be supportive and educational in the labor process. I find the increasing need for anesthesia directly correlates with mainly what boils down to things:

    *nurses/staff are just too busy (some have two or more laboring patients at the same time). This is very inconducive to being truly supportive and helping a woman cope with the labor process and the pain. How can we be, when splitting our time and dedication among more than one actively-laboring family? Did this increased ratio come about due to the rise in epidural-ized women? Or did the need for epidurals really rise as nurses became increasingly taxed out and unable to be truly present in the labor process for these women?

    *poor education on the parts of the patients and their support people as well as NURSING STAFF themselves-----so few patients and health care consumers take the time to really LEARN about the labor process and the changes and discomforts that go with it. I always like to say forewarned, forearmed. I think the more a woman and her support people know about the process going in, the more likely they will be able to cope with the discomfort that goes with it. This also goes for staff/doctors. So many just don't know how to care for a naturally-laboring woman at all. So many these days even FEAR this process! Others dont' want to deal because they are just too plain busy. (see number one)

    Seems to me, the rising rate of epidural use has seen a concomittant rise in the numbers of health care providers who are ill-equipped to truly assist, effectively care for and advocate for naturally-laboring women. Well, from where I sit, it's like a chicken or egg thing---which really came first? All I know, is it's really sad.

    Here is a simple equation that goes through my head all the time when discussing the subject of natural labor versus anesthesized labor, IOW the bottom line:

    Lack of education + high maternal anxiety = increased fear and intolerance of any discomfort whatsoever, and in severe cases, fetal and/or maternal compromise. Both medical/nursing staff and patients have it in their hands not to let this happen.
    Last edit by SmilingBluEyes on Oct 22, '06
  13. by   cherrymary
    Quote from 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.
    Right, and not only that they have the potential for slowing labor down (partly due to being strapped to one place, working against gravity), there's the fact that after getting an epidural women are NPO. At least at my hospital (I'm a doula) they are allowed to eat and drink lightly before they have one. So if you get an epidural before your labor is well-established (3-4 cm) you're setting yourself up for a long fast... First time labors can be 24+ hours, and inductions are generally days, not hours. That's a long time to go without food. Imagine telling a marathon runner they could only have ice chips for two or three days before the race!! It's not a surprise that this often leads to cesarean due to maternal exhaustion.

    I'm not against the use of epidurals, although as a doula I offer my clients alternative ways of dealing with pain (walking, changing position frequently, using the birth ball, massage, warm compresses, hot showers, breathing, visualization, aromatherapy, unconditional love and encouragement), but I do think they should be used judiciously, since we know that they can cause contractions to slow or even stop, which is dangerous for mom and baby. For this reason I also think that women should not be regularly induced before 42 weeks without indication of fetal distress (non-stress testing etc.) or other high-risk factors, which they currently are.

    Just my $0.02!!!

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