opinions about epidurals

mbesan · Aug 8, 2006

I had three epidurals and all turned out well. I was adviced to have it since i had PVCs during my pregnancies and the doctor said she didn't want to put extra stress due to pain in labor. i won't trade a normal delivery with it. I have enjoyed my labor period, and i can easily comprehend the doctor's instructions during delivery. The urge was there but no pain. I had my babies out in two pushes, all of them and my babies were all nursed the mment i woke up.:monkeydance:

twotrees2 · Aug 8, 2006

"menstrual cramps my ass"
Graciegirl, what's up with that comment? Are you trying to say I'm lying? Why would I lie? That was my experience.

i am sure she wasn't posting this to be directed at you but how she felt at the time they hit - i know with my last 3 after having the first one and someone would make some comment on how its not that bad etc - i would be thinking the same thing she said lol - not directed at them directly cause maybe they did not have the pain so bad but at the situation. hugs to you and i am glad you had a great experience- if my health weren't so poor i might try one more time fort the "good one"

SmilingBluEyes · Aug 8, 2006

SO on the basis that labor is a temporary condition, let me make an outrageous comparison.

ROOT CANAL procedure: also a temporary situation/procedure. So, Do you think the dental patient should not have her insurance cover the local anesthetic and/or sedatation that prevents the horrible pain and nervousness/anxiety that goes w/having such a procedure done, or just pay out of pocket since it's temporary and not chronic, and therefore will end at some point (the associated pain)? I mean,why should I pay for her to have these things, since it is costing me, as a member of the same insurance plan, to pay for these things? After all, the root canal is probably her fault, since she let her tooth go so bad it became necessary, right?

I still think it's unfair to say that laboring women should have to "suck it up" and deal with natural labor because some people feel it should be so or that they are wimpy. It's so individual. I am all for natural labor, but also for medicated labor if a woman elects. It should be up to her practitioner and herself and not us, which way it goes! And yes, epidural should be covered, just like anesthesia for root canals or other procedures (like colonoscopy) are covered by insurance!

twotrees2 · Aug 8, 2006

Women have become so wimpy. Yes, epidurals are a necessary evil, but make no mistake, when there's a problem, it can be a serious one. OB used to be so much more fun when women were helping women get through the process but now its all so mechanized ("I want my epidural.)" People should have epidurals if they want, but unless there's a medical indication, it should
be paid for by the patient, not the insurance company. Its a very expensive luxury that wasn't needed until the 1980's when we had a surplus of anesthesiologists looking for more business.

as also a lot goes wrong even without it- when i was orienting to l and d everything tha could go wrong did - preeclamtic - eclamptic, uterine stopping and we were a small town hospital with no resources to help these so flight for life was called ofetn ( after 2 months they let me off at my request to not have to orient to a second station - i think they thought I as jinxed lol) i envy the women brave enough to deliver at home - i think that would be sooo awesome but ( having had 2 pregnancies go bad) i would be terrified of it happening and not being anyone to save the baby.

SmilingBluEyes · Aug 8, 2006

Does anybody let woman walk the halls anymore? I understand about needing fetal monitoring, but is there a point in labor where it's common to let the woman labor down by walking if they desire?

ABSOLUTELY. If you were to labor where I work, you would be encouraged to walk the halls and minimal monitoring, esp if you elected to go naturally. YES there are places and nurses that DO enjoy natural labor experiences and do our best to make them happen for our patients/families.

subee, MSN, CRNA · Aug 8, 2006

SO on the basis that labor is a temporary condition, let me make an outrageous comparison.
ROOT CANAL procedure: also a temporary situation/procedure. So, Do you think the dental patient should not have her insurance cover the local anesthetic and/or sedatation that prevents the horrible pain and nervousness/anxiety that goes w/having such a procedure done, or just pay out of pocket since it's temporary and not chronic, and therefore will end at some point (the associated pain)? I mean,why should I pay for her to have these things, since it is costing me, as a member of the same insurance plan, to pay for these things? After all, the root canal is probably her fault, since she let her tooth go so bad it became necessary, right?
I still think it's unfair to say that laboring women should have to "suck it up" and deal with natural labor because some people feel it should be so or that they are wimpy. It's so individual. I am all for natural labor, but also for medicated labor if a woman elects. It should be up to her practitioner and herself and not us, which way it goes! And yes, epidural should be covered, just like anesthesia for root canals or other procedures (like colonoscopy) are covered by insurance![/quote
Its not a good analogy. A diseased tooth is not going to get better on its own. Some insurers will not pay for anesthesia anymore for colonoscopies since the physician doing the procedure can also give a narcotic and a sedative without anesthesia personnel being present. Like an OB or midwife giving a narcotic or narcotic angonist-antagonist to a laboring mother for pain relief when 24/7 anesthesia is not available. Also, when the endodondist gives local anesthesia that is part of a single bill. A second practitioner is not generating separate charges. I'm confident that if a hypotheical scenario occurred in which insurance companies would not pay for pain relief services provided by anesthesia personnel, any of those people would provide it for no charge for cancer patients but, all of a sudden, labor pain would be relegated to a condition not requiring the services of anesthesia. All of a sudden other measures ,like walking until you crown, would become evidence based practice.

twotrees2 · Aug 8, 2006

I once heard the pain of labor described as "a really baaadd stomach flu." That, to me, is a pretty accurate description. I mean REEAAALLY BBAADD stomach flu. Cramps, and more cramps. Worst cramps you've ever had and they're rhythmic.
I was medicated the first time, not medicated the second. #2 was in a hurry and apparently I was progressing too quickly or had progressed too far, something. The nurse told me it was too late for any pain meds. Didn't want an epidural. It scared me.
Oh, yeah, and after the cramping, comes the big giant head that attempts to cleave you asunder. That smarts. Feels like your flesh is being ripped. Not just the skin, but the underlying soft tissue as well, and the spreading bone. Fortunately, that part doesn't last as long as the cramping contractions, it's over with in a matter of minutes, maybe seconds.
I guess that is one thing that makes labor bearable, you KNOW it will be over soon. In comparison to a broken bone that can cause pain for MONTHS as it knits itself together, and the soft tissue injuries that are healing at the same time, labor is a walk in the park. A painful, strenuous walk in the park.
And as for strenuous, that was the surprising part. I was prepared for pain, but I had no idea how much WORK it would be. There is a reason they call it labor. With the first delivery, they gave me a narcotic IM and I think it made it harder to get things done. My husband told me I TURNED PURPLE from head to toe while I was trying to push that Moose out.
Empowering, I don't know. It just made me tired. And then I had to take home this squalling mass of flesh that I loved w/all my heart, but it was troubled. It wanted many things from me, but couldn't communicate it's needs effectively, yet it demanded to have them met, right away, and I had to try to learn a new language in order to show my love by meeting these needs. Now THAT is EXHAUSTING! (And you thought MEN were bad).
Which pretty much takes us full circle as to how we got in to this mess in the first place, doesn't it?

lol - i love your scenarios- to funny- about it ain't it? i must admit i believe for me my pain had to do with age and health - i should say my recuperation - the first 2 the pain was as bad as the second 2 - but my mom was half right - it was quickly forgotten after ( until the first contraction of the second HAHAHA then very vivid memories of why the heck did i do this again hehe) anyhow - with my second 2 with my health issues ( by the way - i was told i would never carry to term again with my 3rd - and after him the same thing - id never carry to term due to the complications - nearly lost em both not taking the chance on it again haha) anyhow - my recovery was very long it seemed weeks compared to days with the first 2- just something i thought of........

baby cloudie · Aug 8, 2006

hey hey hey..

epidurals not only for giving births..

my wards do have Acute Pain Units thats for epidural patients..

those patients udergo Totak Knee Replacements, Gastrectomy & etc..

do use epidurals..it works well for the patients but some patients got allergic reaction such as itchiness, vomitting , low blood pressure and etc..

so these are new for you all? :yeah:

anniem54 · Aug 8, 2006

This is a fascinating thread, and all the posts reinforce my belief that every woman's body will labor and birth differently, that every woman's past experiences, upbringing, other health issues, attitudes, support (or lack of), etc., will strongly influence how she deals with labor and pain, how she will approach the whole experience and the choices she will make. Having a "natural" birth or having an epidural is such an individual choice based on so many variables. I worked in hospice for awhile and found that the process of assisting patients and families in making the end of life choices that worked for them was very similar to helping a woman find the appropriate options for her labor and birth. Both ends of life require such flexibility because everyone's body is different, and there are so many variations on the theme! My son's "natural" birth 23 years ago was a powerful, transformative experience for me, and I can't imagine going through labor with an epidural and not feeling the labor. I will be the first to say that it hurt in a way I can't begin to describe, but the experience strengthened me as a person, as well as the bond between myself and my very involved and supportive husband (one of the reasons I was able to get through a long labor). I STILL call on my deep sense that if I could get through that, I can get through ANYTHING...and I have! It doesn't make me stronger than the woman in the next room who had an epidural, it doesn't make me a better parent or a better person. It just means it was the right choice for me, and I was blessed with labor nurses who were totally supportive of my choice, even though I found out later they didn't agree. What a gift they gave me, and they are still my role models. 4 1/2 years later I gave birth to my daughter after another drugless labor, again the right choice FOR ME, again blessed with L&D nurses who got A+ in 'supporting your patient' class in nursing school! I float into postpartum frequently, and am occasionally the gopher for the overloaded L&D nurses (very small, rural hospital), and find that most women, whether they opt for an epidural or not, are absolutely TERRIFIED of labor, even the ones who've educated themselves beyond watching A Baby Story on tv. I think our society (advertising, the media) conveys the thought that life should be free of any discomfort, and that if you do experience any pain, there must be someone to blame and sue for it! Fear=tension=increased pain...no wonder epidurals are chosen by so many women! As for problems with epidurals, I see alot of women who can't void afterwards and end up with a foley, or for whom an epidural ends up being the first of many interventions ending with a crash C-section, again a case of so many variables its hard to say if it was because of the epidural or not, but in many cases, it looks like the epidural is what starts the cascade. As a nurse, what I want is to support patients in making fully informed choices which they feel are best for them and their situation, especially when things aren't happening the way they hoped and idealized... 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! Blessings to all of you who will give birth someday. May you have a pregnancy, labor and birth experience that is strong, healthy, and positive, HOWEVER you choose to go through it!

passgasser · Aug 8, 2006

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.

http://www.eurekalert.org/pub_releases/2005-02/nmh-sfn021105.php

http://www.webmd.com/content/article/100/105882.htm?pagenumber=1

http://www.greenjournal.org/cgi/content/full/101/2/279

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.)

hospitalstaph · Aug 8, 2006

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.
http://www.eurekalert.org/pub_releases/2005-02/nmh-sfn021105.php
http://www.webmd.com/content/article/100/105882.htm?pagenumber=1
http://www.greenjournal.org/cgi/content/full/101/2/279
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.)

thanks for the interesting post.

i do think, however, that you misunderstood tntrn's point. she misses the good 'ole days when she helped women through labor. and yeah she probably does find it unfulfilling to watch a monitor. her job has changed and she simply misses the way it was before. for example, don't ya think md's miss the days before crna's came along:lol2: ?

have a great day,

t

SmilingBluEyes · Aug 8, 2006

well said Gasspasser. I was hoping a CRNA would weigh in. Where I work, often the MDAs barely break even. OB IS NOT their big "money maker".

So much for drumming up big business by haunting the L/D units as an anesthesia professional.....

And I stand by my tooth analogy, when speaking of pain. If a person is in intense and intractible pain and cannot get through it w/o intervention, so be it. It's not up to us to decide whether she is ENTITLED or NOT to such interventions as epidurals or pain meds, if she so chooses. It's not up to you or me to decide if it's a "legitmate" insurance claim or not either.

NOW can we stay the course and just stick to our experiences with epidurals w/o getting all judgemental of either side (the natural birth advocate versus the woman who chooses medicated birth)????