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...
Today, no one is expected to have their teeth worked on without Novacaine and I don't know how amputations are done, but I would guess they're done under general anesthesia. If no one is expected to endure those types of pains, because they did it back in the day, why would anyone expect a woman to endure the pain of labor, if she didn't have to?
I respect your opinion for yourself, but would like to offer my perspective. That is: a bad tooth, gangrenous limb, etc are pathologies. Birth and labor are not disease states. So, the two scenarios should not be compared, since they are completely different. Also, from what I observe in daily practice, people tend to jump to quickly to just wanting medication. We live in a society with a, "just give me a pill" mentality.
I am pregnant and having a baby in about 4 months, and my hope is to go completely medication free. I feel the ability to master labor without medication is both safer for me and the baby. If I do end up needing an epidural for whatever reason (ie failure to progress or something) I am not completely opposed. I just want to try without it first.
There's an interesting article in the Boston Globe Magazine today about epidurals. I wasn't able to post the link but it's called The Mother Lode of Pain. Worth a read. You have to register to read the article.
I've had 2 epidurals with my 2 previous pregnancies, I'm 30 weeks now and really hoping to not have one this time. My first one was perfect, my second one scared the crap out of me. First I felt a shock down my left leg and the anesthesiologist had to take it out and do it again, then the left side of me was not numb. They kept giving me boluses to get me through but I still had quite a bit of pain. Then, ironically, after the rest of the epidural wore off, my left foot was still numb and tingly like it was asleep and wouldn't wake up. I had to limp around. They kept saying it would wear off soon, but it took 3 weeks! I was scheduled for a neuro workup to check for nerve damage when it finally started getting feeling. I was so afraid I would never be able to walk or feel normally again that I swore I would never again have an epidural. The anesthesiologist said that a pocket of the anesthetic got trapped into the fatty part of my spine. That experience makes a few hours of labor pains seem like a good trade off (and I know because I labored without relief for several hours with my first and only had the epidural for the last half hour). With my first I thought the epidural relaxed me enough to dilate from 5-6 to 10 in a half hour (the nurses said I probably dilated quickly because of being relaxed) but I don't think that was the case because I got my epidural early on with my second, and it still took several hours to go to 5-6 then I went to 10 in a half hour. I think that is just what my body does, regardless of epidural. (And I was far from relaxed after my 2nd epidural anyway). Sorry this is so long, I just thought I'd put in my 2 cents worth.
I respect your opinion for yourself, but would like to offer my perspective. That is: a bad tooth, gangrenous limb, etc are pathologies. Birth and labor are not disease states.
I had my daughter without any medications after 29 hours of labor and would do it again. Like one of the above posters, I liked being in touch with all of it; I felt in constant communication with my body and the baby. Yes, it was the most pain I've ever experienced, but it was bearable. Plus I got to be up and around as I labored and very soon after her birth.
I called my first nurse "the nazi" (she wanted to control the whole situation and would have were I not such an assertive type with a supportive husband), but luckily her shift ended not too long after I entered the hospital. Then I got assigned a nurse who liked working with the natural deliveries and she and my doc both had the approach that "you know what interventions are available - we won't keep offering, but you're free to ask for them." Yea - letting the patient be in control as much as possible and make decisions based on her needs!
I'm with the majority of the posters here: women need to be informed of the possible benefits and risks of the various interventions (or lack thereof) and make decisions based on their own particular situation and needs.
Having said that, I definitely felt like I was swimming against the tide by going natural; there was a definite push by many people (medical and lay alike) to "get the epidural." I can't count the number of times I heard how crazy it was to want to have my daughter without drugs or to be given the old "you wouldn't dream of getting a tooth filled without novocaine, that would be stupid" remark. (And I have, indeed, had several fillings without drugs because the side effects for me are worse than the pain.)
Make the decision based on what fits best for you and be prepared to make changes if necessary (I wanted natural, but would have done whatever necessary to get my baby here alive and well...) Healthy baby, healthy mom - isn't that the goal we all share?
If no one is expected to endure those types of pains, because they did it back in the day, why would anyone expect a woman to endure the pain of labor, if she didn't have to?
I'm with you on this. I think that if we (humans) are given the ability to problem solve, and the result of solving the problem of the pain associated with dental procedures, amputations, childbirth or any other major medical "event" is to offer a medicine (novocaine, anesthesia, epidural, etc.) that helps to ease that pain....problem solved!!
I had a c/s for failing to progress with my first (failed to progress, even with pitocin...still don't get it) and my second was elective c/s. I'm pretty sure I told the CRNA that I loved him when he walked in the room!!
Blows my mind...a hospital that does L&D but doesn't do epidurals? Wow! Most of our patients would never go there. They come in the door asking for their epidural.
In our hospital, the rule used to be that you have to be 4 cm to get an epidural, but now it is whenever the patients wants it as long as we are committed to delivering at that time. I've also heard of hospitals that say you can't get an epidural after you reach 7 or 8 cms. Not us, you can get an epidural as long as you are able to sit on the side of the bed without sitting on the baby's head. I've seen patients get an epidural at 9cm. The other day a lady came in complete wanting an epidural; the baby was very high so we started a bolus. However, she delivered 400 cc into her 1000cc bolus.
As a L&D nurse, I feel the epidural is very much the patient's choice. I can't tell you how many times I've had mothers refuse to let their teenage daughter have an epidural because she needed to learn a lesson (ha!) or the FOB say that he doesn't want her to have anything because it might hurt his baby. Of course, these are usually the same s.o.b.'s that tell them to quit yelling when they're pushing. I have been known to say something about Karma at that point.
I personally enjoy my patients who have natural childbirth as their choice. They are usually very centered and not very demanding. The patients who are out of control, screaming and demanding medicine (not epidural), I do not try to force epidurals on them, but I do explain that they cannot have IV pain medicine after 7 cm and that is usually when the pain is going to be the worst.
When admitting a patient, I will ask if they want an epidural. If they say no, I tell them that that is their option, but ask if they are refusing for fear or something someone told them about epidurals (I find that a lot of teenagers have "friends" telling them horror stories about epidurals even if they never had one). I tell all my patients who do not want an epidural that when they are interviewed by anesthesia staff (standard procedure) to tell them that they do not want one at this time but not to refuse one outright because even though they can change their mind at any point, if they've told the CRNA outright NO, they will have to be interviewed again to make sure the CRNA knows what they really want. It just saves time in the long run.
My funniest story is the Hispanic woman who came in 9 cm and delivered about 20 minutes after admission. She was telling the translator that she had never been able to get an epidural because the nurses would never let her have one! When the translator told me this later in the hall, I told her that she might relay to the woman that if she wants an epidural with the next baby, she might want to come to the hospital a little sooner.
I am not an ob nurse, I am a doula of sorts. I was getting certified when I changed direction and am a prenursing student now.
Natural childbirth is the ideal situation as far as lower risks. Having a doula present or a good support person really helps natural childbirth patients to get past transition and not need an epidural. It's better for a laboring woman to move around and change positions and be able to listen to her body. I think epidurals are in many cases a substitute for labor support. In this day and age many women just don't get the support they used to ages ago from other women.
Epidurals can be a good thing. Even though I believe in natural birth, I also have a background of terrible abuse. I get panic attacks with pain that result in fight or flight response. The epidurals I chose for my own births were a good thing for me. They relaxed me and made me feel safe. I was able to enjoy the births. No complications, no regrets.
I think women need to wait to get them until labor is good and strong, need to be rotated in bed from side to side to help baby move down, and above all be respecte for whatever choice they make.
I posted earlier in this thread about how I had four babies without any type of pain control. I was never given the option, except for the last one, and I thought since I had done it three times before and lived through it, I could do it again. I don't feel like I did anything special. Things just were the way they were. I'm wondering why this is such a big issue, though?
Back in the day, women had babies in their homes, on their farms, in their boarding houses, on the fields, in caves, or wherever, without pain medication. People also had their teeth ripped from their skulls with pliers and nothing more than a swig of whisky to help make them feel better. People had their limbs amputated, when necessary, with a hand saw and they had to bite a bullet, for whatever reason. I don't know. To keep them from screaming too loud, I guess. Today, no one is expected to have their teeth worked on without Novacaine and I don't know how amputations are done, but I would guess they're done under general anesthesia. If no one is expected to endure those types of pains, because they did it back in the day, why would anyone expect a woman to endure the pain of labor, if she didn't have to?
This is a rhetorical question, but I would be interested in hearing arguments against it.
A while back, there was a speaker in town who gave a presentation on Civil War medicine. (The city where I live was a hub on the Underground Railroad.) I love medical history, and have a huge collection of old medical books, so of course I went. He actually had a bitten bullet with tooth marks in it and everything. It sort of looked like a hardened piece of chewing gum.
I don't have kids, but my SIL had epidurals with both daughters and she would recommend it to anybody. My mom had 3 kids in the 1960s and with each of us, she had a saddle block which she didn't understand because she said they don't do that until it's almost over.
A few years ago, one of the hospitals in the large city where I grew up advertised that epidurals were available in their OB unit, as if they weren't elsewhere. A retired woman doctor wrote a letter to the paper stating that she had stopped delivering babies in 1964, and at that time had been using them for more than 20 years. So, it's nothing new.
As a hospital pharmacist, I oversee their preparation, and one of my technicians said, "I gave birth to three babies, and I was NEVER in enough pain that I would have wanted someone to stick a needle in my back!"
When admitting a patient, I will ask if they want an epidural. If they say no, I tell them that that is their option, but ask if they are refusing for fear or something someone told them about epidurals (I find that a lot of teenagers have "friends" telling them horror stories about epidurals even if they never had one). I tell all my patients who do not want an epidural that when they are interviewed by anesthesia staff (standard procedure) to tell them that they do not want one at this time but not to refuse one outright because even though they can change their mind at any point, if they've told the CRNA outright NO, they will have to be interviewed again to make sure the CRNA knows what they really want. It just saves time in the long run.
Thank you for your advice. I hope to not have an epidural when I give birth. But at least now I know to talk to anesthesia first and say that while I am nervous about getting one and don't desire one right off the bat, that I am not ruling it out and will let my nurse know later on if I change my mind. My thing is that I want to remain mobile, too. Do many places do "walking epidurals" and is there another name for them?
As a hospital pharmacist, I oversee their preparation, and one of my technicians said, "I gave birth to three babies, and I was NEVER in enough pain that I would have wanted someone to stick a needle in my back!"
That's kind of how I feel! I've felt every single agonizing pain as spikey kidney stones made their way down from my kidneys, squeezed through my ureter - causing painful hydronephrosis in the process - into my bladder, and out the urethra, and I never had more than some ibuprophen for that. I survived and felt pretty darn proud of myself afterwards, in fact.
Almabella
81 Posts
Today, no one is expected to have their teeth worked on without Novacaine and I don't know how amputations are done, but I would guess they're done under general anesthesia. If no one is expected to endure those types of pains, because they did it back in the day, why would anyone expect a woman to endure the pain of labor, if she didn't have to?
I respect your opinion for yourself, but would like to offer my perspective. That is: a bad tooth, gangrenous limb, etc are pathologies. Birth and labor are not disease states. So, the two scenarios should not be compared, since they are completely different. Also, from what I observe in daily practice, people tend to jump to quickly to just wanting medication. We live in a society with a, "just give me a pill" mentality.
I am pregnant and having a baby in about 4 months, and my hope is to go completely medication free. I feel the ability to master labor without medication is both safer for me and the baby. If I do end up needing an epidural for whatever reason (ie failure to progress or something) I am not completely opposed. I just want to try without it first.