Recommend epidurals?

ERNurse752, RN · May 23, 2004

I'm not an OB nurse, but I found a couple references that explained some things about epidurals.

The most important thing I wanted to say was that make sure your doc is going to listen to you without pushing his/her personal beliefs onto you, whether you want an epidural or not. It should be your choice if it's medically appropriate in your situation.

I'm sure you'll get a lot more good advice from our OB nurses though. :)

Good luck!

http://www.healthpages.org/AHP/LIBRARY/WOMEN/PREGNANT/LABRDELV/epidural.htm

http://my.webmd.com/content/pages/2/3608_919.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}

(edited to make link work!) (grrr...it still won't, so just copy and paste the 2nd one!)

lady_jezebel · May 23, 2004

Thanks for the info. Even though I'm an RN, I feel completely lost with OB decisions. The information you provided was helpful.

ERNurse752, RN · May 23, 2004

Yeah, OB is a whole other world! Glad I could help a little bit. You're welcome!

L&D_RN_OH · May 23, 2004

Yes, there are risks with epidural use. And yes, I think there are better ways to deal with pain than analgesia. But, that is a personal opinion. Some pts labor w/o pain meds and do just fine. Others, have a hard time dealing with pain, and opt for the epidural. And still others, think they don't want an epidural, but may be encouraged to get one due to their inability to relax enough to let labor happen.

I think you need to assess youe own pain tolerance before making a final decision. I wouldn't pick an epidural because it isthe "easy"way to labor, because in all actuality, being tied to the bed hooked to monitors is not easy. I would recommend taking a childbirth ed class, one not offered by the hosp. Explore your options. You will not be able to get an epidural with the first contraction so you should have an alternate plan until then. You may find that you are handling labor well andmay not need an epidural when you thought you might.

Good luck!

KaroSnowQueen, RN · May 23, 2004

I am 43 and have given birth to 3 kids. All of them I had an epidural with. I would never do it any other way. You can't get one until you are more than 5 cm dilated, but my Lamaze breathing worked fairly well until that point. I am a big baby when it comes to pain tolerance and the stories of these women who go natural just totally amaze me! My personal recommendation is yes, by all means, if you think the pain is too intense, get an epidural!!!

allnurses Guide · May 23, 2004

By all means take a good birth class and ask lots of questions. But remember, you can always attempt a delivery without an epidural and then assess whether you want to try an epidural.

I had three children without pain meds and my last with an epidural. I'm with KaroSnowQueen . . . .the epidural wins hands down. :)

steph

lady_jezebel · May 23, 2004

thanks everone for the input! :)

sagelola · May 23, 2004

I've had 3 children...the first one with an epidural and the last two without.

From my own personal experience, I did not like the epidural...it was bad. What happened...I was 18 yo, and NO ONE told me what labor was like (I kid you not!), so I really didn't know what to expect. This child was induced (all 3 were, actually), so that was pretty intense. The damn epidural itself HURT like hell when they were putting it in. Well, it had been in for awhile and I couldn't feel anything....then I just started to feel a lot of pressure down low in my pelvis...I had no idea what that was, and told the nurse I hadn't urinated recently and maybe that was the cause....she did an in and out cath to help me because I couldn't do it myself, and then decided to check my cervix (which hadn't been done for awhile...can't remember how long now, but it seemed like a couple of hours?)...low and behold! I was fully dilated. That pressure I was feeling?? yeah, it was time to push...no one told me what to expect, the meds weren't lowered or anything....It was just a horrible birthing experience for me.

So...the last 2 I wanted NOTHING other than to be in complete CONTROL of the situation and to be able to recognize what my body was telling me to do. Those experiences were far better for me personally.

Now, I understand that everyone is different, so I say, if you cannot handle it than get an epidural...I would first see how it goes, as some of the other posters have said.

SmilingBluEyes · May 23, 2004

Keep an open mind. Educate yourself and see how it goes. That is my advice to ANYONE expecting or laboring who is undecided on pain control methods. There are SO many; don't box yourself into one way of thinking.

jwk · May 23, 2004

Thanks for the info. Even though I'm an RN, I feel completely lost with OB decisions. The information you provided was helpful.

There are definitely lots of different pain management techniques during labor. In our hospital (17,000 deliveries per year) we have in-house anesthesia, which makes a big difference. Probably 2/3 or more of our patients get an epidural by the time they deliver, including many of our midwives' patients.

Experience counts for labor epidurals, too - someone who does one or two epidurals a month probably won't have as good a result as someone who does several every day.

kmchugh · May 24, 2004

I'm pregnant & assumed that epidural would be the way to go @ delivery. My doc feels certain that there are more effective ways of pain control -- deep breathing, self-hypnosis, etc... What are your opinions on this? Do epidurals have potentially major complications? From what you've observed or personally experienced, would you recommend an epidural?
I'm 33 yo and this is my first child.

Lady Jezebel

I am a CRNA, and do frequent epidurals for laboring patients. The answers to your questions are it depends on you. Like most things in life, you will have your own perception of labor pain. Some women breeze through labor, and I have actually seen women who laughed and carried on conversations while pushing. Other women perceive it differently, and do not wish to try to tolerate it without epidural. L&D RN OH is correct, you need to do an honest assessment of your own ability to tolerate pain and discomfort.

That said, your doctor is wrong. While many women are well able to tolerate labor with breathing, self hypnosis, ete, these are not "more effective" than an epidural. With an epidural, you can undergo episiotomy without feeling a thing. I have done epidurals for patients undergoing abdominal surgery, including c-section, with no other anesthetic. That level of anesthesia cannot be attained with the methods your doctor suggests, so they cannot even be as effective as epidural.

Like most modern medical procedures, epidurals are pretty safe, but they do have attendant risks. Some of the complications are very minor, while others can be life threatening. However, the more severe complications are VERY rare. Bottom line is if I didn't think they were safe, I wouldn't offer them to patients. Placement of epidurals does not have to hurt. If sufficient local anesthetic is used prior to insertion of the epidural needle, then the worst you feel is the "bee sting" sensation of the local. After that, nearly all my patients tell me that all they felt was some fairly mild pressure as I inserted the epidural.

I do believe there are some advantages offered by epidural anesthesia. Generally, at the end of labor, women are exhausted, and spending time with the new baby is difficult. However, I usually put the epidural into my patients when they are dilated to about 4cm, and I advise them to take a nap if they can. They usually can. These moms are less tired after the delivery, and have more energy to devote to interacting with the baby.

There are a number of different medications that can be used in an epidural, each with its own advantages and disadvantages. I have found ropivicane/fentanyl to be a great combination. It takes between 3 to 10 minutes for the block to set up with a bolus dose of 8 cc 0.2% ropivicane with 100 mcg fentanyl. Then I run an infusion (not intermittent bolus doses) of 0.2% ropivicane with 2 mcg/ml fentanyl. Generally, ropivicane is more motor sparing. Therefore, the moms get a good pain block, and while their legs may feel heavy, they do not have the unnerving experience of being completely paralyzed below the level of the epidural. This also means they are better able to push when the time comes. (I'm telling you about the meds so you will have a little knowledge about what to ask the anesthetist.)

In the final analysis, the decision is not mine, it is not your physicians, it isn't the OB nurse's, its yours. Educate yourself, and make the decision for yourself. Don't let anyone (myself included) make your decision for you. The birth of a baby is a joyous event, that should be enjoyed under YOUR terms. If you don't want an epidural, then don't get one. By the same token, if you want one, don't be dissuaded by a physician who may have a prejudice against them. Its your day, it should go your way. If you have other questions, feel free to PM me, or even better, ask your OB to set you up an appointment to discuss your options with the anesthesia providers where you will have the baby.

Kevin McHugh, CRNA