pushing with an epidural

Energizer Bunny · Aug 15, 2004

With my last baby, they turned off the epi when I was complete even though I told them that I had the urge to push (I couldn't NOT push, actually). I felt a lot more than I did with the first two when they didn't turn it off but it wasn't as excruciating as it could have been had he taken longer to come out.

NeuroICURN · Aug 15, 2004

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.

And that, ladies and gentlemen, is why I ask if I'm missing something! LOL :chuckle

So, when I have another child, all I want to know is this......Can the anesthesiologist just pick me up at my house and give me the epidural before we leave?????? LMFAO :rotfl:

SmilingBluEyes · Aug 15, 2004

....................for the right price, sure!

Energizer Bunny · Aug 16, 2004

Now THAT's an idea!!! LOLOLOL!

Mermaid4 · Aug 18, 2004

As long as mom and baby are ok , and especially in a primip or someone who has always had epidurals and doesn't know how it feels to push, I have found that laboring on down is far superior than just having patients push because they are fully dialated..Nature brings the baby down...More than not, having a paitient with little or no sensation push just because she is fully results in eventual exhaustion and an epis for the patient. I don't know about your facility but those opposed to this in my experience often ( not always) are either childless, nurses who have adopted or had csections, or of the very old school where change is difficult..It has not been unusual in cases where certain docs (often male, strangely enough, or perhaps not so strangely) prefer that the pt start pushing as soon as she if fully. To get around that, we often will check with straight cathing but not call if the pt can't feel anything, keep a good eye on the strip, etc, note the increase in bloody show, head compression, etc and usually at that point the pt is feeling pressure and is ready to push. BY FAR, laboring down is superior to having the pt push just because she happens to be ten centimeters. I have had a pt be fully for a couple of hours before I got her pushing and always make sure the bladder is empty before I do.....We rarely need vacuums or episiotomies in those cases, even with primips..Sometimes we will get the epidurilized pt up on a birthing stool to facilitate the baby coming down, although I really hate the labial edema they get that way. You figure, one twelve hour labor you have the energy expendiature of two maratons and then we expect you to push SO it behooves us to conserve as much energy as possible providing mom and baby are doing fine and length of rupture of membranes or other issues aren't a factor...

Mermaid4 · Aug 18, 2004

We don''t turn off the epidural...That is not always needed ( besides, anesthesia should be the one doing that or the ob doc) That point aside, the nerves in the perineum are not as affected by the epidural so if there are no problems with the mom and babe, there is no reason to turn off the thing. A mom can certainly most DEFINITELY feel pressure when the infant decends to a certain point....It does NOT take two hours in every case for an epidural to wear off....( depending upon, I would imagine, what YOU are using in your epidural mix)......When the kid is low enough, the mom feels pressure..Not always a lot, but it is there, plus, if you see a bloody show YOU can suspect something is going on...What is the strength of your epidurals..I am curious...We have rare problems such as that described by neuro rn..

Mermaid4 · Aug 18, 2004

Sorry, I guess the post I referred to was not Neuro Rns...Anyway...Having done things both ways....The way I described works the best in my experience. Sometimes you look when you straight cath or suspect (as with bloody show) something is going on and there is a little head ready to come out...Epidurals are not generally turned off without the consent or knowledge of the patient...But, pushing is a whole different sensation than labor....Much better in most cases.....

starry nights · Aug 18, 2004

Hi - only once have I ever got an order to turn down an epidural, and that was because she was so numb she couldn't even move her legs let alone try to push....in our facility we leave the epidurals alone until any needed suturing is done then shut them off, and she is usually ready to stand to shower in about 90 minutes. I had a prim who was pushing for almost an hour, had good sensation and effective pushs, but she was tired, said she wasn't going to do it anymore and promptly went to sleep - the dr said that was fine as the strip was good, the pt slept for an hour, woke up to the head just starting to show, and she was able to continue pushing for a good delivery soon after...you are right in saying that it depends on the personal experience of the nurse or physician as to whether they agree with this practise or not, as well as the time of night or day....

BETSRN · Aug 18, 2004

Glad to see that others are leaving their moms alone, also.

BETSRN · Aug 18, 2004

Nursing is permitted to turn an epidural off. That doesn;t take a doc to turn the switch!

Mermaid4 · Aug 19, 2004

When anesthesia is involved in our facility, it does..I feel that anesthsia should check out their own meds and regulate them even though I am perfectly capable of messing with the machine..If there is a problem, it is on them and not me....Plus, in many facilities, that is the policy and that is fine with me...We also have two nurses check the settings....No one says we can't do these things, but I don't feel that we should, unless, of course, either the policy changes, or there is a life threatening situation for either mom or baby when anesthesia isn't there...I don't disagree with you but that is my opinion. When in doubt, I flollow hospital policy...I like my license...At other facilities it may not be the same.

As for laboring down, there was a recent study done where we are and lo and behold, when the night shift was on we had far less vac deliveries, episiotomies or failure to progress patients, and therefore, less csections, every single time SO even some of the most staid physicians and nurses originally against the concept finally realized that it is and can be very successful...Not too many docs want to be awakened Just because a pt is fully throughout the night, and since we night nurses pretty much function on our own unless distress occurs or a delivery is imminent , we have more leeway and proved to administration and the medical staff that for the most part, laboring down is an extremely successful venture in most cases. Bully for us AND especially, the patients~

wannabeL&D · Aug 19, 2004

I *wish* that my epidural had been turned down when it was time to push with my first...I couldn't feel a thing, had no idea when I was pushing effectively, and ended up pushing for over 3 hrs. (and she was a 4 lb. 15 oz. 32-weeker) I am thankful that finally she was born without the threatened c-section...because of this, I was determined with my second to go natural--that ended in an emergency section, which is an entirely different story! I am convinced that the time pushing would have been reduced had my epidural been turned down sooner.

Shannon