Question for L&D nurses

[CrazziiRN913, ADN, BSN]

Sooooo I was talking with a friend at work and we were exchanging birth stories when she told me something that struck me as odd. She said when she was in labor with her 1st son the l&d nurses gave her a shot of morphine before she got and epidural!! I am only going into my second semester of nursing school but that just seemed weird so I figured I would ask you guys. And then on top of that her son's heart stopped and and the were able to bring him back but I just thought the while morphine then epidural thing was weird. Please give me some insight!!

Thanx,

~*Mesha*~

[klone, MSN, RN]

When a woman is in prodromal labor, we often do what's called "morphine sleep" - a shot of morphine (either IM or IV, or sometimes both) in order to relax her and her body and allow her to get some rest. It's possible that they tried doing that, but instead of relaxing her, she went into active labor, and they then gave her an epidural. Half-life of morphine is around 4 hours, so if the baby came quickly, it's quite possible that the morphine caused some respiratory depression (not sure what you mean by "heart stopped" and if it happened while in labor or right after baby came out, but in cases of respiratory depression, lack of breathing will cause the heart rate to slow way down, sometimes to the point where chest compressions are needed).

[CrazziiRN913, ADN, BSN]

The baby's heart stopped to the point where they had to shock him to bring him back by jamming the little rod in his head...(I can't remember what the correct terminology is for action, brain fart )

[Bobbkat]

The internal scalp monitor? That is for monitoring his heart rate, but it doesn't administer any type of shock, or correct any problems with heart rate. It just helps the health care team more closely monitor the vital signs of the baby.

[klone, MSN, RN]

The baby's heart stopped to the point where they had to shock him to bring him back by jamming the little rod in his head...(I can't remember what the correct terminology is for action, brain fart )

If you're talking about a fetal scalp electrode, that does not shock the baby's heart. That just more accurately traces the baby's heart beat.

Newborns and fetuses are not ever "shocked". It's not part of newborn rescusitation protocol.

[feisty]

Isn't it fascinating to hear the patients perspective of what is happening during their labor process. I am challenged now more than ever to keep my patient informed of the events and interventions that are occurring. I always communicate with my patients during procedures, but now I will be more aware of the explanations I give.

If the patient's external fetal monitor lost the baby's heartbeat tracing and they applied an FSE (sounds like what might have happened) I could see where the pt might interpret it as the heart actually quit beating. Sad to think of the distress the pt might have experienced during this time.

[klone, MSN, RN]

Isn't it fascinating to hear the patients perspective of what is happening during their labor process.

Yes, absolutely. I've had times in the past where something has happened, and I will overhear a family member talking to somoene else on their cell phone, and listen to how they describe what they perceive to be happening, and it's often VERY different from what is truly taking place.

[tntrn, ASN, RN]

Significant drops in fetal heart rate sometimes occur within 30 minutes after an epidural placement and that might be why the scalp electrode was placed.

[CrazziiRN913, ADN, BSN]

Ok sooo I just went over the story with my frIend again(she sits behind me at work), so I got it a little mixed up(sorry). They gave her the morphine then IMMEDIATELY gave her the epidural, they did lose the fetal heart beat so they had her get on her hands and knees to insert the scalp monitor and she said the nurse that was there said it could give a little shock to the baby upon insertion. But once they inserted the monitor they still could not locate the heart beat so they made her push out the baby as fast as possible and then they took him away and he came back in the room fine.

[klone, MSN, RN]

she said the nurse that was there said it could give a little shock to the baby upon insertion.

The nurse was incorrect.

As someone else said, epidurals can cause a decrease in blood flow to the placenta, which can cause the baby's heart rate to go down or start having late decels (one huge reason why I personally would never get an epidural unless I had to for a C/S). I'm guessing a combination of that, plus rapid descent (if she got her epidural and then very shortly after pushed the baby out, I'm guessing she progressed very rapidly), caused the baby to be a little stunned.

As far as getting morphine, then immediately getting the epidural afterwards, don't know what to tell you. Morphine is not typically used as an IV analgesic during labor. Did she get it in her IV? Or perhaps they gave it to her as a spinal/intrathecal dose before placing the epidural catheter? (many facilities use a combination spinal/epidural during labor).

[CrazziiRN913, ADN, BSN]

She said she got a shot and the nurse said it was morphine I believe

[klone, MSN, RN]

She said she got a shot and the nurse said it was morphine I believe

What does "got a shot" mean? Like an IM injection?