Question on epidurals

bagladyrn, RN · Jun 23, 2013

I'm not going to feed you any answers as the idea of assignments is for you to do the research and formulate your own conclusions. However, here are a few ideas for directions you may want to consider:

Think about the risks of epidurals and how well women are informed of those risks. Think about what various religions teach about childbirth and related pain. What do various cultures say about the gender of the caregiver and what percentage of hospitals can guarantee the appropriate gender of anethesia provider is available (what percentage of anesthesia providers are female?).

If you get some ideas you want to bounce off someone come back and post them and then we can give opinions as to whether we think you are heading the right way.

Kaysmom8 · Jun 23, 2013

What I was thinking was the cost of epidurals, I can't find the average cost per state or any info on when prepaying for an epidural became an acceptable norm. Through my research a Utah senator is trying propose that the state not pay for epidurals for Medicaid patients. I never thought of the idea of appropriate gender availability providers for specific cultures. When I do a search for cultural beliefs of labor pain I can't seem to find any clear answers on this topic.

sbfairy · Jun 24, 2013

You may have to search more about cultural beliefs surrounding child birth rather than labor pains. Within that search you may find some answers. Additionally have you considered researching opinions on epidural among women in general. As someone who occasionally sees pregnant women and women who have recently given birth, women's opinions on epidurals vary widely and the reasons behind them are based on how they feel about introducing any drugs into their bodies while pregnant, etc. Perhaps interview some women you know to see what their opinions are and why. I think you'll be surprised at some of the responses you get, even amongst medical professionals. I think it would be interesting to expand on the idea of medicaid disallowing epidurals because this brings up issues of socioeconomic status and our beliefs as a society about women in lower income brackets reproducing. Interesting topic

Kaysmom8 · Jun 24, 2013

Thanks for your replies, when the assignment is geared towards ethical issues of epidural use I'm a little confused. Ethics is the morals, rights and wrongs (from what I understand when it comes to ethics). I must have read the paper wrong when I thought religion/culture was part of my topic. The only ethical things I found (which wasn't much) was in 1998 a few women were denied epidurals because they couldn't pay for them. Our research has to be within the past 5yrs. Can someone give me just one example of ethical when it comes to epidurals? I'm confused on what ethical issues there are currently that pertain to epidurals? Also I've seen a lot of hospitals requiring prepay for epidurals but I can't find when this became allowed and how they get away with it at all. Any help is appreciated I just need pointed in the right direction.

manusko · Jun 24, 2013

Thanks for your replies when the assignment is geared towards ethical issues of epidural use I'm a little confused. Ethics is the morals, rights and wrongs (from what I understand when it comes to ethics). I must have read the paper wrong when I thought religion/culture was part of my topic. The only ethical things I found (which wasn't much) was in 1998 a few women were denied epidurals because they couldn't pay for them. Our research has to be within the past 5yrs. Can someone give me just one example of ethical when it comes to epidurals? I'm confused on what ethical issues there are currently that pertain to epidurals? Also I've seen a lot of hospitals requiring prepay for epidurals but I can't find when this became allowed and how they get away with it at all. Any help is appreciated I just need pointed in the right direction.[/quote']
I would say that an epidural is a type of pain relief and not necessary for child birth so it would not be against any rules. There are many other pain medications and pain medication delivery methods available. Cheaper alternatives may include IM/IV opioids, single shot spinal injection and nerve blocks. I don't know the prices for each but just giving examples. When an epidural is placed, then anesthesia must be paid for that service. When opioids are given then anesthesia is not necessarily involved.

Aristillus · Jun 24, 2013

I've been an L&D nurse for 30 years and don't know of any patient who has refused an epidural for religious reasons. I do seem to recall that they tried in California a few years back to demand a cash payment from uninsured patients for a "not medically necessary" epidural but it didn't go over real well. One ethical issue you might want to consider is patients who are pushed towards an epidural and yes, it does happen more often than you might guess. Caring for a patient who wants to "go natural" is much more time consuming for the medical staff and I see lots of cases where it's strongly encouraged when chances are with lots of coaching and encouragement the patient might succeed in her wish to have an unmedicated birth. Another ethical issue I've observed is the patient who is maybe 9cm and almost ready to deliver who begs for an epidural only to be told by anesthesia that it's "too late." It really isn't too late and so what if it is, really, at least the patient will know that they tried. Then there's the other side of the coin, a ruptured patient at 1 cm with a first baby screaming for an epidural only to be told it's too early. How early is too early? Not a lot of research on that one but most physicians have their own little policy, some of which depends upon how loudly the patient is screaming and whether or not she's a "private" patient. Just a few thoughts for ya...