sherryrn76

we definitely do not want the insurance companies involved! That's what happened some years ago with the mandatory tiral of labor deal with previous c/s. Then the lawsuts went through the ceiling because we had poor outcomes. Luckily, my hospital is very family/patient center. Last week I had a patient who was an induction for postdates..41+3, who had truly wanted to be a Bradley patient. she warned me ahead of time that she did not want an epidural..4th baby (ages 12,11 and 1), would take stadol, preferably in .5 mg increments but wanted to be oob as much as possible. She also warned me that she would be noisy but that's how she labors. She was definitely noisy but was easy to get under control to push..last tiem she ended up with a fourth degree because she was NOT in control. I kept her calm and we NO EPIS! and no lacerations. I did have to monitor her because of the Pit but did it with her in the rocking chair, on the labor ball,standing at the beside, squatting (of course, I was on my knees on the floor to do that) and, at one point, standing bolt upright in the BED. It was great..I had a blast. Even as a tertiary hospital, we do all we can to accomodate the patient. We do have an awful lot of interventions nowadays but we can work around them. Thankfully, because of our interventions, we don't have some of the "surprises" we used to have..undiagnosed anomalies, thick mec nobody knew about until the time of delivery, undiagnosed twins, sudden fetal death during labor. Deliver just one stillborn child who 15 minutes earlier had a heartrate on auscultation and you'll never mind monitors again. Also epidurals really help the panicky patient who probably would've ended up with a fourth degree without it. We have the luxury of having a range dosage on our epidurals. I f the patient is unable to feel pressure to push, we can lower the dose...it's on a continous pump. Also we don't start pushing until mom can feel some pressure. If they are complete/+1 or so with an epidural, we'll simply wait and let Mother Nature bring the baby down while mom is still comfortable. Even our residents will go for that. One lst thing..new awohnn guidelines say patient may have epidural whenever she requests it. We are the only service that denies pain relief until the patient hurts worse. Thanks for letting me give my opinion. we have also found epidurals to be quite beneficial for PIHers.