pushing with an epidural

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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

Sorry didn't proofread, of course I meant "talk" not "tale".

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I hear you rdhdnrs.....that last 1cm can take so long sometimes.:wink2:

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Rofl heck yes, Lisa.....that last cm or two can be a bugger rofl. The doctor is never called just cause a gal is complete......unless she is a grand multip moving fast.

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Specializes in Neurology, Neurosurgerical & Trauma ICU.

Thanks guys...I am learning sooooo much here. Hopefully, one of these days when it comes time for me to have another, I'll be able to call on all of you to give me some words of wisdom!!!

(My first child is almost 10 and I was 17 when I had him, so I definately didn't get to enjoy myself and really educate myself before it all happened.)

NeuroICURN

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I agree with Deb (of course :)). Even with an epidural I have found that most pts can feel the pressure when the head moves down to a +2 station, even if they couldn't before. One of the great things about working nights is you can labor down a pt becuase the doc is usually asleep in his room and has no idea if she is complete!

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Ditto, I agree, letting the woman labor down is helpful and much less work. Again, it sounds like the physicians need a little education about the benefits ;-) Oh well, another thread!!!!

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I agree with Deb (of course :)). One of the great things about working nights is you can labor down a pt becuase the doc is usually asleep in his room and has no idea if she is complete!

Definitely! We have a little more freedom on nights.

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Usually, I turn off the epidural pump and let the mom labor down. The hardest part siometimes is keeping the doc out of the room! If you leave well enough alone, Mom will have the urge to push when the head comes down and her epidural has worn down a bit.

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Specializes in Neurology, Neurosurgerical & Trauma ICU.
Usually, I turn off the epidural pump and let the mom labor down. The hardest part siometimes is keeping the doc out of the room! If you leave well enough alone, Mom will have the urge to push when the head comes down and her epidural has worn down a bit.

Ok....I'll say it again, I don't do L&D, so help me out if I'm missing something here.........

BUT, isn't the purpose of an epidural pain relief???? So, by turning OFF the epidural, you are taking away the pt's pain control. That sounds a little cruel to me. Perhaps a better alternative would be to turn it down, rather than off????

I'm sorry, but as a nurse and a woman who has given birth, I have a LOT of issues with a person saying they just turn off someone's CHOSEN pain relief!

Well, there's my humble opinion. Feel free to reply. Like I said, maybe I'm not aware of something.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I never turn off epidurals; but sometimes DO turn them down a wee bit if NO sensation can be felt. I have had more than one woman for one reason or another unable to push the baby out in the end, and dang if that epidural is not handy to control pain....or use for a csection should need arise...... plus, I have learned, it's hard to "catch up" once pain comes back.

But in defense of Betsy's post; a lot of people DO turn off the epidural, knowing it wears off in 2 hours or more and it works out GREAT. As long as the laboring mom knows what's happening, it's not unethical. And epidurals can be "dosed up" , even massively if the need arises for a csection.

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Specializes in NICU.

I'm not a labor nurse, either....I go to high risk deliveries for the babies, so I'm always happy when the baby is almost out when I walk in.

I have a friend who has a cardiac problem, so her delivery was interesting. She was given an epidural early, because they didn't want her to feel the labor. She never had to push, her contractions brought the baby out, without any problem. Her delivery was in a hospital that specializes in high risk antepartums and deliveries. She was on a cardiac monitor, and if necessary they could have put her on an external pacemaker. The other option was a c/s, so the epidural was a great success.

I didn't know it was possible to deliver like that!

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It takes well over two hours for the effects of an epidural to wear off. When I talk about turning off the epidural off it is before the birth (shortly before) so that the lady can have some feeling to push the baby out safely and successfully. If the lady has no feeling, there is a much higher chance of having to have an operative delivery (ie: forceps or a vacuum). Those interventions are not without risks,also.

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