OB

[SNELM]

When is a client past the point of an epidural? and what should you do if your multigravida patient is +3 station 100% effaced and 9cm and is demanding pain medication.

[Elvish, BSN, DNP, RN, NP]

What have you come up with so far in thinking about it?

That will help us answer your question better. :)

Moving to Ob/Gyn nursing forum.

[CrazierThanYou]

Wouldn't it be too late then?

[ibambamama]

Ha- in my hospital I don't think there is such a thing as too late! I've seen doctors order epidurals for their ladies who are fully dilated and seen mom's come upstairs from our birth center, after two hours of pushing, who then get an epidural, labor down for an hour and rest- then have their babies.

Of course, sometimes this doesn't work and mom delivers before anesth can get there. Plus, well, if she's +3? I don't think a woman like that is going to make it the 10-15 minutes it would take them to get the epidural done....

[clwb2008]

I worked in a busy womens/birthing hospital w/ dedicated anesthesia for L&D. The general practice was that no woman would be refused an epidural but often a patient like this wont make it in time. My practice would be to explain the issues related to her expected rapid progress but still prep her for epidural if she insisted. I dont think it is right to refuse it. Also I have a time or 2 seen a multiparous women looking very close to delivery who stalled in 2nd stage (altho not too often tho).

[wtbcrna, MSN, DNP, CRNA]

I just do a low does spinal at this point instead of an epidural. A spinal is quicker, will provide analgesia, and if dosed correctly won't interfere with motor function that much.