Pain Meds and Epidural's during laboor

netglow, ASN, RN · Jan 24, 2009

Are you a nursing student? This information should be very easy to find in your Maternity book... It is the simple stuff... you have to do your reading. :up:

nkochrn, RN · Jan 30, 2009

Our hospital doesn't do Epidurals. We do Spinal Analgesic though, which means the patient still has feeling everywhere but her pain is decreased. The CRNA won't do them till 5-6 cm and very rarely does them once they're passed that. In my experience the spinal helps the mom relax and she usually dilates to complete about as soon as it's in.

ArborVitae · Jan 30, 2009

Generally the rule of thumb is that every woman's body reacts differently to medication, and every birth is unique (which I know doesn't sound like much of a rule).

However, in my own experience as a Doula, and in all the literature I've read is that one "intervention" tends to lead to another.

For example, you have a woman who's dilated to 3cm, she's not "progressing" so you put her on the Pit, and start cranking it up to get her contracting "normally", this brings on abnormally painful/strong contractions which can put stress on the baby causing a drop in the fetal heart rate. Also with the pain of the Pit contractions the mother requests an epidural. The epidural can cause a drop in the mother's blood pressure, as well as oxygen to the baby, which then on top of the stress of the constant contractions caused by the Pit can result in distress and thus a c-section occurs.

I'd advise you to watch for this pattern in the births you observe.

PS

Epidurals have been known to lengthen the duration of labor, at such time Pitocin is used to help progress the labor, and the you can wind up in the same situation as above. Most hospitals I've worked with will provide epidurals from 3cm to 9cm.

BabyLady, BSN, RN · Jan 30, 2009

generally the rule of thumb is that every woman's body reacts differently to medication, and every birth is unique (which i know doesn't sound like much of a rule).
however, in my own experience as a doula, and in all the literature i've read is that one "intervention" tends to lead to another.
for example, you have a woman who's dilated to 3cm, she's not "progressing" so you put her on the pit, and start cranking it up to get her contracting "normally", this brings on abnormally painful/strong contractions which can put stress on the baby causing a drop in the fetal heart rate. also with the pain of the pit contractions the mother requests an epidural. the epidural can cause a drop in the mother's blood pressure, as well as oxygen to the baby, which then on top of the stress of the constant contractions caused by the pit can result in distress and thus a c-section occurs.
i'd advise you to watch for this pattern in the births you observe.
ps
epidurals have been known to lengthen the duration of labor, at such time pitocin is used to help progress the labor, and the you can wind up in the same situation as above. most hospitals i've worked with will provide epidurals from 3cm to 9cm.

amen to that!!!! :bowingpur:bowingpur:bowingpur

kishinne · Jan 30, 2009

it depends upon the pain threshhold of the pregnant woman....if she can tolerate the pain then she can go on with the nature of labor...but if she can't handle the pain and ask permission to her ob-gyne to have epidural anesthesia to lessen the pain she felt...then it is ok with informed consent..yes its true that if patient is on epidural anesthesia it will prolong the labor.In the hospital that i worked at ,the tendency of having ceasarean section is possible according to my experience...

mom2mnaj · Feb 3, 2009

My experience has been that generalizations can not be made regarding wheather or not epidurals prolong labor. I would say in my experience, it is 50/50. Some seem to prolong, but I have also seen the young primip, writhing in pain at 2-3 cm, get an epidural and within the span of an hour or two, go to complete and deliver lady partslly. These women usually are able to nap a bit, and have a much more pleasant experience regarding their delivery.

Also, please do not disregard a patient's pain just because she is not dilated far enough. There is a current lawsuit (I believe in Chicago) where a patient is suing because her epidural was delayed and she experienced unnecessary pain. I can't remember the specifics but one of our clinical managers shared the article with us. Just something to be aware of.

Elvish, BSN, DNP, RN, NP · Feb 3, 2009

My experience has been that generalizations can not be made regarding wheather or not epidurals prolong labor. I would say in my experience, it is 50/50. Some seem to prolong, but I have also seen the young primip, writhing in pain at 2-3 cm, get an epidural and within the span of an hour or two, go to complete and deliver lady partslly. These women usually are able to nap a bit, and have a much more pleasant experience regarding their delivery.

You described my primip labor experience to a T. My water broke at 1500 on a Sat. Nary a contraction...but I think I'm +GBS (actually negative, typo in my records) so off I go to the hospital. Really want to do things naturally, but after 8 hours of dilating from 1 to 2 they wanted to hang pit. The contractions as they were were horrible - I was puking, grumpy, and not dealing well. From about 1530 til about midnight (those 8 hours where I dilated 1cm) I had no pain control, and in retrospect, I remember the FHRs being in the high 160s-170s...probably because I was not coping well with the pain. Finally I got my epidural shortly after midnight...and went from 2 to complete in about 5.5 hours. Labored down for a bit, which felt really good. Pushed almost 2 hrs and got a nice 8+1 son as a reward.

If I had to go back and do some things differently on my end, it would be to not complain about being pregnant, which led my OB to strip my membranes (didn't know at the time that's what was going on). But that's a different thread.

It is so hard to tell....some women will never get beyond 1 if you start the epidural right away, and others, it allows them to relax and open up. Gotta watch the patient, not the rule book, nor the monitor. Best rule I ever learned.

CEG · Feb 4, 2009

Also, please do not disregard a patient's pain just because she is not dilated far enough. There is a current lawsuit (I believe in Chicago) where a patient is suing because her epidural was delayed and she experienced unnecessary pain. I can't remember the specifics but one of our clinical managers shared the article with us. Just something to be aware of.

I remember this article- this was an extreme case where the doctor was extremely verbally and physically abuse- using profanity and yelling at the patient and staff. He forced the patient to labor in lithotomy and refused her requested for pain meds. I can't remember exactly but I believe he forced her to push at 8 cm saying he had somewhere to be and cut an epis. I think she ended up with a hemorrhage or some other complication. Not that pain should be ignored in any case but I think this is a different matter- I would like to see this woman win her case and set a legal precedent and stop doctors from abusing women.

lisamct · Feb 4, 2009

There was some research noted in the BJM recently which suggested that the earlier in labour an epidural was sited the less of an effect it had on the duration of labour itself, if I can find the reference I'll post it.

As others have said individuals react differently to different medications so its really difficult to tell. We have no strict guidelines for when you can and cant get an epidural, Ive seen them sited at 1cm and 9cms. Later epidurals are most seen in our unit in primips as even if theyre examined and found to be 9cms they may still have several hours of labour to go and if theyve decided on an epidural at that stage then so be it.

2curlygirls · Feb 5, 2009

GEtting an epidural sped both my labors. And I had a doula for both.

Elvish, we had similar labors!!! I got an 8+1'er too! But the girly kind.