pushing with an epidural

NeuroICURN · Aug 9, 2004

Hi there - I have been browsing here for awhile and greatly appreciate all the knowledge and tidbits you all pass on...I was wondering what most of you do regarding an epidural when the pt becomes fully dilated with little sensation to push - one Dr tells me to wait at least an hour (with a prim - usually the mults know which muscles need to be used in order to push effectively) before starting to push so that the head comes down more and the pt doesn't get too tired; some nurses agree with this and some don't - yesterday I was working with the ones who didn't and ended up the shift on a bad note...any suggestions or advice for me would be appreciated...Thanks so much
p.s. when she finally did start pushing it was less than 1/2 hour till delivery

Ok, forgive me because I don't do L&D.....but I'm still interested in it as a woman who wants to have more children.

First of all...what is a "prim" and a "mult"???? And why wouldn't the woman start pushing??? Also, you mentioned that your shift ended on a bad note...what happened?

Thanks,

NeuroICURN

SmilingBluEyes · Aug 9, 2004

"primip" refers to a first time mom...."multip" is a person who has had at least one baby or more...... (primipara versus multipara).

Now as far as pushing and epidurals, your doctor is absolutely 100% correct in waiting to have the moms push. I have always let the uterus "labor the baby down" to at least +2 station before having anyone push. This make for FAR less work for the mom in the way of pushing for too long and usually when a baby is WAY down low, the pressure comes on and women can feel enough to push with contractions. For some women, this may take 1 or 2 hours after becoming complete. So what? Why have them PUSHING all that time? As long as the baby is doing well and the mother is comfortable, why rush it?

I never have women push simply because they are complete, whether they have an epidural or not......the time usually comes when the pressure gets to them and the urge to push takes over. It's the easiest way to go for the laboring woman and also the baby as well. The uterus does a FINE job of bringing down the baby all by itself, most of the time, as least to +2 or more....let nature do her thing.

L&D_RN_OH · Aug 9, 2004

I agree with Deb. If Mom has no urge to push, then by all means let her labor down. If however, she feels the pressure and wants to push, and baby is at +2 station or more, than go ahead and encourage her to push.

Some docs will insist pts start pushing as soon as they hit 10 cm, even if baby is still fairly high and Mom is not feeling the urge. With these docs, if they haven't checked the pt themselves, then the pt may be 9 cm for awhile.

starry nights · Aug 9, 2004

I will remember that 9 cm for sure!!! Thanks for the tips and encouragement - I also feel it makes more sense that way.....the "ending the shift on a bad note" was basically why was I waiting when she could be (maybe) having her baby before change of shift and getting out of there - as soon as I went to give report to the incoming shift the nurse that went to cover started her pushing, and I a) felt angry because she hadn't been with this pt at all and it was unfair to the pt as well as gave the impression to the family that here comes the nurse that knows what needs to be done and b) felt like a loser and I should have been doing something more as she was pushing well and the baby was coming down nicely and c) that extra hour of contractions really saved her a lot of work! (and now I feel better about it so thanks a bunch!)

hippienurse · Aug 9, 2004

I am just a new student, but I have my own experiences as a laboring mother and as a doula to call on. My first birth (where I wasn't as knowledgable) I didn't know to wait, I told them I had to push and I pushed for 2 1/2 hours! Needless to say, I didn't want that to happen again and got educated! I told the doctor once I was feeling the urge to push and was fully dilated I still wanted to wait a bit and breathe thru the contractions to "labor the baby down" (good wording) and it worked great! Pushed 15 minutes that time. I could feel the baby moving down during those panting sesssions thru contractions, it was hard but worth it!

tantalus · Aug 10, 2004

Couldn't agree more with SmilinBluEyes....Good old Mother Nature has been doing this a heck of a lot longer than all of us put together...let her do her thing...and watch...and monitor...if Mother Nature hiccups for whatever reason...then step in.

As a footnote...a lot of epidurals in the UK now contain some Fentanyl...a so called mobile epidural....no the mom cannot walk around the room but she can usually feel the contraction but with no pain and consequently can feel the pressure of when to push as nature designs it.

SmilingBluEyes · Aug 10, 2004

Ours are fentanyl epidurals, too, Tantalus! Oh and welcome to the forum!

tantalus · Aug 10, 2004

Thanks...I just wish I'd found it sooner!

SmilingBluEyes · Aug 10, 2004

Sooner or later, people find this place. But be careful as you can see, I became addicted as I am to caffeine.....

I am WAYYYYYYYYYYYY too talkative.

tantalus · Aug 10, 2004

It would be great to chat...but I guess in a thread's not the place, eh?!

rdhdnrs · Aug 10, 2004

Deb,

You don't tale too much!! Just enough!

I love "laboring down". I think it causes much less wear and tear on the mom, the baby, the mom's family--and the nurse! Also, it reduces the incidence of those variables you sometimes get while pushing, therefore reducing the incidence of overeager residents rushing into the room with vacuums, forceps, etc.

There have been many times my patient has "not been able to push through an anterior lip", kind of like being 9 cm for a while!!

Lisa