Ok, so we've all heard the horror stories of bad outcomes from epidurals, and the fact that "natural" childbirth is much healthier for mom and baby has probably been drilled into every nurse (maybe not, but this has been my experience). Then there are those occassions when an epidural is a necessity.
So, I'm just curious: what is your personal opinion of epidurals? Whether you work with laboring moms, or have had a baby yourself, or both. What are some personal opinions about and experiences with epidurals...
I had my 3 girls in the late 70s and early 80s... no drugs for me. It hurt like hell... but I wouldn't have had it any other way. Like others have said... the power of the body is awesome!
For example, don't ya think MD's miss the days before CRNA's came along:lol2: ?
Probably not, or if so they have a faulty memory. There were nurses providing anesthesia as a specialty before there were anesthesiologists.
I understand that tntrn might be missing the "good old days." My point was that the "old days" weren't necessarily all "good." I sincerely doubt that all she is doing is "watching a monitor." The point for all of us, RN's, CRNA's, and even MD's is that times change. How we do things change. If we cannot, as nurses, adapt to changing environments, then we could go the way of the dinosaur.
I had an epidural with my daughter. I was 19 and in labor for 36 hours, finally pushing for 2 hours and ended up with a cesarean and a 9 pound baby...
Yeah, I'd say go for it as long as you are informed about the risk involved.
I wouldnt ever go without one should I have another baby. right before they had me push they turned off the epidural and by time they ran us in for the cesarean it had worn off completely, so for about 15 minutes I was in excrutiating pain. That tiny bit I felt was enough to have me order the dang thing the minute I see 2 pink lines again!
Specializes in critical care, management, med surg, edu.
Perhaps I'm just crazy... But am I the only one out here left who finds value in the awesome power of labor? You know - the value of women discovering excatly what their bodies are capable of? That they can do this thing that their mothers, aunts, grandmothers did? There is also value for the significant other to witness this powerful force called labor.... and knowing that their partner is a strong and capable woman?
I couldn't agree more. I am proud to say that I gave each of my children a natural birth (lamaze), free of chemicals. I suppose; however, that if labor is artificially induced with drugs, that artificial pain control may be needed. It seems to me that drs have taken away a mother's right to determine how she will give birth to her child. Inductions along with speeding up and slowing down the labor so that birth will fit into the drs schedule seems so artificial and WRONG. I don't understand why women have given up this right. Labor is tough, but not unbearable.
Also, to the person who wrote about passing kidney stones with only Ibuprofen---my mother had 4 babies and later in life, 2 bouts of kidney stones. She said she'd choose an unmedicated labor over a kidney stone any day!
That was me, and that's good to hear! My mother and I talked the other day and she really encouraged me to try it without an epidural. She said she had nothing for pain during her labor and also had pitocin, but that the labor pain wasn't nearly as bad as what she felt during her gallbladder attack ten years later! She also said that the delivery hurt less than the labor - both hurt, yes, but at least with the delivery she was able to fight the pain by pushing, and the euphoria of knowing it was almost over really helped a lot. She said that if they offer IV pain medication early in the labor, to get some and rest so that later on, when IV pain meds aren't an option, I'll have some energy. I'm really excited about trying to do this without an epidural, because I just think I'd feel more in control and that if I can get through labor and delivery, I can get through anything in life! And I've NEVER had this fantasy about walking into the hospital and getting an epidural so I could have a pain-free labor and delivery. I've ALWAYS anticipated "the best and worst pain of your life" with childbirth and kind of feel like it's a part of the whole process.
My kidney stones were like a 7 on the pain scale. I only passed one big stone (that was at home with the ibuprophen) and the others I had removed with a scope after two weeks of pain. They were stuck in my left ureter and would move a little here and there, so I had a lot of sharp pain as they scraped their way down. Plus I had hydronephrosis from the urine backup and felt like someone was stabbing me in the back with a dull butterknife for those two weeks before the scope. Either way, it wasn't pleasant. And I survived.
i've read through this whole thread, and i think it's time to clear up a few misconceptions.
first is the notion that we anesthesia providers started doing labor epidurals as a means to drum up more income. if that was ever true, it certainly is not true now. you might be surprised to know that the reimbursement rate for placing and monitoring an epidural is very low. so low, in fact, that if the anesthesia provider is being paid hourly by the hospital or anesthesia group, then if the labor continues for more than about an hour to an hour and a half after epidural placement, then epidurals become a money losing proposition. in order to break even, much less make money, each anesthesia provider assigned to the ob department must place and monitor four to six epidurals during the time they are present, supposing an average of four hours of labor from epidural placement to delivery. so, only at the larger hospitals are labor epidurals a break even proposition. (and if the epidurals are being placed and monitored at night, and if the provider is on overtime, that number goes up substantially.) even if the anesthesia provider is being paid a salary, it's a money-losing proposition, in that the provider can generate more income by providing general anesthetics in the or.
add to that the liability involved, and labor epidurals become very expensive. earlier in the thread, someone referred readers to two sites that supposedly gave excellent information on the potential complications of epidurals. these sites contained obvious bias. in the case of the site written by lewis e. mehl-madrona, md, phd, the information contained several errors, and was at least a decade out of date. he makes the following statement, with no support: "a general estimate of the overall complication rate of epidural anesthesia is 23%." anesthesia is a high-risk profession, liability wise. if this complication rate were even remotely true, we would have stopped doing labor epidurals a long time ago. i'm not going to go through either site point by point. suffice it to say that there is newer research out there that refutes, if not disproves, nearly all of what these sites tell you. you might start with the research of dr cynthia wong, at northwest university of medicine.
i cannot speak for all anesthesia providers, but i can tell you that i don't push epidurals on anyone. if for no other reason, the liability risks of doing so are too great. however, i do read in many posts here a definite desire to push parturients away from epidurals. i think such nurses are doing a great disservice to their patients.
read the following quote from tntrn:
"in the 70's and 80's i worked in a hospital (300 a month) and we did no epidurals. the population was prepared for birthing without them and they did just fine. now that everybody has to have one the second they walk in the door, a part of me is unfulfilled as a labor nurse...there's a lot to do for the epiduralized patient, but i don't find she needs the support that i prided myself in being able to give her."
in other words, these darn patients aren't doing it the way i find most fulfilling. the most polite way i can say it is that you are not primarily there for your own fulfillment. this should be a joyous occasion for the family. our fulfillment isn't even secondary, its irrelevant. we have a responsibility to do everything in our power to make the occasion fulfilling and as happily memorable for the family as we can. which means doing everything we can, within reason, to meet the mother's expectations without judgement. if a nurse cannot do that, then perhaps it is time to move on.
(by the way, itching, nausea, and low blood pressure are not indications of allergic reaction to epidurals. itching can be a normal reaction to epidural or spinal narcotics, and nausea is often a result of low blood pressure. low blood pressure can usually be prevented by administration of an adequate fluid bolus before spinal or epidural placement.)
thank you for the eyeopening cost factors- i know about that working in ltc we ofetn loose money on certain patients and procedures - never thought of it here - also - after rereading the post above - i thought of likening it to say - one of my dying cancer patients - if i can control the pain and not have to provide extra emotional support in that area - i am free to provide other emotional support in other areas - i could see it being the same way in l&d and think it would fulfill me just as much - but i'm not there so i don't know that for sure - i only know it does with my pain free cancer patients. just my opinion.
I truly dislike the argument that "women have been giving birth for ever with no pain medication" That's not true for one thing. People have been trying to ease labor pain since time began. One of the initial uses (back in ancient Egypt) for what is now known as aspirin was reducing pain of labor. It's far from being a new concept.
I am in total agreement with you. I had two children...one with an epidural and one without. For me, the experience without was much better. It makes me sad sometimes that women are so convinced that they can't birth a baby without an epidural. Birth was such an empowering experience for me. I wish that we could convince more women that they are able to birth their baby. I also struggle with the fact that so many labor nurses depend on the epidural rather than spending time with their patients. Coaching a woman through a natural childbirth is becoming a lost art. Technology is wonderful, but our bodies were made to labor and birth and sometimes I think we are underestimating women and what they are capable of.
Perhaps I'm just crazy... But am I the only one out here left who finds value in the awesome power of labor? You know - the value of women discovering excatly what their bodies are capable of? That they can do this thing that their mothers, aunts, grandmothers did? There is also value for the significant other to witness this powerful force called labor.... and knowing that their partner is a strong and capable woman?
It's true that coaching a woman through a natural labor is very hard and time consuming work, but doesn't anybody else love it?
Doesn't anybody else get sick of piling on intervention after intervention that comes with anesthesia? Itching, vomiting, cathing, decels...
Me, 2 babies, no epidurals. I know how strong I am and remember it every day when I parent my 3 and 5 year olds.
I think this is one of those issues where a woman should be given good information with pros and cons for each alternative and then allowed to make her own decision without pressure one way or the other. And women have really become empowered to make decisions here over the last few decades. I just wished the medical establishment presented natural childbirth as an option more often. I get the idea that many folks in the medical establishment think of it as some hippie, alternative thing and therefore their patients do also.
I am all for natural childbirth (had two myself) but I respect women who feel they wouldn't get anything out of it (and in all probability they are right) and support safe pain relief. It seems cruel or paternalistic to me to deny or charge extra for pain relief for women who want it -- as well as sexist on some level.
She said that if they offer IV pain medication early in the labor, to get some and rest so that later on, when IV pain meds aren't an option, I'll have some energy.
Someone told me IV pain meds get into the baby's bloodstream and can lead to drowsy newborns {and decreased mother-infant bonding}. Whereas epidural meds don't enter the baby's bloodstream. Does this sound right?
Perhaps I'm just crazy... But am I the only one out here left who finds value in the awesome power of labor? You know - the value of women discovering excatly what their bodies are capable of? That they can do this thing that their mothers, aunts, grandmothers did? There is also value for the significant other to witness this powerful force called labor.... and knowing that their partner is a strong and capable woman?
It's true that coaching a woman through a natural labor is very hard and time consuming work, but doesn't anybody else love it?
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I have no problem coaching women, or any other patient through whatever procedure they choose. However... I am all about patient choice, and I refuse to "push" anything on anyone.
With my first son I was induced because my AFI was extremely low, I had started off with a not so great reaction to the pit... it wasn't working, so they just kept turning it up until finally it hit me like a brick wall. The nurses were trying to be very encouraging and basically ignored me asking for pain meds... "honey, you're the one who got yourself this way, now it's time to deal with it". My contractions got so bad and intense that my little one started to get into trouble, and of course with everything going on, me in so much pain, the nurses and doctors all concerned about the baby's condition, I was in absolutely no state of mind to where I could even push, or breathe normally for that matter. Of course at this point it was too late for an epidural because I probably couldn't have even stayed still long enough for it. I wound up having to have a little cocktail that included a heavy dose of Demerol to just stop everything and calm me down. It was the most horrific experience of my life. I consider this way more dangerous than just letting me have the stupid pain control before hand.
With my second I had an amazing doctor and she brought in the anesthesiologist for a consult early in labor to discuss options. We came up with a game plan, and had a plan b and a plan c. It wasn't "pain free" by any means, but it was manageable, and the whole experience was much more enjoyable (for everyone).
Now... I know exactly what my body is capable of. It's capable of learning to walk again after being hit by a car going thirty-five miles an hour; it's capable of carrying two pregnancies on an arthritic hip and bad back. It's also capable of running a marathon, transferring the 200# women to the commode when no one is there to help me, sprinting to catch my son before he steps one toe in the street, going without sleep for days while taking care of a baby, studying, and working my way through nursing school. I'm very well aware of what I am capable of as a person. I could care less what my mother, grandmother, or any other woman on earth has done before me, just the same as I don't care how anyone else dresses, or what car they drive. Would you get dental work done with no anesthetics just to prove what a strong woman you are?
When I did my LD clinicals I did see some women go through a totally natural child birth just fine, and I also saw some go through it not so fine. So I'm sure it can be done, it's just one of those things I would not care to find out for myself. To each their own.
SmilingBluEyes
20,964 Posts
ummm no. this is not a new concept for most of us...
BUT we are talking about labor epidurals here, not those for other pain intervention purposes.