Moms who want to feel absolutely NO pain

Specialties Ob/Gyn

Published

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. )

Specializes in L&D.

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.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

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.

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!!!

I do not like to feel pain. I would want them to start the epidural ASAP. I don't think that makes me any less worthy of a person.

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.

That's for sure. It really disgusts me to see some of the pious attitudes here (and it is beyond venting). When I had my first child #1-I am a very small person, #2-I'm very sensitive to outside stimuli. I am thankful the nurses at the hospital where I had my first child did not feel the way it looks like some here do. Like, if you don't want to be in pain that makes you less of a woman, means you have some kind of defect and should be held in disdain.

I am starting to believe every patient needs a pushy family member by their side.

Specializes in postpartum, nursery, high risk L&D.
That's for sure. It really disgusts me to see some of the pious attitudes here (and it is beyond venting). When I had my first child #1-I am a very small person, #2-I'm very sensitive to outside stimuli. I am thankful the nurses at the hospital where I had my first child did not feel the way it looks like some here do. Like, if you don't want to be in pain that makes you less of a woman, means you have some kind of defect and should be held in disdain.

I am starting to believe every patient needs a pushy family member by their side.

maybe I missed it, but I did not get that from ANY of the posts here...

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
That's for sure. It really disgusts me to see some of the pious attitudes here (and it is beyond venting). When I had my first child #1-I am a very small person, #2-I'm very sensitive to outside stimuli. I am thankful the nurses at the hospital where I had my first child did not feel the way it looks like some here do. Like, if you don't want to be in pain that makes you less of a woman, means you have some kind of defect and should be held in disdain.

I am starting to believe every patient needs a pushy family member by their side.

Be fair; the majority of people here are very supportive of the choices laboring women make. I don't see a whole lot of condemnation of women who chose to have epidurals in this thread.

And you may want to keep in mind one thing: in some cases, pushy family members make situations worse, not better. As a nurse, I am sure you are aware of this.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I do not like to feel pain. I would want them to start the epidural ASAP. I don't think that makes me any less worthy of a person.

No not at all. But keep in mind, inappropriate timing of epidural CAN certainly raise the risk of a woman undergoing c-section for failure to progress, as just one reason/case.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
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!!!

I agree with you on all counts here. Epidural use in early or prodromal labor can definately raise risks and should be considered carefully. I have had a few cases whereby women had been previously sexually assaulted or otherwise scarred, and could not tolerate cervical checks, let alone lady partsl birth or pain. For these women, the doctors wrote the order "epidural upon admission" when they were admitted for induction. I can certainly understand cases like these. But in most cases, it's just a very bad idea to get an epidural too early in labor.
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.

Hospitals around here make you NPO just for showing up! Natural, Epidural, Pitocin, walking in the hall. You eat nada unti the baby is on the warmer.

Specializes in Critical Care.

I don't know what the big deal is. I had 3 boys and I didn't have an epidural or any pain management for that matter, and I don't recall hurting a bit.

~faith,

Timothy.

:chair: :chair: :sofahider :sofahider :troll:

Specializes in OB.
I don't know what the big deal is. I had 3 boys and I didn't have an epidural or any pain management for that matter, and I don't recall hurting a bit.

~faith,

Timothy.

:chair: :chair: :sofahider :sofahider :troll:

You may not have had pain then Timothy, but I bet you will if your wife reads this post.....:trout:

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